mrmic

I somewhat remember that early on with the LUI freeze elution there were some attempts to elute non-ABO antibody specificities. At that time some suggested an additional source of protein and/or a minimal "LISS" environment might help with detecting these other antibody specificities. I'm not sure it worked out too well and other elution methods were much better. We just used for ABO elutes.

What? No one questioned NISS? I am impressed. Long Live NISS!

Inspectors are like a box of chocolates, you never know what you are going to get. I tend to agree with those who put forth do what you are comfortable doing for validation and/or QC. If you, your staff and pathologists are ok with your process then an Inspector (AABB or CAP) can have an opinion but they cannot tell you to stop or defend a deficiency. If your documentation has merit then you have a strong case of how you use your expired red cells or antisera for the care of your patients. We all do the best we can with what we have to work with.

Wow this is a late post. I just can't find the time to keep up sometimes. I certainly was not implying that either Duffy antibody would not be able to cause HDN but rather theoretically speaking given the circumstances it didn't quite give the picture of HDN. Again, even that is not a absolute. Looking back at all the comments and possible causes, which all had merit, I failed to see any reference to the possibility of an autoimmune issue and that there may be a possibility that the specificities are part of an newly development of autoantibody complex forming, i.e. mimicking specificities. Although these are normally seen within the Rh-Hr specificities, other specificities are not unheard of. Follow-up testing for cases like this rarely pan-out, if the infant clinically unaffected, the parents get their baby and disappear (sometimes and at least may not show up again until the next pregnancy). Too bad, would make a good abstract.... "My" thoughts or opinions for this site are based on previous experiences or readings (actual book in hand journals) and etc. Immunohematology Reference Laboratories see a variety of cases sent for consultations and that is what makes it so intriguing and challenging for us to give the clinician the information he/she needs to take care of their patient and that we are right there with him to help. We may not always have a specific answer but we can look for histories of similar cases and what the outcomes have been and give it our best educated interpretation of what might be happening and what transfusion recommendations we might propose. I'm about to retire and my ramblings will decrease (Yea goes the crowd). As far a the gel system, again my own thoughts/experiences we had in our Immunohematology Reference Lab, starting back even before Ortho commercially prepared system was as follows: Basically it is a micro-LISS-system with an optimized serum to cell ratio. Although we could not find a niche for using it on our investigations, we did start keeping it around to reproduce issues our hospitals were seeing with its use their routine transfusion service and to help provide educational information on what was happening and whether it had any clinical relevance. There was a lot of weak reactivity of various strengths referred to us by a variety of hospitals. Many these were related to the problems seen with the LISS tube system. Maybe even a little more since it much more sensitive based on how the method is set up commercially to work. Lastly, I believe that Malcolm Needs is truly an asset to this site and provides excellent information to all regarding such a variety of topics and also provides excellent references to support the information he provides. Thank you Mr. Needs! I hope you continue to provide your insight in this forum for many more years. mic

Since this is a accreditation agency group I would like to get an opinion on the requirement of the transfusion service's requirement to re-type the donor units. I do not know if this has been previously studied or written about in the past. Just thinking outside the box... If a donor center were to re-type the unit after the unit had been labeled and the unit tagged as such for the re-typed would the transfusion service be required to re-type the unit? You can't make an argument that you do not trust the donor center since you do not repeat HIV or etc. testing, and those tests are quite important. You cannot make an argument that you have found mis-typed units, because, that is the past, not after the proposed change in testing at the donor center; what is that per-cent? You cannot make an argument that the techs at the transfusion center never make a mistake; what is that per-cent? You cannot make a financial argument if there was a significant issue with the unit after transfusion the patient would sue everyone anyway. You can't say because it is a regulation, since those can be changed and that is what this is about. You can't make the argument that all rbc transfusions are fatal, because they are not. I might make techs uncomfortable about the change, but techs were uncomfortable when we went to LISS from albumin or physical crossmatch vs electronic crossmatch. What are your thoughts?

My initial answer would be no. Haven't seen this happen with a transfusion of 1 unit. Would have to recheck the whole process of the 1st sample (pre transfusion), starting from the collection (correct patient, correct collection site, correct person collecting, correct labeling, specimen handling, specimen testing, etc.etc)…. maybe there was an error along that path and not a immunohematological issue?

Anti-Fya and Anti-Fyb are not well known to cause significant HDFN. I have not seen one, at least. Was there any follow-up testing of the infant? What were the laboratory findings, i.e. bilirubin etc. ? It has been a few months now, have you had a chance to re-type the infant's red cells? Is there a chance that it really was a weak binding of Anti-Fya with Fya+ red cell antigens? If only a gel-card method of interpretation of a "weak positive" as being negative was used, I wouldn't necessarily be convinced that the infant is Fya-. Gel card methods do funny things sometimes.

