How to Post

[L106]

Just checking if this is how you post a new thread.

[tbostock]

A suggestion for all who post: try to put a key word or two in the post title. It's more helpful than a generic "help" or "hi guys, can you help" title. Makes it easier to search if you have a key word in the title too. Thanks to all.

[DR VAISHALI]

hi. i have recently joined this community. i want to post new questions regarding blood bank equipments like refrigerator and deep freezer and gel cards. so pls help.

[Malcolm Needs ☆]

hi. i have recently joined this community. i want to post new questions regarding blood bank equipments like refrigerator and deep freezer and gel cards. so pls help.

If you go to the Forum, and scroll down to Equipment, and double click on "Equipment", all of the threads under this subject will appear. Somewhere near the top, towards the left hand side, you will see an icon that says (something like) "NEW THREAD".

You just click on that, chose a heading, and then away you go!!!!!!!!!

:):)

[irshadaad]

i want know composition of modified LISS

[Stoogiesfreak]

We currently have a patient that we have crossmatched and transfused many times over the past year. This patient has been typed as A Neg by six different blood bank techs and received at least 16 units all A Negative. He is receiving chemo, but the dosage has been lowered.

Last week he came in again and this time he is typing as A Positive - very weak +/- to 1+ on immediate spin. This in on four different sample all collected by 4 different phlebotomists.

I am lost for an explanation. In the meantime we have decided to leave him as A Neg and give A Neg if necessary. Any ideas? I am starting to lean in the area of something to do with his chemotherapy. Help! Thanks, John

[Malcolm Needs ☆]

We currently have a patient that we have crossmatched and transfused many times over the past year. This patient has been typed as A Neg by six different blood bank techs and received at least 16 units all A Negative. He is receiving chemo, but the dosage has been lowered.

Last week he came in again and this time he is typing as A Positive - very weak +/- to 1+ on immediate spin. This in on four different sample all collected by 4 different phlebotomists.

I am lost for an explanation. In the meantime we have decided to leave him as A Neg and give A Neg if necessary. Any ideas? I am starting to lean in the area of something to do with his chemotherapy. Help! Thanks, John

Could you tell us why the patient is having chemotherapy? There are certain haematological oncology conditions where it is known that the D antigen is weakened, in some rare cases, so much so that an apparant anti-D is produced.

:confused::confused:

[Stoogiesfreak]

Hi Malcolm,

This particular patient is in end stage lung cancer.

Thanks,

John

[Eagle Eye]

Patient is receiving A Neg units so how can he produce Anti-D?

Did he receive any IV IgG?

Any plasma or platelets? I am thinking regarding passive anti-D???

Can you check to see id anti-D IgM/IgG/ mixture of both?

[Stoogiesfreak]

This patient was scheduled to receive platelets, but they reduced his chemo dosage and his count responded and platelets were not given. Our Anti-D sera is a mixture. I also checked and he has not been at any other facility. There is no record of IgG being given. Sorry, I wish I had more information.

Also, the patient's antibody screen is negative and an ID panel was performed just to rule out anything and we did not pick up anything on an ID panel either. ???

Thanks,

John

[L106]

Patient is receiving A Neg units so how can he produce Anti-D?

Did he receive any IV IgG?

Any plasma or platelets? I am thinking regarding passive anti-D???

Can you check to see id anti-D IgM/IgG/ mixture of both?

The poster did not say that the patient was producing Anti-D. Rather, the patient's red cells appears to now be typing as weakly Rh(o) D Positive.

Have you performed a Direct Antiglobulin Test on the patient's red cells?

[Stoogiesfreak]

The DAT is negative with IgG and Poly.

John

[Eagle Eye]

The poster did not say that the patient was producing Anti-D. Rather, the patient's red cells appears to now be typing as weakly Rh(o) D Positive.

Have you performed a Direct Antiglobulin Test on the patient's red cells?

:tongue::tongue::tongue: ooooops...Sorry. My mistake. Please disregard my post.....Again Sorry.

[Malcolm Needs ☆]

Hi Malcolm,

This particular patient is in end stage lung cancer.

Thanks,

John

Hmm, that looks like my idea is completely out of the window, unless the patient has marrow metasteses.

:redface::redface:

[Stoogiesfreak]

Malcolm, Good thought - I will check today. I appreciate the help!

John

[Stoogiesfreak]

Good Morning!

I took the patient's cells and did a Du on the sample. The immediate spin is still +/- to 1+, but the IgG phase is 3+. This tells me that he is probably a true weak D (Du) and it was possibly masked by the chemo or the cancer. My thought process is that if this patient had been transfused with D positive cells the weak D (Du) would not have increased in strength.

Any thoughts?

Thanks,

John

[Deny Morlino]

My thought process is that if this patient had been transfused with D positive cells the weak D (Du) would not have increased in strength.

Any thoughts?

Thanks,

John

If the weak D is due to a reduced number of binding sites on the cell surface then I agree the strength of the reaction would stay the same.

If the weak D is due to a partial D then transfusing D positive cells may have had the potential to form a partial anti-D. Conservative is to continue with the A negative units as you stated you have. Interesting case either way. We have a good size oncology population here as well so I will keep an eye out for the same sort of scenario.

[Malcolm Needs ☆]

If the weak D is due to a reduced number of binding sites on the cell surface then I agree the strength of the reaction would stay the same.

If the weak D is due to a partial D then transfusing D positive cells may have had the potential to form a partial anti-D. Conservative is to continue with the A negative units as you stated you have. Interesting case either way. We have a good size oncology population here as well so I will keep an eye out for the same sort of scenario.

Sorry Deny, could you explain the bold bit again in a slightly different way? I'm probably being particularly thick today, but I'm not sure that I have understood you.

:o:confused::redface:

[Stoogiesfreak]

Thanks Deny,

We have gone over this from all angles - I hope! We have decided to continue with A Negative units for transfusion until we can prove otherwise. Thanks again for your input - I feel like we have made the best decision so far, and I am glad I am getting agreement!

John

[Deny Morlino]

Doubtful you are thick Malcolm . Looking back at my post I jumbled thoughts. The reactions were indicative of a weak D and I referred to a partial D in the second half of my post (doing too many things at once again ). Apologies if any confusion resulted.

We would still stay with a conservative approach here especially considering the status of the patient.

Edited June 28, 2010 by Deny Morlino
Added last thought

[Malcolm Needs ☆]

Doubtful you are thick Malcolm . Looking back at my post I jumbled thoughts. The reactions were indicative of a weak D and I referred to a partial D in the second half of my post (doing too many things at once again ). Apologies if any confusion resulted.

We would still stay with a conservative approach here especially considering the status of the patient.

Thanks Deny; now I undertsand (I think - but I was being a bit thick)!!!!!!!!!!!!!!

:redface:

[Deny Morlino]

After jumbling my thoughts I went to the technical manual to "set myself straight" so to speak. In the discussion of clinical considerations of weak and partial D the discussion indicates some weak D types (1, 2, and 3) are "unlikely to make anti-D and can receive D positive blood." Other weak-D types (11 and 15 are mentioned) while rarer have made anti-D. As there is not yet a cost effective way to determine the specific type of weak D to ascertain the risk of anti-D production, a conservative approach might be prudent. Granted, the statistics indicate that hospitalized patients receiving D positive blood had a lower chance of forming anti-D and the patient in discussion is probably immunosuppressed considering the chemo. I would still play it conservative. (OK I think I have beaten this topic into submission now...I will leave it alone )