John Eggington

No transfusion, so far. I believe that EPO is being administered. It does seem likely the patient will need transfusion at some point, the clinicians have a bit more time to think about it. Still awaiting full resolution of the D type for 'fully informed' decision. Hopefully we'll have all the information in place before transfusion is required.

Interesting, those of us doing electronic crossmatch would never see this.

I agree with every word you say Phil, EXCEPT that, as the baby is fine, trying to identify an antibody directed against a low-prevalence antigen is like hitting your head against a brick wall, over and over and over again!  One has to remember that it is not just the specificities within the 701 series (assuming that it is not a novel specificity all together), but most of the "larger" Blood Group Systems also contain low-prevalence antigens (just look at the Diego Blood Group System, as an example); you could spend many "happy" hours testing the plasma, and still get nowhere.
So, the serologist in me says "YES", the pragmatist in me shouts "NO"!!!!!!!
The thing is, the next pregnancy, if there is one, should, without doubt, be closely monitored (probably by MCA Doppler, or something similar), but, if either an IUT or an exchange transfusion (or a top-up transfusion, come to that) is required, finding compatible blood would be easy, even without knowing the actual antibody specificity.

Gestational age also has an impact, I.e., the more premature a baby is the more likely you are to see this phenomenon

Gestational age also has an impact, I.e., the more premature a baby is the more likely you are to see this phenomenon

Gestational age also has an impact, I.e., the more premature a baby is the more likely you are to see this phenomenon

Gestational age also has an impact, I.e., the more premature a baby is the more likely you are to see this phenomenon

You are going to hate me mollyredone (if you don't already), but why all females of child-bearing AGE?  Surely, this should be (albeit a horrible phrase) child-bearing POTENTIAL?  A female of, for example, 5-years-old is NOT of child-bearing age, but she is most certainly of child-bearing potential, and, if she is D Negative, or expresses a variant D other than Weak D Types 1, 2 or 3, has the potential to produce an immune anti-D, given the correct stimulus.  Should she not be tested?..........or are you only talking about peri-partum cases - in which case I apologise and withdraw my comments (totally).
 

Gestational age also has an impact, I.e., the more premature a baby is the more likely you are to see this phenomenon

It is almost certainly due to the immaturity of the ABO antigens.
You have to remember that these antigens are carbohydrates and cannot, therefore, be direct gene products.
The direct gene products have to be proteins, and in the case of the ABO, H and Lewis antigens (indeed, any antigen that is carbohydrate, rather than protein based) is a transferase enzyme.  In the case of the A antigen, the transferase enzyme is alpha-1-3-N-acetyl-D-galactosyltransferase that transfers an N-acetyl-D-galactosamine residue from a uridine donor molecule to the subterminal D-galactose residue of either the type 1 or type 2 backbone molecules.  Very often, at birth, the transferase molecule is not working at its full kinetic capacity - which is why you see mixed-field reactions with ABO grouping reagents (and why almost all babies are Le(a-b-)).

Cold agglutinins that do not react at 30oC and above are a very expensive waste of time that cause unwarranted anxiety to everyone who does not realise this fact.

We use a saline method where by we use 4 drops of plasma to one drop cells, to super-saturate the cell. Incubate 30- 60 min and use IgG at coombs.
This method has served us well in patients with warm autos. Malcom, of course, went into detail about strong bonds and titers, etc., but I tell my techs that "any self respecting allo- antibody will be detected by this method" -
and yes, I'm old school. So it was, back then, once you have discovered there is a problem, or you have actually detected an antibody, going back  to a saline method is a fine and accepted way to get around the garbage you may be detecting in GEL or other "enhancing" method.
Liz
 

I agree almost entirely with what you say StevenB - you may be surprised to know!!!!!!!!!!!!!!
The thing is that my laboratory (or what used to be my laboratory - I've changed jobs, and am now in a sort of national position, doing the theoretical training [as opposed to the practical training]) IS a Reference Laboratory, and so all of the people who work in it are trained to the nth degree, before they are "let loose" on live patient's sample, and all are trained in this technique and use it virtually everyday (therefore, keeping up competency).
I, myself, was trained by a combination of Dr. Kenneth Goldsmith, Dr. Carolyn Giles and Joyce Poole, when I was working at the International Blood Group Reference Laboratory, with help from Dr. Patricia Tippett, Dr. Robert Race, Dr. Ruth Sanger and Dr. Geoff Daniels - amongst others!  I had a good grounding!!!!!!!!!!!!!

The 'DAT neg', 'auto pos', gal auto antibodies are almost always best managed by using a tube technique. The autoantibody may well bind during the tube incubation phase but is eluted away during the wash phase. You usually find that if you do a gel DAT, but add patient plasma to it and incubate like an IAT, the  cells will be IgG coated.

In the hands of an experienced serologist, a totally safe technique, despite, I'm afraid, what John Judd et al may say!

We have solid phase and occasionally get these "warm auto" like reactions.  Doing a tube screen w/o enhancement ( aka 30" saline) is our problem solving method.  If the patient has been transfused we'll do AHG XM just to make sure.  Like Malcolm says, before all these new fangled but convenient techniques people were not dropping dead from every transfusion.
 

The 'DAT neg', 'auto pos', gal auto antibodies are almost always best managed by using a tube technique. The autoantibody may well bind during the tube incubation phase but is eluted away during the wash phase. You usually find that if you do a gel DAT, but add patient plasma to it and incubate like an IAT, the  cells will be IgG coated.

The 'DAT neg', 'auto pos', gal auto antibodies are almost always best managed by using a tube technique. The autoantibody may well bind during the tube incubation phase but is eluted away during the wash phase. You usually find that if you do a gel DAT, but add patient plasma to it and incubate like an IAT, the  cells will be IgG coated.

The 'DAT neg', 'auto pos', gal auto antibodies are almost always best managed by using a tube technique. The autoantibody may well bind during the tube incubation phase but is eluted away during the wash phase. You usually find that if you do a gel DAT, but add patient plasma to it and incubate like an IAT, the  cells will be IgG coated.

The 'DAT neg', 'auto pos', gal auto antibodies are almost always best managed by using a tube technique. The autoantibody may well bind during the tube incubation phase but is eluted away during the wash phase. You usually find that if you do a gel DAT, but add patient plasma to it and incubate like an IAT, the  cells will be IgG coated.

The 'DAT neg', 'auto pos', gal auto antibodies are almost always best managed by using a tube technique. The autoantibody may well bind during the tube incubation phase but is eluted away during the wash phase. You usually find that if you do a gel DAT, but add patient plasma to it and incubate like an IAT, the  cells will be IgG coated.

The 'DAT neg', 'auto pos', gal auto antibodies are almost always best managed by using a tube technique. The autoantibody may well bind during the tube incubation phase but is eluted away during the wash phase. You usually find that if you do a gel DAT, but add patient plasma to it and incubate like an IAT, the  cells will be IgG coated.

Thanks for that Sandra.
Yes, we required a couple of units of Rhnull recently, and had to import one from France and the other from Japan, but Tooting is actually, and overall, a net exporter.

It would be nice to have the ability to perform tube testing for those rare cases of which you speak, but my only worry is, as they are rare, would you be able to guarantee competency when called upon to perform these tests.
It is slightly different for me, working in a Reference Laboratory, as, although such cases are rare within each of our hospitals, almost all of them pass through my laboratory, and so keeping up competency is extremely easy.
Tube testing in the wrong hands can be fraught with danger.

You are not kidding it is!!!!!!!!!!!!!!!!!!!!!!!