"Does anybody know what time it is" Chicago, 1970. Does anybody know what titer it is? Simple question, answer not too simple. If you are following titers of a specific antibody for a specific reason (anti-D, pregnancy), it is important to establish the method you use is reproducible and that it correlates with what the physicians that are going to be using that information for. As has been pointed out with previous responses, the methods used for antibody enhancement may affect the endpoint results of the antibody titration. The physician is often attempting to make a decision for the care of the mother and her child, current or future. The laboratory should provide a interpretation of the results based on results they have laboratory data and based on histories of patients previously followed. Certainly, literature should be searched for information that has been shared regarding this subject, as the one previously mentioned, however, if your laboratory is involved in following titrations and clinical significance, it is probably important you established the data for your own laboratory.

I know this is a late response but re-reading some posts brings up old ponderings. I have always been interested in the non-immune stimulated antibody specificities (naturally occurring). When we have seen these in different patient populations, i.e. malignancies, pregnancies, and autoimmune anemias. There was some papers that put forth the term "mimicking" antibody specificities, we may occur from immune malignancies, drugs, herbs, etc., or due to a dilutional effect or specific enhancement methods. At the time we attempted to absorb and elute the antibody specificity in question with red cells that were negative for the antigen of the specificity in question. With some success but not 100%. Maybe the antibody was actually directed to some specific epitope that was part of or in common with the antigen in question? Is the ultimate test to transfuse the patient to determine if the red cell survival is affected by this apparent mis-match? I do not see a lot of red cell survival studies anymore. However, I will stop there. Only to say to Ms. Adams thank you for your non-immune stimulation of my old days immunohematology...…it is a naturally occurring problem I have reading BB posts......

I certainly agree with Mr. Blumberg and Mr. Needs as well as others, everyone brings up excellent points and explanations. My only comment I could put forth for consideration would be from a BB Pathologist I once worked with many years ago having observed similar cases. "Pregnancy is a disease".

I am interested if anyone has attempted to use one of the wireless temperature monitoring systems to monitor the coolers being used within the hospital? More hospital in the USA are looking at these systems for their refrigerator/freezer/room temperatures monitoring. That would seem to be an excellent monitoring and data documentation for the products outside BB's control.

It is all relative. Yes, antibodies' titers can rise and fall during pregancy whether or not the fetus is positive for the corresponding antigen(s). So titers may not be helpful in a subsequent pregnancy from a mother whom has shown to be an immune responder. But, it may be a one piece of the puzzle a physician can use to make decisions about the management of the pregnancy. It may be an opportunity for us to be part of the team, share our knowledge and experiences with the team, follow the immunohematology path, maybe learn something ourselves and share with our peers. I would be willing to follow the titers, it's Immunohematology, it's what we do, and maybe, just maybe, we might discover something relative. My soapbox for the day, just comments from my perspective as an old retired SBB.

WOW, don't see anti-JK3 too often! Have you already pursued family members and extended family members? Also, is there a ethnic group you may want to screen? We have had some success in the past in our area with Native Americans whom have had some members with a antibodies to a high antigens. Certainly would want that patient and or other family members start donating and freezing their donations for their and others' future. Technically, I agree with Mr. Needs approach with trying to resolve your immediate requirements. Good luck and best wishes for your patient's recovery.

I would be interested in the patient's history; male/female/ pregnancy/infections/drugs/drug use/medications/herb etc. use/transplants. Also, specimen information; standard clot tube/clot activator? / edta or other anticoagulant, time from collection to testing/ storage time? etc. Have new specimens been collected and retested by same and different methods or lot #s. I apologize in advance if this is asking for basic "given" items that were all ready looked at but before I would investigate unusual laboratory findings I am always interested in history first before finding out there were other contributing factors. laboratory question; are you able to remove the cells from the cell-typing gel-tube and elute anti-A from the cells. Will be watching to see your final decision on this case! Thanks for presenting it.

Sooooooo.........is is 1 positive reactive cell out of 3 selected cells ok? What next? Do you keep testing "homozygous or heterozygous" selected antigen positive cells til you get 3 negative? It's not just rulling out, it's looking for what's in. It is a good thing to have a Immunohematology Reference Lab partner to assist with multiple antibodies or antibodies to antigens of high frequency. Your blood supplier should have this service for you... Probability calculations do not always go hand to hand with antigen expression. 🐀 mic