Chapter 6 Answers to discussion questions

6.1 There is an antenatal screening programme to identify women at risk of HDFN. What would be the key elements for a screening programme to identify women at risk of having an infant due to HPA antibodies? Identify the limitations of such a strategy including any ethical issues.

1. Screen for HPA-1b1b women
2. Screen for immune response gene DRB3*0101
3. Test women positive for a & b for HPA-1a antibodies

Other points: What techniques should be used? What antibodies should be tested? What are the cost/benefit issues? How would women with HPA-1a antibodies be cancelled given there is no way of correlating antibody levels with clinical outcome?

 

6.2 Explore the different strategies for reducing the incidence of TRALI.

Some of these strategies can be obtained from Williamson et al. 2007. Reduce number of female donors. Use plasma from male donors to re-suspend buffy coat platelets. Use platelet suspension medium to re-suspend buffy coat platelets. Screen female donors for HLA and HNA antibodies.

 

6.3 Discuss the advantages and disadvantages of commercial companies supplying test kits for a niche area of blood transfusion such as platelet and granulocyte immunology.

The test kits will be stringently requiring adherence by the regulatory bodies, and will require minimal training in a competent laboratory and are batch tested by the company. The disadvantage is that rare platelet genotypes will not be available and will require “home brew” testing kits developed in house.