Rh-fan

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.

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

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

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....

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

I had never heard of it either until after attending a SCAB conference a few months ago.  Apparently you can add Combs AHG (IgG) to bind to the antibodies that are causing a positive DAT.   This will then block those antibodies from reacting when phenotyping a patient through the AHG phase. How or why this doesn't block the antigen when phenotyping I do not know? But I was told it doesn't.  I was also told this technique is mainly used for those patients with a strong postive DAT, where the DAT is still reacting after treatment with EGA.
 
Thanks,

Before I lurched into the world of Transfusion Science, I wanted to be a fireman.  Here I am when I was about 7!

Nice, specialy the fraise
 
"Technicalities only known to chiefs and Malcolm"
 
Almost nothing is changed.
 
Peter

Malcolm,
 
I found Kuziva (very easy between 2200 other people) and we had a nice talk about that "serology rules".  

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

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

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

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.

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

There is a difference for the immune system between IgM antibody formation to 'sugar" structures then the formation of IgG antibodies to a protein. No or little IgM production (to sugars) will not say there is no IgG production or boostering to a protein. I do not think that it will give a acute transfusion reaction but a boostering and delayed reaction is still possible.

Malcolm is right.
Up to 50% of the patients with WAA make allo antibodies against Rh and K. When they make allo antibodies the immune system is triggerd and the WAA can become stronger or even make a switch for IgG1 tot IgG3 subclass (meaning more red cel destruction). So selecting Rh and K compatible units is no waste.

When you use a indirect antiglobulin test for your weak D testing, it can not be negative when your DAT is positive. Only when your DAT is very weak, on the edge of detecting, maybe the weak D test can be negative but this is a very smal change