Emelie

It's Martin who's analyzed it (we've sent new samples so they can confirm their findings) We'd better do as they say, then 😄

Thank you! I found it difficult to find general recommendations regarding Bel. I discussed it with our reference lab just now, they weren't convinced about the transferase's ability to produce a complete antigen, since the expression was extremely low. I thought, as you say, that the absence of anti-B would implicate a normal B antigen but they were unwilling to recommend anything but A or 0 blood. This particular patient has a mutation not earlier documented, so it might be their cause for taking extra caution. Thank you for some great insight! It's an amazing forum for gaining new knowledge!

Hi! We have a patient who genotyped as A Bel. Is the Bel subgroup a complete antigen or partial? The patient expresses extremely low levels of B, would it be safe to transfuse with AB blood? The patient has no detectable anti-B occurring naturally. As far as I can tell by the litterature, Bel cells are not agglutinated with anti-B (but do bind to them)? We will, of course, have our doctor decide what recommendations to give, but I would like to know how other treat these patients as it´s a first for us. Please explain it like I´m five :)

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Tricore; yes, in Sweden many larger hospitals use PI instead of irradiation when preparing platelets, the methods are equivalent. In moderately sized hospitals it's more convenient and cost efficient to irradiate the (rather few) components needed at the irradiation center instead.

We are our own blood suppliers and we too cooperate with our hospital's irradiation center to irradiate blood products. If they weren't able to accomodate our demand we might switch to pathogen inactivation, such as Intercept, for the platelets and hope the irradiation center are willing to handle the smaller amount of RBC's.

The physician rates the reaction from mild to severe where I work, if the reaction is considered mild, we don't do anything other than document it in the computer system so that we can see if there are additional transfusion reactions connected to that specific blood donor, or if a certain patient often has a reaction. If we get a call about a suspected reaction and they don't send us any samples I usually just assume it was rated as mild, depending on what information I've gotten. We do not document the time ourselves, the nurses are required to fill in a form which covers all that.

Where I work we're alone during nights and weekends, so situations that would have been perfectly fine daytime with a couple colleagues around can easily get quite overwhelming with only a doctor on call-duty to discuss with. Like when there's a traffic accident or some other trauma with several badly injured victims and one of them turn out to have a pos ab screen - it can be quite stressful to set up an ab panel while simultaneously handing out lots of blood and keeping up with the thawing of FFP, and if our stocks are getting low, managing the transfer of blood and platelets from other hospitals to our own. I rarely encounter those extreme situations, but I had a slightly annoying weekend a couple months ago, working alone, when an ER patient needed a lot of blood acutely and of course she had a pos ab screen with several ab's. There wasn't a chance for me to identify them properly so I phenotyped her thoroughly and cross-matched units. I tested her against more than 20 units that fit her phenotype as far as I knew (Rh, K, Fy, Jk, MNS) and still only found 2 that were compatible. She received a lot more units of rbc's that weekend and we do all xm manually, but the most frustrating thing was when our primary "help-lab" sent back the results from her blood work marked as "Un-identified antibodies"... and it's not a one-time only patient, this one was at the hospital for quite some time getting several more transfusions and will most likely be back. We've sent new samples to a ref lab and hope for more exciting answers this time In my opinion, it's important to always double-check with the medically responsible doctor before doing anything when you're uncertain, rather ask for expert advice one time extra than one too little, and document everything they say in order to keep your back free. As a blood lab tech I am not qualified to make decisions regarding patients, no matter what opinions I harbour (though it's obviously important to always give sufficient info about ab's and other findings to the patient's doctor to help them make proper decisions). And, of course, always do a background check on a patient when something seems really odd, bm transplants and recent transfusions at other hospitals can mess things up, and there might be important information to be had

We only use apheresis plts, AB0 compatible for frequent recipients such as haematology pts since the cell survival is somewhat better, but do not consider Rh at all, unless we have had to buy pooled units from another supplier. We have strict limits reg the levels of rbc's in our apheresis products so it's only the plt ag we consider - i.e. no concerns regarding K either.