DLabGirl

I almost forgot, here you go! Image 1 .jfif Image 2 .jfif

Happy Friday everyone! First off, Thank you Malcolm 😊 for that excellent PPT lecture! 👌 With your permission, I'd love to share it with my students; it's exactly the kind of content that helps bring these complex concepts to life (and mildly melt brains in the best way possible). Speaking of melted brains… let's talk Anti-G differentiation, shall we? While I agree that differentiation isn’t necessary for transfusion purposes because in cases where anti-G is suspected, the recommendation is the same (D and C antigen-negative PRBCs); in the US Reference Lab world, it's a whole different dance. Differentiating anti-D + anti-C from anti-G is essential in alloimmunized patients with anti-D + anti-C for Rh Immune Globulin (RhIg) prophylaxis administration indication. Medical teams want to know if a patient is a candidate for RhIG, and if it's still indicated, especially to avoid future medical and legal complications. And so begins the beautiful (read: painstaking) double adsorption and elution process. 😫 The presence/development of a real anti-D indicates the patient does not require RhIg administration, whereas the presence of anti-G indicates the need for RhIg prophylaxis. That way, RhIG is avoided in patients with a real anti-D (although clinical correlation is recommended to guide every decision). In this case, we saw what looked/reacted like anti-D and anti-C (1). Adsorption with R2R2 cells showed anti-C in the adsorbed serum (2) and anti-D and/or G in the adsorbing R2R2 cell eluate (3). Usually, we would stop and call anti-C and anti-D, if we have no reactions on C Ag Pos cells, but since suspected anti-G was in the mix, we routinely differentiate/separate it. The anti-D was confirmed in (4) by adsorbing the eluate containing the suspected (anti-D + anti-G) with an r'r unit. So far, so good. However, when we tried to separate the anti-G by elution of the adsorbing r′r cells, expecting a reaction on D and C antigen-positive cells (5), we got a negative result (Cue dramatic music). I know, I know...at this point you’re probably wondering if we’re still in the Blood Bank or if we’ve accidentally wandered into theoretical physics. Trust me, my brain also wobbles when explaining G differentiation. It's the kind of thing that makes you rethink your career choices... for about 5 minutes... and then roll up your sleeves and start prepping another adsorption. 😅 A couple of housekeeping: We ficin treat our adsorbing cells, and sometimes use PEG in adsorption for efficiency. After briefly considering a career in something less chaotic, we retraced our steps. No PEG this time, 60-minute incubation, followed up with a DAT after each adsorption to check for antibody coating... and voilà: finally got the positive reaction we were looking for. The patient has anti-D, anti-C, and anti-G. I can only think of a possible weak DAT strength pending elution, or PEG interference when used in adsorption. As always, this is Blood Bank, we know a million things can go wrong, and often do. But in the end, science (and a lot of perseverance) wins. Thanks again to everyone for your input, patience, your brains, and your sense of humor. And again, Malcolm, thanks for your lecture, teaching, dedication and inspiration! I wish everyone a calm weekend. May your panels be clear, your DATs negative, and your eluates informative. 😉

An example of Anti-G Separation/Differentiation - Any thoughts? Thank you! Anti-C.-D.-G separation.HEIC

It is an honor to be here! I'm already learning so much from all of you! Thank you!!!🙏💕