Posted October 13, 201113 yr comment_39216 Recently we had a gentleman with an anti-Jka. When we consulted with our reference lab on our panel (because we wern't sure) we had asked if we should check the patient for the Jka antigen but they said the didn't recommend that. Why?
October 13, 201113 yr comment_39218 For me part of the id is to verify the patient is negative for the ag the antibody is directed against.
October 13, 201113 yr comment_39219 Recently we had a gentleman with an anti-Jka. When we consulted with our reference lab on our panel (because we wern't sure) we had asked if we should check the patient for the Jka antigen but they said the didn't recommend that. Why?Did they give a reason for this particularly left field piece of advice?
October 13, 201113 yr comment_39220 Sorry, no good explanation here. You need to ask your reference lab why.Donna
October 13, 201113 yr Author comment_39221 Our reference labs explained it that their policy is to only use the rule out on all the significant antibodies and never go to antigen typing because the antibody may be an auto which would confuse the whole situation.
October 13, 201113 yr comment_39223 Our reference labs explained it that their policy is to only use the rule out on all the significant antibodies and never go to antigen typing because the antibody may be an auto which would confuse the whole situation.That sounds if they do not want to think, that is very odd for a reference lab. A reference lab must make the difference between an allo or an auto antibody, your transfusion advice can/will depent on it.
October 13, 201113 yr comment_39224 As Malcolm implied.....somebody is out in left field.I was trained with (and still follow) David Saikin's rule that testing should be done to prove that the patient's red cells lack the corresponding antigen before reporting out the antibody's specificity.Now, if your patient's red cells have a Positive Direct Antiglobulin Test, it is a different story. It is true that you cannot type the patient's red cells with any reagent that uses Anti-Human Globulin (Coombs) reagent. The Pos DAT will most likely cause a positive reaction with any AHG-type of antisera, so your results will not be valid. Perhaps this is what your reference lab was trying to explain. (Did your patient have a Pos DAT?)Donna
October 13, 201113 yr Author comment_39231 Sorry Donna. didn't see that question on DAT but it was negative.
October 13, 201113 yr comment_39233 Then I no longer think that their suggestion was left field - I think that it was actually off the field altogether!!!!!!!!!!!!!!!!
October 14, 201113 yr comment_39248 Have you inspected or audited for Reference Laboartory; How do you know that they are qualified to act as a Reference Laboratory for you; I would seek to change laboratories if this is the level of service that you receive. Thank the Lord for Malcolm Needs Laboratory and their services. Most of my staff have benefited greatly from a visit to his laboratory.
October 14, 201113 yr comment_39255 Have you inspected or audited for Reference Laboartory; How do you know that they are qualified to act as a Reference Laboratory for you; I would seek to change laboratories if this is the level of service that you receive. Thank the Lord for Malcolm Needs Laboratory and their services. Most of my staff have benefited greatly from a visit to his laboratory.At last, a brilliant post!!!!!!!!!!!!!!!!!!!!!!!!Seriously though, thanks mprandeair.:blowkiss::blowkiss:
October 14, 201113 yr comment_39258 I would say that most of us have benefited from the presence of Malcolm on this site, let alone a visit to his laboratory. THANKS MALCOLM.
October 14, 201113 yr comment_39263 Very flattering and thanks everyone, but enough is enough; it's getting embarrassing.
October 17, 201113 yr comment_39292 One other thought on your patient's antigen type - was he or she recently transfused? If so, antigen typing would be inappropriate unless a cell separation was performed and the type was done on neocytes.
October 18, 201113 yr comment_39316 Does anyone routinely test the pt for Jkb ag if they find anti-Jka (or viceversa)?
October 18, 201113 yr comment_39332 Does anyone routinely test the pt for Jkb ag if they find anti-Jka (or viceversa)?No we don't. What does everybody else do?Also, Ann, thanks for bringing up the situation of a recently-transfused patient.
October 18, 201113 yr comment_39333 Does anyone routinely test the pt for Jkb ag if they find anti-Jka (or viceversa)?Yes - every time we get one.The same applies for all other antithetical antigens when we identify an antibody (with the exception of Kp©, or when no grouping antibody is available).
October 19, 201113 yr comment_39345 Yes - every time we get one.The same applies for all other antithetical antigens when we identify an antibody (with the exception of Kp©, or when no grouping antibody is available).What is the reason for that? We do that for Le(a) antibodies (but that reason is clear) but for non of the other antibodies. Are you looking for null types or what?Peter
October 19, 201113 yr comment_39347 No, we are just "squaring the circle" as we call it - but finding a null type would be great!
October 19, 201113 yr comment_39349 I don't usually check for the other antigen, though I have done so if things aren't making sense
October 19, 201113 yr comment_39351 I always screen for M and N antigens together. I believe the package insert for one of the antigen manufacturers indicated testing both for valid results quite some time ago.
October 19, 201113 yr comment_39360 Does anyone routinely test the pt for Jkb ag if they find anti-Jka (or viceversa)?Like Malcolm, we test for Jkb every time we get a Jka, and vice versa.
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