NAN47

hi malcolm just wanted to say thanks for that excellent explanation and thankyou for taking the time to do it. It was really helpful! So glad I found this website and all the help and advice I have received has been great! tricia:D

thanks malcolm, In the case study it gave you the donors phenotype which was both C and c negative and I was wondering whether or not that this was a mis-print in the paper. I have read about RH null individuals but had never come across someone who was just negative for C and c antigens. thanks again

hi there, was wondering if someone could tell me if it is possible for someones phenotype to be negative for C and c. but for them to express the D and E antigens. and if so would this person be used as a bone marrow donor. Have just recently sat the higher specialist exams in blood transfusion and one of the case studies involved selecting the appropriate blood for the BM recipient post transplant. confused thanks:confused:

Thanks Malcolm - maybe I have learned something in the course of my studying!!! Okay - dont know if this is any easy question or not but here goes... which 2 blood group glycoproteins have enzymatic activity and what do they do? tricia

hi Is it HLA-DRB1*11 and HLA DRB1*13, not sure why though, all I have is that the combined frequency was found to be 83% in immunised K patients and 52% in healthy controls? tricia

hi my guess is the Kidd blood group system, Jka-,Jkb-. not sure though!

thanks for that, that was really helpful, I am hoping to get over to our local reference centre in August for a few days, to see more on Special Investigations etc. In the course of my studying I am realising what a vast subject area blood transfusion is, but also very interesting!! thanks again, am sure that i will have lots more to ask!!

ok - have pondered and deliberated over this for long enough and whilst i may just be demonstrating the SS part of KISS, this is what I have come up with and I am not very confident about it!! ok the antibodies which i have positively identified is anti-M reactive at 37c by IAT and depressed by enzyme as expected. Patients M- phenotype also confirms this. Other antibody specificities which ? positively identified as according to BCSH guidelines for assigning specificity include; anti-C, anti-S, anti-Fya and anti-Jkb. I have excluded anti-Cw and Kpa due to the fact that they are rarely clinically significant and are often not expressed on antibody screening cells. ? anti-Le(a) as this would only require to be IAT cross-match compatible. This process which I used for achieve this result is the 'crossing out' method and excluding specificities base on non-reactivity with the serum and this allowed tentative exclusion of antibodies to antigens expressed on non-reactive cells. Additional test which i would perform would be to include an auto-control as a way of excluding an underlying auto-antibody. I would then use an additional panel ( Diamed ID) as a way of further excluding specificities ie would use a reagent cell which is R1R1 M- as a way of excluding anti-C ( would have expected this to have reacted by enzyme) . I would select reagent cells and sytematically try to eliminate each of the potential specificities present. I would also crossmatch by IAT blood which is antigen negative for each of the probable antibodies present as a way of demonstrating comaptibility to the blood and providing additional confirmation of antibody specificity. I really feel that this is not correct but have been racking my brains and it is the best i can come up with!! thanks tricia ? also deliberated the point of a room temperature panel???

ok thanks, will give it a go and see how i get on. Think that my problem is that i often look at the more complex sides to things first, whilst ignoring the obvious!! will try to remember KISS!! thanks:)

Hi there, thanks so much for your input! Yeah we do coombs and enzyme panels on our positive antibody screens, we also have the Diamed - ID panels which i would use to try and eliminate possible specificities. I also have an understanding of the principles of how enzyme techniques affect/destroy certain antigenic specificities ie M fya etc, also that i would expect to see the Rhesus specificities being enhanced by the enzyme technique. I would also look use the ruling out technique and looking at reaction pattern strength to aid my investigation. However when we have multiple possible antibodies which we couldnt confirm we would crossmatch units for compatibility and then send it to the reference centre for confirmation. also i would do an autologous control to help to identify whether there could be a possible auto-antibody present in anddition to alloantibodies I have a basic understanding of adsorption and elution techniques ( however I actually havent performed them personally) and was wondering if that is the route that the reference centre would go down or if they have other panel in use to rule out and determine and antibodies which are being masked. part of the question is which antibodies of clinical significance, if any cannot be excluded and which can be positively identified, am not sure how i would answer that without further investigation? hope i am making sense!! many thanks ps i will give it a bash!!

thanks Malcolm!!!

Hi I am a BMS in Haematology and Blood Transfusion in the UK and i am currently studing for the higher specialist diploma in Transfusion science. I have been looking at last years past papers and one of the case studies has got me stumped. was looking for some advice as to how is best to tackle such a question. I am a little confused as I work in a district general hospital as opposed to a reference centre and I am not sure whether i should answer the question with what I would do in my post or look at it from the perspective of what the reference centre would do. any help would be gratefully received! Case Study 3.docx

Hi thanks for that information, jcdayaz - no I wont use that incident as a negative - have had a very positive response from those who are currently using electronic issue, i would just use it to highlight that as with so many things in life - you have to expect the unexpected! thanks!

ps jcdayaz, could you tell me where your hospital is based - its just that would be a interesting situation to include in my presentation on electronic issue. thanks

Hi there, thanks for that information - that is quite a scary situation, can i just ask where the original units issued via electronic issue or were they cross-matched and found to be negative? If electronic issue wasnt used was there another reason why the patient wasnt eligible for EI. many thanks tricia

Thanks Brenda, that was really helpful. I was also wondering how you went about assessing the feasibility of introducing the electronic issue process into a blood bank. ie how many of the requests for blood would actually be suitable for electronic issue , and trying to work out whether there would be a high enough percentage to warrant its introduction?. I have some thoughts on how I would go about this ( such as a retrospective study over say a 3 month period of crossmatch requests and ascertaining how many of these met the eligibility criteria) . any guidance or advice on this would be gratefully received. thanks tricia:)

Would just like to say thankyou to everyone who posted a reply for my request for information on electronic issue. It has been very helpful and gratefully received. Would also like to add, that I have found this website to be very helpful towards my preparation for the higher specialist diploma in Transfusion Science ( wish i had discovered the forum earlier!!) Have found reading the posts very helpful and also all the topics in the Educational Materials section. So thanks again everyone! tricia:)

ok thanks will check that out!

thank you for your help, will try to contact those people. yes i have already obtained the MHRA guidance, and have included all the specifications of the process in my presentation - was just hoping to add a little something extra to it by including how it works for those who use it. very grateful for your help Patricia

Hi I am a specialist Biomedical Scientist who is currently based at a hospital in Scotland UK, At the moment i am currently undertaking a higher specialist diploma in transfusion science, and i am currently preparing a presentation on electronic crossmatching/issue. As the hospital where i work doesnt use electronic issue, i was hoping that others may like to share there views on it with me, such as how it has affected their blood banks workload, blood usage etc and also if there has been adverse incidents resulting from its use? many thanks, grateful for any help! Patricia