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I can't recall having come across an anti-D reacting like this (as far as I can remember these days - which isn't very far at my age!!!!!), but I do remember once finding an anti-E that only reacted by IAT, and not with enzyme-treated red cells, which I sent to the International Blood Group Reference Laboratory for confirmation, and it was confirmed by no less a person than Joyce Poole. We published a poster about it at a BBTS Annual Scientific Meeting (MacRate EB, Carrington T, De Lord C, Needs M, Win N. Anti-E Detectable by IAG and Not by Enzyme? How Confusing! Transfusion Medicine 2001; 11 (Suppl. 1): 30.).

The bad news is time flies. The good news is you're the pilot. ~ Michael Altshuler

If a transfusion is required and urgent (severe symptomatic anemia), a X-match in IAT at 37°C may be tested. You do not necessarily need P-negative blood (very scarce) unless severe transfusion refractory anemia which would support the need of P negative units. For transfusion, patient should be placed in a warm environment and ensuring that the transfused blood is (pre)warm as well. Hereunder are some references: Clinical and epidemiological features of paroxysmal cold hemoglobinuria: a systematic review - PMC Autoimmune Hemolytic Anemia and Red Blood Cell Autoantibodies | Archives of Pathology & Laboratory Medicine

If it was that urgent a case, I can't see what else you can do, because thawing a pp unit that may not be necessary would be a terrible waste.

It is my understanding that, while resistant, it is not totally unaffected and can even be enhanced due to cleavage. From the internet search: Rh Antigens and Papain: While intact Rh-positive red blood cells treated with papain may not show a change in the size of the Rh-containing polypeptides, sequential treatment with phospholipase A2 followed by papain does result in cleavage of a 35-Kd protein band to a 30-Kd band, suggesting some effect on the Rh-related polypeptides. Increased Agglutination: Interestingly, papain treatment often leads to enhanced agglutination (clumping) of red blood cells by anti-D antibodies. This suggests that while the D antigen itself might not be entirely destroyed, the changes in the red cell membrane caused by papain somehow make the antigen more accessible to the antibody or enhance the agglutination process. One theory is that papain modifies the red cell surface, reducing its electronegativity and exposing hidden antigens. Here's a couple of articles discussing: https://www.sciencedirect.com/science/article/pii/S0006497120626842 https://www.sciencedirect.com/science/article/pii/S0006497120858455#:~:text=studies%20described%20here.-,RESULTS,produce%20other%20detectable%20cleavage%20products. Very interesting ... thank you!

What we do for ourselves dies with us - what we do for others remains and is immortal. ~ Albert Pike

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Today would also have been the birthday of the late GREAT John Judd.

In all the validations I've done in the past (hundreds), we always mimicked the actual condition as close as possible. One great example was that we had one person do QC of a manufacturing process. Only that one person. When they were out on leave, someone else performed the QC, and it failed. It failed with almost everyone because they did the process differently. It's best to have the validation / qualification / quality control done under the same conditions in which it will be performed.

Don't let a title become a trap. "I have to be a doctor." "I need to get into that school." "I can't quit this job—it's Google." There are many ways to live an amazing life. Stop thinking about the status of this particular title and focus on the substance of what you want. You’ll often find there are many ways to get similar amounts of joy, purpose, or freedom. If you attach your happiness to a single path, you'll become blind to other wonderful opportunities around you. And many of them might be a better fit for you or deliver a similar result with less struggle. ~ James Clear

Don't sit down and wait for the opportunities to come. Get up and make them. ~ Madam C.J. Walker

The bad news is time flies. The good news is you're the pilot. ~ Michael Altshuler

Don't sit down and wait for the opportunities to come. Get up and make them. ~ Madam C.J. Walker

Act as if what you do makes a difference. It does. ~ William James

@Malcolm Needs yes, sorry I missed the part of using anti-IgG for IAT @37deg.

That sounds interesting and very similar! We're thinking to run the Bio-Rad variant D kit as it may just be a variant and just showing as D- in the cards which happens occasionally. Still a bit strange for any kind of anti-D to show reactions like this. I'll do the same as you did and have a chat with IBGRL about our findings to see if it's of any interest to them.

The person who learns the most in any classroom is the teacher. If you really want to learn a topic, then “teach” it. Write a book. Teach a class. Build a product. Start a company. The act of making something will force you to learn more deeply than reading ever will. ~ James Clear

Welcome!

Thank you, you absolute legends!

Welcome to this simply AMAZING site Phillip E. ENJOY!!!!!!!!!!!!!!

