[Technical difficulties in clinical immunohaematology].
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ABO Blood-Group System↗
Biomedical subjects
J Chiaroni
Publications and source records attributed to J Chiaroni.
[Guidelines in clinical immunohematology].
In order to take into account the improvement of the knowledge, technologies, automation and computerization in immuno-haematology, the French national regulatory service have redefined the way to complete immunohaematology tests and their links to the blood component distribution. We describe these modalities for each test considering three questions "What?", "When?" and "How?".
ABO Blood-Group System↗
[Suspicious pigmented skin lesions. Screening campaign by occupational physicians in the Provence-Alpes-Côte d'Azur region].
OBJECTIVE: Cutaneous melanoma prevention has become a public health issue. The incidence of this cancer has been steadily growing for 50 years, and the related death ratio is not decreasing. Today, the surgical resection of a thin lesion is the only validated curative treatment. The early detection of melanoma represents a major line in the management of such tumours. METHODS: Occupational physicians of the PACA area were invited to participate in a campaign for the screening of pigmented suspect cutaneous lesions for 2 years. Voluntary physicians were trained to use the ABCDEF diagnostic criterion. Lesions were detected during regular yearly consultations (1998/1999) and the data concerning the development and care of these lesions was collected during consultations over the following year (1999/2000). RESULTS: Two hundred and fifty occupational physicians of the PACA area participated in the campaign. Two pre-cancerous lesions and 10 cancers (5 melanoma and 5 pigmented basocellular carcinoma) were found among the 487 suspect lesions detected. Each melanoma had a Breslow score of less than 0.9 mm and were of good or even excellent prognosis. CONCLUSION: The cutaneous examination, although rapid, during the occupational medicine consultations, is an effective means of detecting the early onset tumoral lesions which, at that stage may potentially be cured. The ABCDEF criterion is a useful diagnostic tool and should be taught to the all the medical and paramedical staff.
Adult↗
[Immune safety in blood transfusions].
Immune security of blood donation is defined by all means aiming at reducing or eliminating the immune risk related to blood donation. It concerns the whole transfusion process from the blood donor to the receiver. The immune risk of blood donation is directly related to the polymorphism of molecular and cellular blood groups systems. Immune security consists in avoiding the meeting of antigens and augmented by the direct baneful consequences of the immune conflict. This requires the previous immune characterisation of blood products and of the patients and of their compatibility, which must be strongly maintained along the transfusion process. To control this process, which is still too much deficient, represents the true guarantee of immune security of blood donation.
Blood Donors↗
[Methodology for the development of a program for following and maintaining the competency of human resources].
The progressive introduction of a management program for the maintenance and assessment of staff competence has also focussed attention on the human factor, a major consideration in risk management and quality control. This article has examined the relevant tools and practical means of application, and proposes a methodology combining a methodical analysis of processes with the determination of the minimal knowledge required for participation in the practical and theoretical training programs that provide a means of objective evaluation. The results obtained in terms of technical, organizational and cultural impact have also been analyzed.
Blood Banks↗
[Impact of the removal of A2 test erythrocytes and the anti-AB reactant on the interpretation of the ABO blood grouping].
This work evaluates the impact of the removal of the anti-AB reagents and A2 test-red blood cells on the interpretation of ABO blood grouping. The first step of the work was a multicentric study concerning the interpretation of "all coming" blood groupings, reporting the results of 105 195 ABO blood groupings of donors and patients carried out on microplates using an automated or a half-automated technique. Their interpretation was performed following four different methods, in order to appreciate the impact on the results of the removal of either anti-AB test-serum, A2 test-red blood cells, or the combination of both. Moreover, a qualitative and quantitative analysis of the interpretations of the blood groupings that were initially not performed (rejections), was carried out in order to determine the most often implied reagent and to quantify a possible gain in interpretation after removing it. A complementary study of the same type concerning more specifically weak ABO phenotypes was carried out to evaluate, in terms of sanitary risks, the consequences of a possible non-interpretation of these phenotypes in patients who would be potential receivers of blood cell products, and in blood donors.
