Leaderboard

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

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

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.

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: