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Hi It might be silly question but can we rule out Anti-K by using Heterozygous line ? I understand KK red cell have more sites (4000-6000) where as Kk red cells have 2500-3500) sites. Also BSH guidelines suggest you need to have one homozygous line to exclude antibody. It is difficult to exclude when patient has more than one antibody.

Hi Jermin Your question regarding dilution, you should follow manufacturer instruction because if you do anything outside manufacturer instructions you might have to validate process again. Second question regarding staining and storing sample 4 C for 4 days. Why would store sample for 4 days. Because Rh neg lady should have her antiD dose within72 hours. Secondly I would suggest if you prepare slide and don't fix them then there might EDTA changes on your slide. If you fix your slide with different lot and when you stain patient slide it might be different batch no. You are not really controlling process. Control should be done the exactly the same way the way you run your patients sample or run parellal with patient. Otherwise check ISO 15189 manual I would suggest check with QMG staff.

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.

When you say let NHSBT know you mean reference lab or frozen blood bank? Reference lab are already aware of this case. I was checking history and found the email communications where it suggested in her last pregnancy that if patient show 2+ or>2 reaction then need Inb negative blood. Do you think this is why we didn't provide Inb neg blood in her first pregnancy?

A pregnant lady in her first prenancy develop Anti-Inb at that time her titre was 8. As far as I know anti-Inb doesn't cause HDFN but it can cause HTR. In her first prenancy we kept ready 2 unit of ABO ,D Rh and K matched compatible blood. No blood required in first prenancy. But now in her second pregnancy her titre gone upto 64 at 28 weeks . If blood required , does she need to have Inb negative blood ?

How often would you perform elution if patient is on regular transfusion ( every 14 days) with positive DAT?

If patient had transfusion in last 28 days and if DAT is positive I understand we have to perform elution to find out wheather is there any clinical significant antibody present. But if patient is on regular transfusion (not AIHA) and DAT is positive do we still have to send sample to reference lab for elution eventhough elution is done within 28 days. For eg : If patient had transfusion last 28 days.current DAT is positive, sample sent to ref lab for elution : no antibody detected. 1 week later patient need transfusion but DAT is positive. Is it still necessary to perform elution eventhough elution is performed 1 week ago.( No sign of haemolysis in this case). My manger thinks when there is DAT positive patient is on regular transfusion we have to perform elution every time patient need blood. I am still confused when to perform elution?

HI all, SHOT has gathered data and recommended minimum standards for hospital blood transfusion for staff qualifications. Is it just recommendations or we have to strictly follow the criteria because UKAS has accepted this criteria.

If a child is found to have anti-i by what mechanism can it cause complement activation bearing in mind all adult cells Are i negative. Does it bind non specifically to the patients red cells?

In UK, antigen type is done by our national bloos service, there are 101% right because it's been checked twice.

Thanks Malcolm! ! I will be carefull in my exam. This was interesting case ,just want to confirm our performance. Baby already had 4 unit paediatric pack.