gagpinks

In uk if quantification level is 0.4 IU/mL or above we consider as a immune anti-D and we do not issue RhIg. However if lady comes in ED we perform Group and antibody screen before we issue RhIg.

RCI will have to prepare as well for quantification. Can't imagine every two weeks after 28 weeks. How would they perform quantification? Will they absorb anti Inb and then perform quantification?

And guess what now she also developed anti-c . It will be so difficult if she get pregnant again.

We have been asked by reference lab to provide informmation if patient is on CD38. It will be useful for them to process the sample. if patient is on DARA how does reference lab process the sample. Do they use different absorption techniques?

Yes it is same lady. Now this time she delivered at home☺

After all these preparation patient delivered at home. Baby and Mum didn't need any blood.

In uk we follow strictly zero tolerance policy therfore no pre printed label allowed. There are chances where patient could be misidentified and labelled wrongly. Recently we had near miss incident. Patient came to A&E and G/S was performed and Group was O pos. Then Patient transfer to ward and clever nurse decided to take two sample same time eventhough two sample policy (2 sample at 2 different time and by 2 different phlebotomy ). She decided to send one sample and thought will send second sample after one hour. Lab performed group and this time it was Bpos. So lab asked for second sample and nurse send same sample(taken same timewith first sample ) for second time. So second sample again B pos. As per our protocols we two sample has same group we can accept the group. Luckily patient was sure about his group and question about it. Fourth sample taken and found to be O Pos. Case was investigated by TP and found there was WBIT from ward nurse. SO no matter what policy, system or rule we bring mistakes are still happening. It's really depends on person who takes blood. They need to be visulant.

Lady is at low risk bleeding at delivery so plan is to transfuse ABO and D and Rh compatible in case of emergency with methylprednisolone or if she is stable but need blood than frozen unit can be obtained.

Hi Cliff We count 4 hours from the time it's out of controlled temperature. If you pack your unit in controlled transport box than time start from it opened the box. It's worth looking JPAC guidelines

Lady has delivered the baby and her final quantification level is 34.1 IU/mL . Baby had single exchange transfusion and doing well. Just wondering if baby required top up transfusion to treat late anaemia, does top up pack has to be irradiated? I know if baby had IUT then certainly required irradiated blood for top up transfusion. But I am not sure about exchange transfusion.

Do you think Patient might have persistent hereditary Feta haemoglobin ( HPFH)?

Yes Enzyme IAT will definitely help to solve the problem. Just wondering how about performing panel with known Anti-D to check quality control of panel cells. Did you send sample to reference lab for quantification?

Pregnant lady has slightly raised HbF level in third trimester. It also depends upon the staining procedure and how we we count the cell. We use Molison formula. Sometimes it's difficult to differentiate lymphocyte and fetal cells. Which might be counted as fetal cells and give false positive results. This is why flow cytometry is more accurate. But as far as I know when baby group is not available it is safer to give Rh IvIgG to prevent sensitisation.

She is 28 weeks now and titre is 64.