ABO Blood-Group System↗
[External quality evaluation].
Since ten years, the immunohaematology working group of the French Society of Blood Transfusion has organized a quality control. Tests concern essentially the screening and identification of irregular antibodies, direct antiglobulin tests and elutions.
Autoantibodies↗
[Problem-solving in immunohematology: direct compatibility laboratory test ].
Cross-matching between the serum of a patient and the red blood cells to be transfused is most important for the prevention of hemolytic transfusion reactions in allo-immunized or new-born patients found positive with direct antiglobulin test. Cross-matching is a time-consuming and complex laboratory test. In order to obtain valid results, it is necessary to abide by some technical rules detailed in this article. The choice of the blood units to be cross-matched depends on the patient's clinical story and on the specificity of anti-erythrocyte antibodies present in the serum. The identification and the management of most frequent difficulties met by using the cross-match technique are discussed hereby.
Adult↗
HLA-DRB1 and DQB1 polymorphisms in southern France and genetic relationships with other Mediterranean populations.
This study presents the results of HLA-DRB1 and DQB1 sequence-specific oligonucleotide probe (SSOP) typing for a population sample of 181 individuals originating from southern France. On the basis of allele and haplotype frequencies, we compared our population with others from the Mediterranean area. Allele frequencies are comparable to those found in other western European populations (France, Portugal, Spain) and indicate neighboring exchanges. The haplotype frequencies showed relationships with North Africans and Jewish populations, as well as the common origin of Moroccan and Lebanese Jews. Therefore, allele frequencies seem to be more able to show recent exchanges while haplotype frequencies might show ancestral relationships. These results may serve as references for future studies of HLA and disease in southern France.
Alleles↗
[Evolving methods in immunohematology].
The immunogenic nature of erythrocyte polymorphism is in variance with the incompatible transfusion. Indeed, the fixing of an antibody on the corresponding antigen generally condemns the cell concerned with its destruction. Therefore, in order to ensure the immunohemolytic safety of the transfusions, it is necessary to avoid an in vivo encounter between antigens and antibodies, whose feasibility study in vitro is a determining element. Because of the requirement standards of such analyses and the preoccupation with the continuous improvement of transfusion safety, the evolution of the methods used in immunohematology is a constant concern for all those involved in the process. Thus, during the last few years, new technologies have been introduced which aim at improving performance and sometimes implementing alternatives to agglutination. This improvement is not limited to the search for an overall increase in specificity-sensitivity; it also takes into account the capability to detect "the clinically significant" as well as the limitations of human reliability, which justifies the introduction of automation and computerization. The whole of these methodological evolutions associated with that of the performance of reagents, legitimate the need to reconsider the realization of erythrocyte typing and the search for anti-erythrocyte antibodies.
Agglutination Tests↗
[Analytical validation in erythrocyte immunohematology].
In a transfusional or foeto-maternal context, hemolysis by incompatibility due to anti-erythrocyte antibodies (regular or irregular) remains the most frequent and most serious immunological risk in the receiver. In order to prevent this risk, a number of actions must be taken, such as the realization of the immunohematologic analyses for which the methodological practices have been legislated because of their serious clinical consequences. Several elements play a role in the reliability of the analyses and their results: the selection of the reagents and their validation in the routine technique used; the validation of reception; the controls involved in secondary preparations (e.g., blood cells reagent); and the daily internal controls. All this requires the choice of adapted controls and the management of possible anomalies.
Adult↗
Decision aides in immunohematology: detection of anti-erythrocyte antibodies.
Detection and identification of irregular red-cell antibody in the serum or plasma of a patient is of prime importance for the prevention of hemolytic transfusion reactions and the biological supervision of the hemolytic disease of the foetus or the newborn. Practice in these tests is replete with complex biological problems. Using problem solving strategies, we discuss the recognition and resolution of the most frequent difficulties encountered in red cell antibody identification.
Algorithms↗
[Problem-solving in immunohematology: interpretation of ABO typing and its difficulties].
