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Posts posted by Rh-fan
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We had a case recently where a patient came in through the ER, she gave the nurse an Antibody card for a Jka that was identified years ago in Texas. When we called to get more info we were told that the patient was not coherent and no family was available. We did the screen (positive), and antibody Id and found a E, K (no sign of the Jka). 2 units were set up(E,K,Jka neg) and transfused. The next day they ordered 2 more units, a nurse from the floor called to say that the patient was insisting she had another antibody card that she could not find. I spoke to the patient and she told me she had 2 cards from different hospitals, she was also able to tell me all (or at least several) of the hospitals she had been transfused at. I proceded to call all of them and found another hospital in Texas that had identified E, c. We antigen typed the units she was given and 1 was c positive. Post transfusion had a lovely c.
Morale of the story...Always listen to the patient....
In the Netherlands since the recent guidelines, we have to select Rh fenotype compatible for al patients that have a (Rh, Kell, Jk, Fy Ss) antibody, to prevent these problems.
Maybe I have mentioned this before but we have now a almost nation covering database for the registration of allo antibodies, TRIX. Before transfusion a hospitol have to look in that system (mostly done by the LIS system) to see if the patient is known with antibodies. Since the introduction of the database I have heard a lot of stories (and seen publications) about patients with undetectable antibodies. I think the UK and the USA for sure are to big (to many hospitals) for such a system but in the Netherlands (100 hospitals) it is working fine.
Peter
- Malcolm Needs and Sandy L
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- We use untreated cells and take 1 part of serum (600ul) and 2 parts of cells (1200ul). The first to times we incubate for 30 min, then go to 60 min.
After absorptiun we use 25ul of serum in the Birad/Diamed gel test.
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Maybe they use anti human IgG Fab fragment that bind to the bound IgG. If you then add anti Fya and after washing complete anti human IgG. That sounds like something that could work.
Peter
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My first thouth was anti BI (anti B only reactive with adult and not cord cells), but the non reactivity of the AB sample confuses me. That exclude anything directed against a B antigen.
Was anti Cw excluded, that can reactive at RT and CCDee are more often pos. Just an unlucky draw with the B cells.
It would be nice to hear about the follow-up.
Peter
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We use EGA or do genotyping.
How does these 'blocking' works?
I have also heard about IgG monoclonals from mouse, and by the use of anti Mouse-IgG (instead of anti Human-IgG) they gave good results.
David, W.A.R.M. is the comercial name of ZZAP (or not?), if it is the same as ZZAP then you destroy more than Kell (also Fy, MNS, Lu).
Peter
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Nice, specialy the fraise
"Technicalities only known to chiefs and Malcolm"
Almost nothing is changed.
Peter
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No need for any hospital to perform Du testing on patients.
Most of then will be negative and when you found a patient that is postive in Du only you need to treat them as D neg. Is a lot of work and costs and any profit.
In the Netherlands it is in the guidelines to determine the RhD antigen of a patient with onl one reagent (IgM at RT).
Peter
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Malcolm,
I found Kuziva (very easy between 2200 other people) and we had a nice talk about that "serology rules".
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The ISBT meeting is at this moment in Amsterdam. Are there any forum members there?
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Liz,
I love to see that ppt when it is ready (even without the singing).
Peter
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anti LebH will be reactive with the pool of O cells.
Anti LebH will reactive with cells that have H (group O and A2) and the Leb antigen. Cells that have Leb but lack (a lot of) H (A1) will not be reactive with anti LebH.
The differance between anti A and anti A,B makes me think of Ax. In those patients we se sometimes a very strong anti A1 that also is reactive with A2 cells (better to say anti A instead of A1). The problem is in your patient is the weak reaction with A1 cells.
Can you test A1 cells in the same way you tested the different A2 cells?
Peter
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Has anyone seen this Youtube video?
It is a movie about the Lewis system and it is made by Stephen Schilling.
