BB Protocol 2

Question 1

Referral tests? (3)

Answer 1

1. Advance Ab Ix (Elution / autoadsorption) / Extended phenotyping
2. ABO / Rh anomaly
3. HDFN

Question 2

MTP? (4)

Answer 2

1. Massive transfusion = >10 RBC unit within 1d
2. Patient should be >12y
3. 4 RBC + 4 Plasma + 4 PLT (1:1:1)
4. +30min +1h…, 2h no request = STOP

Question 3

AbID? (4)

Answer 3

1. 11 panel cell + 2 Mi(+) + 2 Mi(-) + Mur(+)B + Mur(+)A
2. DAT if applicable
3. Phenotyping
4. Referral to RC

In practice, Reg case with test ABIDNI, +RCP for phenotyping.
Enter Ab screen, AbID & DAT result. Add ABID at conclusion
Enter phenotype score if RCP is ordered.
Send email to hematologist, who Authorize the result / Refer the case to RC

Question 4

When would you suspect a mixture of Ab? (3)

Answer 4

1. Thermal dependent (eg: some - after prewarm)
2. Phase dependent (eg: some IS- IAT+)
3. Varied reaction strength (eg: 1+ & 2+ coexist)

Question 5

Ab ID ALL +, DAT-, why? (2)

Answer 5

1. Multiple AlloAb
2. Antibody against high frequency Antigen / Anti-H

Question 6

Ab ID ALL -, why? (4)

Answer 6

1. Antigen not included in the panel
2. Heterozygous panel cell (Ag weakly expressed)
3. Weak Ab
4. Anti-C’

Question 7

In general, Antigen-negative IAT-compatible is used for Ab+ cases, is there exception? (2)

Answer 7

Yes.
1. Random pick IAT-compatible can be used for M(not 37C reactive) N, P, Lea/b, Lua
2. Prewarm IAT-compatible can be used for AutoColdAb case, AbID for the ColdAb is not necessary

Question 8

Ab+, proceed to phenotyping, corresponding Ag+, why?

Answer 8

1. If DAT+, consider AutoAb / Ab coated patient RBC
2. If DAT- , it should be wrong AbID
3. Recent transfusion (should be mf)
4. Drugs like daratumumab (Anti-CD38)

Question 9

Name 2 Ab exist in both IgM & IgG (2) Do they cause HDFN? (1)

Answer 9

PP1Pk & Vel.
Yes. PP1Pk HDFN related to spontaneous abortion,while Vel is more on causing hemolysis