Shall I consider this anti M is clinically significant ?

[Desoki]

Dear Friends

I know the clinically significant antibody; that's antibody react at 37c or react with AHG, but since one week I had a case positive antibody screen with immediate spine by tube method but still positive in all stages 37c and AHG, the antibody was anti M with negative autocontrol this negative was through all stages.

My question is, shall I conceder this anti M clinically significant antibody because it still gives positive in 37 and AHG so give patient M negative unit, or I have to conceder this anti M clinically insignificant because that antibody react at room temperature and that continuing reaction at 37 & AHG is due to strong IgM not faded by incubation stage of indirect comb test, so no need to give M negative unit?

[rravkin@aol.com]

Mohammad, the anti-M you ruled in is probably comprised of concentrations of IgM and IgG, which would account for it's reactivity at the different phases, and is most definitely clinically significant.

[Deny Morlino]

I would err on the side of caution and consider it clinically significant.

[R1R2]

Hi Mohammed,

Did you conduct your AHG tests strictly at 37 C, i.e. prewarm?

[Malcolm Needs ☆]

Hi Mohammed,When you say that the anti-M reacts by IAT, is the IAT method you are using a pre-warmed, warm-washed tube IAT, or a column agglutination technology? This is very important to know. It may make a very big difference as to whether or not this anti-M is clinically significant.I also hate to disagree with people, but many examples of anti-M are either a mixture of an IgM and a "cold-reacting" IgG, and some are more or less "pure" "cold-reacting" IgG, but this fact does NOT necessarily mean that they are clinically significant.

[SMILLER]

I would say that considering the importance of a cold-reacting antibody, the significance of a RT or 4C reaction is not what is important. It is whether or not it may be reacting at 37C or AHG. If you cannot rule out the latter (by getting a negative result somehow), then you cannot say that it will not react in vivo.

Scott

[Malcolm Needs ☆]

I agree with Scott.Until proven otherwise, a "cold-reacting" antibody should be regarded as clinically significant, but, that having been said, it is easy to prove it otherwise by performing the tests at STRICTLY 37oC.

[Desoki]

Hi Mohammed,

Did you conduct your AHG tests strictly at 37 C, i.e. prewarm?

yes I did all tests after prewarming also I use Tube method for IAT not gel method

[Malcolm Needs ☆]

Hi msdesoki,

Thanks for that.

In that case, this anti-M certainly sounds as if it is clinically significant, and should be honoured as such.

[Desoki]

Hi msdesoki,

Thanks for that.

In that case, this anti-M certainly sounds as if it is clinically significant, and should be honoured as such.

Thaks Malkolm

But for another case when I should conceder anti M clinically nonsignificant-if its reaction disappear at 37 or what?

[Desoki]

Also Malcolm, you didn't give me your opanion about question of comb's check cell validity?

[rcurrie]

Don't forget to ask the physician about the procedure. We have had cold reacting only anti-M become clinically significant when the patient was chilled down for open heart surgery.

[Malcolm Needs ☆]

Also Malcolm, you didn't give me your opanion about question of comb's check cell validity?

Yes, sorry about that. I will get around to it, but I am still having to get on to this site as and when I can, because of the fire that has made my family homeless. I rescued my own laptop from the wreckage of my home yesterday, but, sadly, it is no longer working, so getting on to the site is much more difficult for me at present.

I PROMISE that I will get around to answering your query as soon as I can.

[Cliff]

Malcolm, I am very sorry to hear about your fire, hopefully all of your family and pets are safe.

[Malcolm Needs ☆]

Thanks Cliff.

Yes the family are all safe (although my son did have to jump from a first floor window to escape - but like any 13-year-old, you would think that this is an everyday happening for all the way it has affected him!!!!!!!) and, apart from the odd spider, we have no pets!

[DOGLOVER]

I agrre, if you can't pre-warm it away, you need to consider it clinically significant. One caveat, antibodies don't always read the book about how they are supposed to behave. We have one kid who has an anti-M that pre-warms away amd dpesm't even always demonstrate but if we give her M+ rbcs the survival time is way shortened. sometimes you can't win.

Malcolm, I am glad no one was hurt in the fire and hope you will be able to get your life back together soon.

[SMILLER]

Holy cow Malcolm! I am glad you are all OK!

Scott

[Desoki]

Yes, sorry about that. I will get around to it, but I am still having to get on to this site as and when I can, because of the fire that has made my family homeless. I rescued my own laptop from the wreckage of my home yesterday, but, sadly, it is no longer working, so getting on to the site is much more difficult for me at present.

I PROMISE that I will get around to answering your query as soon as I can.

No Problem take your time, also thanks God that you and your family are fine

[Malcolm Needs ☆]

Sorry, but I still can't seem to be able to use the "Thanks Post" on my wife's iPad, but I really do appreciate all of your sentiments.

[Cliff]

Sorry, but I still can't seem to be able to use the "Thanks Post" on my wife's iPad, but I really do appreciate all of your sentiments.

I'm not sure, but suspect it's a Flash thingy - Apple doesn't like / allow Flash so it won't work with an iPad.

[Malcolm Needs ☆]

I think you are probably right Cliff, because I've had no problem with my work computer.I was going to blame my wife, but I'm not that brave!!!!!!!!!

[Abdulhameed Al-Attas]

Malcolm,I am sorry to hear of the fire and I am all thankful that there were no injuries or loss of life.

You are really an awesome! it takes a ton of courage and dedication to continue on after an event like this.

I know it must have been a devestating experience.

As best you can for the time being keep up the great work!

I very much appreciate your wonderfully unique contributions to this forum and I am sure that all members of BloodBankTalk, wish you and your family a speedy recovery .

Edited October 5, 2012 by Abdulhameed Al-Attas

[Malcolm Needs ☆]

Thank you very much indeed.

[BldBnker4]

So sorry to hear of your loss, Malcolm! Glad you and your family are all okay! Hope you find new lodgings soon and that your insurance company pays well!

[Malcolm Needs ☆]

Thanks BldBnker4