He has also made simmilar video's about the MNS, Kell, Duffy, Kidd and Lutheran system. You can also find them on Youtube ( search for 'blood group song' or his name).
I specialy like the MNS movie, where M and N are show as a few simple geeks, S, s and U are shown as dangerous criminals. Very funny.
A co-worker of my found them and I have planed to use them in future lessons on this systems.
Have fun watching the video's.
Peter
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EGA is nice but in this case it will not help. EGA can also be used to remove HLA antigens (and Kell). The procedure takes more than 10 minutes (instead of 2 hours when you use Chloroquine)
In case of allo antibodies against donors cells, the EGA will remove the antibodies. When you then test the eluate again with the patient cells (that contains donor cells) will be reactive. In that case you have to collect/concentrate reticulocytes and test the eluate with those, that is a real autocontrol.
As Malcolm mentioned, If transfusion is more the 3 months ago, it must be auto antibodies.
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We have tried all sorts, but now use the usual 20 minutes with column agglutination technology (Bio-Rad), and this works well, with good validation against the tube technique we used to use.
No unexpected cases of HDFN yet, after a good 5 years (or longer).
Mostly the column technology is much more sensitive than a tube test without aditives. Do you do not have that experiance?
Peter
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The frequency of the TSEN antigen is very low. Also in donortyping the problem is is not that big because you always perfom a cross-match after you have typend the donor (you can see that as a second typing with a polyclonal anti S (made by the patient)).
In patient typing it is no problem at all. When you type the patient "fals" S negative, you think the patient can make an anti S. No problem.
Peter
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Mabel you have a point but still my mind goes in the direction of goodchild.
It is not possible to test every day, every antigen on every cell you use.
But we can follow the directions of the company selling the panel. If the campany can sell a panel that can be used for 2 months it is a big positive selling point (compaired to the other company's). They do not stretsch the time you can use the panel because they can not clame the antigen prsentation is good enough. Why is almost everbody that uses a panel then stretching that time, do they know better than the company (even without proper controls)?
Is anyone using reagents for Hb or any other test, that is expired? Then why do we do it for ABID panels. I do no see the difference.
Peter
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I hope my institute will not shut down the connection to this filty forum.
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I have made some copies from our Methodes book (from 1993) from the American Red Cross about C3b, C3d and C4 coating.
I hope this will be of use.
Peter
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http://www.hemobioscience.com/PDFs/C3_Press_Release_Final.pdf
Have you seen this ad?
It are commercial C3 coated cells.
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We use fress serum and sucrose to sensitice cells with C4 (for detection of anti Ch/Rg antibodies), I know that these cells also have C3 on the surface but I have never tested it.
What do you want to do with those cells after sensitization?
Peter
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Mabel,
In case of a positive DAT we do it to see if there is a mixed-field (transfusion).
We grade the all reactions macroscopicly and only read microscopic to look for pseudo-agglutionation or mixed-field reactions.
Peter
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We do not use expired cells to rule out, only sometimes to prove the specificity (extra positive).
But when you do it you have to do the controls that Malcolm sugested, show that there is weakening of the antigen you use to rule out. In the absence of a weak antibody you can switch to a diluted antibody or perform the antigen expression in titer compaired to a cell that is not expired. (a weak antibody is better, but this can be used as an alternative).
The "4 months rule" did not make me say the same as Malcolm
but I needed a few minutes to get from the flour on my chair again.Peter
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We try to use a 1 + 4 ratio (1 part cells + 4 parts of serum). 20% cells is the best situation to bind the most antibodies
Peter
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There was no pre transfusion typing but we performed genotyping.
Peter
but I needed a few minutes to get from the flour on my chair again.
How would you handle this scenario?
in Transfusion Services
Posted
On day 10 we also had performed enzym treated cells in anti IgG cards. When only one or a few reactions are found and they are all Jka or Jkb pos, we do that to look for anti Jk antibodies. The most sensitive methode to look for anti Jk antibodies. And also feno- or genotype the patient tot see what can be made.