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If you look for evidence that people are conspiring to hold you back and the world is working against you, then it will take you no time at all to find precisely that. If you expect to encounter helpful people and experience a world that is working with you, then you find plenty of evidence to support that view as well. The raw material for a sweet life or a bitter life is always there. The story you emphasize is the one you notice. ~ James Clear

A real friend is one who walks in when the rest of the world walks out. ~ Walter Winchell

Happiness is a warm puppy. ~ Charles M. Schulz

You can choose a ready guide In some celestial voice If you choose not to decide You still have made a choice You can choose from phantom fears And kindness that can kill I will choose a path that’s clear I will choose free will. ~ Rush (rock band)

Fantastic song! 👍

It is showing pretty strongly (3-4+) on Echo.

He taught some of my classes when I took the MABB lecture series❤️

Be happy for this moment. This moment is your life. ~ Omar Khayyam

Shucks @donellda, I missed that. Happy birthday!

Thank you

Thank you❤️

Kind words can be short and easy to speak, but their echoes are truly endless. ~ Mother Teresa

I'll say! Happy B-day!

Lot's of great people born on this day 😉. Happy Birthday!🎂

Having a positive mental attitude is asking how something can be done rather than saying it can’t be done. ~ Bo Bennett

Thanks very much

Our greatest weakness lies in giving up. The most certain way to succeed is always to try just one more time. ~ Thomas A. Edison

You must be the change you wish to see in the world. ~ Mahatma Gandhi

Whenever you are stuck searching for the optimal plan, remember: Getting started changes everything. ~ James Clear

If we shall take the good we find, asking no questions, we shall have heaping measures. ~ Ralph Waldo Emerson

Yes, it's now Werfen (haven't been too happy with that change). We utilize the Capture-R NEG/POS control Serum and monitor reaction strength. This approach was selected to ensure quality and exceed the "Manufacturer's Recommendation" which, as you stated, will be decided on a lab by lab basis.

Presuming that "Panocell III" is the Werfen 3-cell screen, for which antigens are you testing and how did you decide on those ? Just curious. I think everyone may approach this nutmeg a little differently.

AGREED - and killing the patient in some circumstances!!!!!!!!!!!!!!!!!!

Also, were any of the transfused units antigen positive? This is the quickest way to get a negative indirect antiglobulin test ;).

I agree Darin, it is almost certainly a dilutional effect, BUT, it could also be the effect of a soluble antigen (obviously not within the Duffy Blood Group System). If the antibody had a specificity within, for example, the Lewis Blood Group System, or the Chido/Rodgers Blood Group System, the antigen in the plasma could well adsorb out the circulating antibody. That having been said, this explanation is FAR less likely than your suggestion of the dilutional effect.

Hi Steve, I'll give it a go anyway! Almost everyone in the world is positive for the LW(a) antigen (and a few for the LW( antigen. However, auto-anti-LW (I use the generic term, because very few have ever been differentiated into auto-anti-LWa or auto-anti-LWb) is quite a common specificity in AIHA (again, how common, I couldn't say, because most of the time, we don't bother going for the specificity, because it would make no difference to the clinical treatment of the patient), and, in some cases, the patient becomes transiently serologically LW weak or LW-. It is unclear as to whether the red cells are actually LW weak or LW-, or just that the antigen sites are blocked by the auto-antibody, but, again, so what! Anyway, as you know, anti-LW reacts very much like anti-D, except that D- red cells, like D+ red cells, are also LW+, but have weaken expression of the LW antigen. This is because the number of LW antigen sites on D- red cells (average 2835) is much less than on D+ red cells (average 4400 sites); hence it can look like anti-D. Very often, when red cells are treated with papain, the anti-LW will react equally strongly with D+ or D- red cells, BUT by IAT, the anti-LW will react much more strongly with the D+ red cells than the D- red cells (essentially, you get no visible reaction). Now then, for some reason, the LW antigen is expressed MUCH more stongly on cord red cells, again, because of the number of LW antigen sites (average 5150 for D+ cord blood cells, and 3620 for D- cord blood cells). AS you can see from these figures, the number of LW sites on a D- cord blood cells (3620) is higher than the number of sites on an adult D- red cell (2835) and, although not as high a number of sites as on an adult D+ red cell (4400), will often react visibly with an anti-LW by IAT. D- cord blood cells will not, of course, react with a true anti-D, therefore, if a group O, D-, DAT- cord blood cell reacts by IAT with an antibody that looks like an anti-D (but anti-D is unlikely, from the patient's history), then there is an excellent chance that the true specificity is anti-LW. I hope that helps?????????? :whew::whew: