Sandra June Nance

• MS, MT(ASCP)SBB
• Managing Director at Red Cross

For patients requiring multiple transfusions and patients with positive direct antiglobulin tests (DATs), an extended red blood cell (RBC) phenotype can provide valuable information and help to determine the risk of forming alloantibodies. In some instances, the phenotype may be used for prophylactic matching. Phenotyping in this patient population...

Conclusions: This review was derived from a presentation made on September 2, 2016, for the first Academy Day presented by the Working Party on Immunohematology at the International Society of Blood Transfusion (ISBT) Congress in Dubai. The focus of this review is on the clinical significance of alloimmunization in transfusion-specifically, the pa...

Conclusions: For patients requiring multiple transfusions and patients with positive direct antiglobulin tests (DATs), an extended red blood cell (RBC) phenotype can provide valuable information and help to determine the risk of forming alloantibodies. In some instances, the phenotype may be used for prophylactic matching. Phenotyping in this pati...

Background: RhD variants have altered D epitopes and/or decreased antigen copies per red cell. Individuals carrying these variants may test antigen negative, weakly positive, or positive by serology, and may or may not be at risk of alloimmunisation after exposure. There have been recommendations to perform RHD genotyping of patients, pregnant wom...

Background: Paroxysmal cold hemoglobinuria (PCH) is a form of autoimmune hemolytic anemia caused by the Donath-Landsteiner antibody (D-L antibody). In children, this is typically a transient immune-mediated hemolysis that follows a viral illness and does not recur. Recurrent acute or chronic PCH due to D-L antibody is very rare. Case report: We...

Flow cytometric methods are commonly used to analyze white blood cell surface antigen expression. We developed a flow cytometric method to detect red blood cell (RBC)-bound immunoglobulin (Ig)G, IgA, and IgM. RBCs were washed; incubated with fluorescein isothiocyanate (FITC)-conjugated anti-IgG, -IgA, or -IgM; washed; and analyzed on the flow cytom...

For the majority of acute or emergent transfusion requests, pretransfusion testing results are unremarkable and transfusion proceeds with no unanticipated delay. For a small percentage of cases, often in patents that are chronically transfused, the pretransfusion testing yields results that require further testing. Most often, the patient's serum c...

International rare blood donor panels or registries are important in the consistent availability of rare blood for patients who need this scarce resource. In countries where it has been possible to commit resources to this effort and often where the need is great, donors have been entered into a registry. The ISBT leadership recognized the importan...

Background: Hyperhemolysis is a serious transfusion reaction, most often described in patients with hemoglobinopathies. Hyperhemolysis is characterized by the destruction of host red blood cells (RBCs), in addition to donor RBCs, via an unknown mechanism. Study design and methods: We present the case of a 58-year-old woman with treated human imm...

Background Drug-induced immune hemolytic anemia (DIIHA) is a rare, but important condition requiring specialized laboratory testing for diagnosis. We report a case of DIIHA with antibodies against carboplatin and vincristine (VCR) in a child with an optic pathway glioma. Platinum-based drugs are established to cause DIIHA; to our knowledge, this is...

The Colton (CO) blood group system consists of four antigens, Co(a), Co(b), Co3, and Co4, located on aquaporin-1 (AQP1), with Co(a) highly prevalent in all populations (99.8%). The Colton null phenotype, Co(a-b-), is very rare, and individuals with this phenotype lack the high-prevalence antigen Co3. To date, only six Co(a-b-) probands have been re...

Background A basic definition of a rare donor unit is that unit not available for the patient at the time of the transfusion need. However, there are some patients who required exquisitely phenotyped, even genotyped units, for optimal survival of transfused red cells. Often, the rare phenotyped unit needed is negative for an antigen of high prevale...

Since the early 1960s, it was recognized that patients with very complex serology may be limited in the availability of rare blood for transfusion. Over the years, there have been publications about the quest to meet those needs. Although the world's literature on how to find, recruit and maintain rare blood donors is not overwhelming, there are qu...

When a patient needs a rare blood type not present or identified routinely, immediate assistance is needed from the facility capable of supplying the product. If this reserve is not available domestically, patient care is in jeopardy. This presentation will discuss fundamentals of establishing an International Rare Blood Donor Center.

The Consortium for Blood Group Genes is a worldwide organization whose goal is to have a vehicle to interact, establish guidelines, operate a proficiency program, and provide education for laboratories involved in DNA and RNA testing for the prediction of blood group, platelet, and neutrophil antigens.

When transfusion is needed for a patient with a rare blood type and the corresponding antibody, it can be challenging and lead to delays in transfusion. Sometimes, the blood cannot be found. Globally, the community of rare donor facilities is extremely collaborative and is quickly engaged in locating and delivering blood to the patients in need of...

The gene polymorphisms responsible for the antigens Doa, Dob, Hy, and Joa in the Dombrock (Do) blood group system have been identified. Four different mutations have been reported to cause the Dombrock null [Gy(a-)] phenotype. These include splice mutations, an eight-nucleotide deletion, and insertion of a stop codon. Here a Dombrock null caused by...

Due to the scarcity of reliable antibodies, RBC typing for Doa and Dob is notoriously difficult. Inaccurate typing can place patients at risk for hemolytic transfusion reactions. The molecular basis of the DOA/DOB polymorphism is associated with three nucleotide changes:378 C>T, 624 T>C,and 793 A>G of DO. While the 378 C>T and 624 T>C are silent mu...

An anti-Vel, nearly missed in antibody identification studies, and the effect of a commercially available rabbit RBC stroma (RESt, Immucor) adsorptions on eight anti-Vel sera are reported. Anti-Vel is an antibody to an antigen of high prevalence. A 48-year-old woman with chronic vaginal bleeding presented with a Hct of 14.7 percent. The transfusion...

Three women have been identified with an antibody to a "new" high-incidence antigen found on multiple cell lines. The proposita, M.A.M., presented during her third pregnancy with an antibody reacting with all RBCs tested except her own. She delivered a thrombocytopenic infant with a 3+ DAT, but without symptoms of HDN. The second example, A.N., pre...

Provision of HPA-1a-Negative Platelets for Neonatal Alloimmune Thrombocytopenia: Screening, Testing and Transfusion Protocol

HPA-1a-negative platelet products are not routinely available for newborns with alloimmune thrombocytopenia. In this article we describe a program established to identify normal pheresis donors who are HPA-1a-negative and to organize their future donations so that our regional blood center would always have an HPA-1a-negative platelet product avail...

Anti-Jka was detected by solid-phase red cell adherence (SPRCA) antibody detection and identification tests in the plasma of a 9-month-old female infant during a routine presurgical evaluation. The patient and her nonidentical twin sister, who also had anti-Jka in her plasma, were products of an uncomplicated in vitro fertilization, full-term pregn...

This chapter gives the reader an overview of the relationship between the blood donor and the blood transfusion recipient. The text includes a review of recruitment, collection , and testing of the donors and their blood.There is a discussion of the red cell components that can be made from whole blood, including the routinely manufactured products...

In Red Cell Transfusion: A Practical Guide, well-known experts in transfusion medicine describe in critical detail the most important procedures for obtaining, selecting, and transfusing red blood cells into patients. These highly experienced practitioners discuss such key issues as transfusion problems in the immunocompromised, the complications o...

Red blood cells (RBCs) lacking S and s blood group antigens are classified as S-s-U- or S-s-U+var but the classification may vary due to the characteristics of anti-U and to the technique used. Tests on RBCs known to lack glycophorin B (GPB) or to possess an altered form of GPB showed that polyethylene glycol-indirect antiglobulin testing or MicroT...

Researchers in Transfusion Medicine Science have benefited from the use of the flow cytofluorometer. The flow cytometer has distinct advantages over visual examination of antigen-antibody reactions. The flow cytometer measures fluorescence per cell, and through the use of anti-IgG tagged with a fluorochrome, cells with differing levels of cell-boun...

The monocyte monolayer assay (MMA), an in vitro model of in vivo antibody-mediated red blood cell destruction, was previously reported to predict the severity of hemolytic disease of the fetus and newborn accurately when only Rh antibodies and antigen-positive babies were studied. We studied 33 women whose serum contained antibodies with the potent...