Practice in immunohematology is replete with complex problems that require practitioners' problem-solving performance. In immunohematology, the acquisition of the reasoning process and necessary skills for making clinical decisions is based on teaching problem-solving strategies which potentially reduce errors and improve patient outcome. We discuss the recognition and resolution of the common causes of discrepancies in ABO typing results using problem-solving strategies.
ABO Blood-Group System↗
[Data interchange in blood transfusion: the impact of a new standard on the evolution of health electronic data exchange in France].
The sanitary and social data interchange within care establishments or networks is today the subject of many national or international considerations. Electronic data interchange in the health field has characteristics linked to ethical and deontological principles of care staff. Used daily, this tool contributes to the quality of care, to the optimization of patient treatment and to the organization of the system care. In the transfusion field, the standardization of messages related to the traceability of blood products in now required by the No. 2 instruction of French Blood Agency, which rules the using of national norms elaborated by the French Agency of Normalization. If the technicality is the greater part of these regulated and formalized messages, this standardization systematizes and justifies the nominative and ciphered data interchange in an open environment, opening a new dimension in the interoperability of data system between care establishments. This article analyzes the characteristics and the potential impact of this normalization on the evolution of the electronic data interchange in the health field.
Blood Transfusion↗
[Numeric terminology of erythrocyte blood group antigens].
Since the discovery of the first human blood groups, the terminology for erythrocyte blood group antigens has evolved and become inconsistent. In some cases, a single letter is used (eg, A/B, E/e), in some others a symbol with a superscript to denote allelic products is used (eg, Fya/Fyb, Jka/Jkb) while in still others, a numerical notation is used (eg, Fy3, Lu4, K11). Even within the same blood group system, antigens have been named by different terminology (eg, K/k, Kpa/Kpb, K11/K17) and the same antigen was given different names in different laboratories. Therefore a necessary alternative 'popular' terminology was suggested by the ISBT (International Society of Blood Transfusion) Working Party; In its last monograph, published in 1995 and reviewed in 1996, erythrocyte blood group antigens are classified into 23 systems, 5 collections and 2 series. The Working Party also suggested guidelines for establishing new blood group systems and including new specificities into the nomenclature.
Blood Group Antigens↗
[Immuno-hemolytic transfusion reactions. III. Report of 61 cases].
Blood transfusion is mainly bound to immunological and infectious risks. The immunological risk originates from an incompatibility between the blood of the donor and that of the recipient; this risk remains insufficiently assessed. A multicentre study has been carried out by the French Blood Transfusion Society and the National Institute for Blood Transfusion. Sixty-one accidents due to an erythrocyte incompatibility were found: 26 cases with ABO incompatibility, and 35 cases with alloantibodies of other blood group systems. For the former category of accidents, the most frequent cause was due to a failure in the realization of the bedside ABO check. For the latter, the main problem was the achievement and the interpretation of antibody screening. The long term follow-up shows no chronic after-effects of immunological accidents. For each accident, errors have been identified and analysed. It was proven that they all originate from health care establishments.
ABO Blood-Group System↗
[Creation of a blood bank at the GRALL pediatric hospital in Ho Chi Minh, Vietnam].
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Blood Banks↗
Neonatal thrombocytopenia in HLA-DR, -DQ, -DP-typed mother due to rare anti-HPA-1b (PLA2) (Zwb) fetomaternal immunization.
A new case of rare neonatal alloimmune thrombocytopenia, due to an IgG anti-HPA-1b in a mother HPA-1 (a+, b-), was diagnosed using monoclonal antibody-specific immobilization of platelet antigens. Clinically, it was similar to the 2 previously reported observations and confirmed that, in this particular case of anti-HPA-1b, the treatment with random platelet pools may be as effective as selected single-donor platelet units when maternal platelets are unusable. The HLA-DR, -DQ, -DP genotypes of the family were obtained by PCR-SSO. The mother's typing, compared to the HLA-DR of the 6 similar cases reported in Europe, suggests that a combined effect of two rare HLA haplotypes might enhance this immunization.
Adult↗