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Everything posted by ackkap
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I’m certainly not a doctor, but from a technologist perspective, when we give the clinician a Hgb S level of 35% and their goal was 30% or less for their patient suffering from Acute Chest Syndrome, I know we will be getting another order for an Erythrocytapheresis meaning we have to find 6-8 more units that are negative for C, E, and K antigens and all the other antibodies they may have developed to get their Hgb S level below 30%.
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We have a pretty big (and growing) Adult Sickle Cell Clinic with a majority of the patients getting Erythrocytapheresis for their disease. We give all our patients sickle negative RBC’s. The reason I was given was that when tracking the Hgb concentration (A, A2, S, C, etc.) by hemoglobin electrophoresis, we want the results for the patient, not the Hgb S positive unit that we are transfusing them. We are told the doctors adjust treatment based on the hemoglobin electrophoresis levels.
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When a Rh negative woman has a pregnancy terminated, at what week gestation will your facility give a dose of Rhogam without performing a Kleihauer-Betke (or Flow Cytometry)? Currently at our hospital, less than 13 week gestation has Rhogam issued without a Kleihauer-Betke. Greater than 13 week gestation, a Kleihauer-Betke is performed before Rhogam is issued. Thanks!
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Pony - Thanks for your comments. I think they are right on. We have sent Immucor a sample yesterday so I will let you know of their findings. Our patient delivered yesterday and the baby had a negative DAT and negative antibody screen, so I do believe our patient only made IgM Anti-D. Immucor all along was telling me it must be IgM because the ECHO didn't pick it up and I didn't believe. I just couldn't get past a 4+ positive Ortho Gel result that yielded a negative ECHO result. I believe now!
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Wow! All of your Rh Neg Anti-E and Anti-C's need additional testing in Gel to rule out an Anti-D. It seems like the ECHO has a history of missing Anti-D's yet nothing has been done by Immucor about it.
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Jalomache - to answer your questions, the samples were run the same day fresh, not frozen, from the primary tube, using manual Gel and then immediately placed on the ECHO. We drained the sample and asked for a redraw and saw the exact same results (4+ D in Gel; Negative Screen, Negative ID on the ECHO). No clerical errors and according to the transfer hospital and the patient, she had not received Rhogam. I agree with you, though, you can't always believe the patient! Immucor was telling me it may have been a newly developing IgM Anti-D so gel would find it, but not the ECHO because according to their literature, ECHO's only pick up IgG antibodies. I'm not sure I believe that response.
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I also called Immucor to report my findings and they asked me about the possible weak D as well. We did run the weak-D and it was negative. I'm starting to have doubts about my ECHO especially if its missing 4+ Anti-D's! Has anyone else had this same issue??
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We are in the process of validating our new ECHO. Our current method is manual Ortho Gel. We have a 28 week pregnant O negative female with a 4+ antibody screen in gel. Her antibody was identified as Anti-D (4+ reaction strength) in Gel and titered out to 8 at 37 degrees and 8 at IgG using Immucor screening cells in tube testing. My question/problem is when we ran it on the ECHO, the screen and all panels available to us were negative. I've seen many posts where the ECHO is too sensitive an instrument, but no posts where a 4+ antibody in Gel produced a negative reaction in Solid Phase (ECHO). Has anyone had similiar results or an explanation why the ECHO results are not coming up? According to the patient and the hospital she transfered from, she has not received Rhogam and had a negative antibody screen at the start of this pregnancy.
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Thanks to everyone for your responses. Malcolm is right with the babys phenotype. Here's the whole story. An O neg baby was born to a mother who had a 4+ anti-c (little). Amazingly, the baby's antibody screen was negative with a negative DAT so my scenerio thankfully is hypothetical. If we had to give this baby blood in an emergency, I dont think I would have the time to have one thawed. Best case of course would be a fresh r'r' unit from my supplier, which they do not have. What would be the product of choice in an emergency? I thought an O Pos, little c negative crossmatch compatible with the mother unit would be a better choice than an incompatible O negative, little c positive unit. I have not read the package insert on Rhogam in some time, but I'm pretty sure it's not recommended for a newborn. Has anyone ever given rhogam to a newborn? Would you even need one because the babies immune system isn't yet developed and most likely wouldn't develop the anti-D?
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This is my first post after reading this site forever! If the baby needs blood, what would I give?