A 49-year-old woman presented with a hemoglobin level of 9.5 g per dL (95 g/L), reticulocyte count of 6.7 percent (0.067), and hemoglobinuria. The next day, the hemoglobin had dropped to 5.8 g per dL (58 g/L), and total bilirubin was 8.8 mg per dL (150 mumol/L). The serum reacted 2+ with all red cells (RBCs). The direct antiglobulin test (DAT) was...

The ability of the monocyte monolayer assay (MMA) and the chemiluminescence test (CLT) to predict the clinical significance of alloantibodies associated with hemolytic disease of the newborn (HDN) was assessed by the use of 22 well-characterized antisera--predominantly anti-D--from alloimmunized pregnant women. Seventeen sera were obtained before d...

A unique case of acute hemolysis following transfusion of red cells (RBCs) that were found compatible by immediate-spin (IS) crossmatch technique is reported. Screening tests for unexpected antibodies, using low-ionic-strength saline (LISS), 10 minutes' incubation at 37 degrees C, and anti-IgG, were nonreactive; however, 1 transfused unit was found...

The need to detect antibodies that agglutinate and/or hemolyze red cells (RBCs) directly at 37 degrees C, but do not react in subsequently performed indirect antiglobulin tests (IATs), is of concern relative to the streamlining and automation of antibody detection methods. To determine incidence and significance of such reactions, data from 87,480...

The role of the blood bank laboratory with regard to the SLE patient has been usually restricted to blood transfusion therapy. With the developing science of transfusion medicine however, the role is changing. There have been studies regarding red cell-bound proteins, associations with the Rg blood group and C4A deficiency, complement receptors, HL...

In the first death associated with immune hemolytic anemia due to cefotetan, the patient developed hemolytic anemia and renal failure, dying 12 days after the beginning of 1 week's cefotetan therapy. The patient's serum contained strong antibodies reacting with cefotetan-treated red cells (RBCs) and with uncoated RBCs in the presence of cefotetan;...

A flow cytometry method was used to compare the amount of red cell (RBC)-bound IgG in 73 patients with and without immune hemolytic anemia (IHA). The positive results in 10 of the direct antiglobulin tests (DATs) were idiopathic, and those in 25 were due to methyldopa therapy; 38 of the 73 DAT-positive patients were babies born to women with IgG al...

The authors performed monocyte monolayer assays (MMAs) with the use of normal donor monocytes, and homologous reagent red blood cells, sensitized in vitro, with antibodies in maternal sera. The sera were from 16 pregnant women with Rh antibodies, drawn at the time of amniotic fluid analysis. They compared the predictive value (PV) of the MMAs and t...

A simple and objective assay was developed for the detection and quantitation of fetal-maternal hemorrhage with the use of flow cytometry. In vitro prepared control mixtures of 10%, 2%, 1%, 0.5%, 0.25%, 0.125%, and 0.06% D+ RBCs in D- RBCs were tested (8-11) different times by flow cytometry and gave mean % D+ results of 11.10%, 1.90%, 0.92%, 0.45%...

A flow cytometry method, developed in our laboratory to measure red cell (RBC)-bound IgG, was compared to the manual titration technique in the measurement of RBC antigen strength to determine zygosity. Parallel studies using antibodies to antigens in the Rh, Kell, Kidd, Ss, and Duffy systems were performed. The antisera (n = 20) were tested agains...

Several published reports have documented the variable survival of Yt(a+) red cells (RBC) in patients with anti-Yt(a) as measured by 51Chromium (Cr)-labeled RBC survival studies. Similar studies with anti-Yt(b) have not been reported. A 51Cr-labeled RBC survival study was performed using Yt(b+) RBCs and a monocyte monolayer assay in a young hemodia...

A 3-year-old female receiving Pediazole (erythromycin ethylsuccinate and sulfisoxazole) for tonsillitis and otitis media developed severe hemolytic anemia. No serum drug-dependent antibodies could be demonstrated with an in vitro 'immune-complex' method using Pediazole, pure erythromycin ethylsuccinate or pure sulfisoxazole. However, a method using...