Zhen Mei

Assistant Clinical Professor of Transfusion Medicine and Coagulation Pathology, Department of Pathology and Laboratory Medicine, UCLA School of Medicine

[Zhen Mei @jimmeiah23]

With the family enjoying the Party on the Pier for the UCLA Mattel Children's hospital!! Thanks to @UCLA_Pathology 😁

[Zhen Mei @jimmeiah23]

Thanks @UCLA_Pathology for supporting #partyonthepier, had a great time!

[Zhen Mei @jimmeiah23]

Party on the Pier! #UCLA @UCLA_Pathology

[Zhen Mei @jimmeiah23]

Look who decided to turn up in LA to give a talk on atypical HUS 😎@UChicagoPath @ChangUCanSpare

[Zhen Mei @jimmeiah23]

Can't believe my baby is 2 already!! So thankful for her health and her strength everyday ❤️ @ Gardena, California https://t.co/4dW0OzMWol

[Zhen Mei @jimmeiah23]

Congrats to the DGSOM class of 2025 on their a white coat ceremony today! Heartwarming reminder of what inspired me to become a physician in the first place, hope some of you join us @UCLA_Pathology !

[Zhen Mei @jimmeiah23]

please feel free to suggest and discuss additional ideas not listed in the poll, such as: repeat exchange with compatible red cells, other medications/therapeutic options, etc.

[Zhen Mei @jimmeiah23]

QuIBBLE #3: a sickle cell patient comes into the ER overnight and it is determined they need an emergent red cell exchange. Type and screen shows a few antibodies, so Rh and Kell-matched antigen-negative blood is provided for the exchange.

[Zhen Mei @jimmeiah23]

The following morning, upon further investigation, history of an antibody that was not detected on the type and screen is found. Half of the units that were given during the red cell exchange were found to be positive for that antigen. What will you do?

[Zhen Mei @jimmeiah23]

Thanks for all the votes and replies; check back tomorrow for the next QuIBBLE!

[Zhen Mei @jimmeiah23]

QuIBBLE #2: Antibody screen performed shows an anti-c pattern. DAT IgG is positive. Eluate displays a similar pattern. Patient's phenotype is positive for c. What type of RBCs will you provide?

[Zhen Mei @jimmeiah23]

Resolution: this patient was provided Rh and K matched RBCs. The hemoglobin increase was appropriate; no signs or lab values indicative of hemolysis were observed. I acknowledge that some institutions would have provided c- RBCs but our policy with warm autos is to Rh and K match

[Zhen Mei @jimmeiah23]

@bullock_tom Great points: this was a young Caucasian male with anti-c only reactivity and had never been transfused before

[Zhen Mei @jimmeiah23]

@maryamasif_md We don't do the autocontrol here, but I would agree with your interpretation that this is a warm auto with little c specificity

[Zhen Mei @jimmeiah23]

@TeamCaptainJohn @Tmbmd91 As for hemolyzing faster, it probably won't hemolyze the transfused e+ cells any faster, but my interpretation is an e- unit would at least hemolyze slower due to lack of the observed target specificity (though it could still be hemolyzed!)

[Zhen Mei @jimmeiah23]

@TeamCaptainJohn @Tmbmd91 Great points. I have not found the strength to correlate well with clinical risk of hemolysis with these autoantibodies; sometimes 1+ will hemolyze and many times 4+ will not

[Zhen Mei @jimmeiah23]

@ksk_ny Performed when the DAT was positive. This was the first encounter with this patient.

[Zhen Mei @jimmeiah23]

@TeamCaptainJohn Yes, the screen was run due to discrepant typing on an outside unit that was labeled as A+

[Zhen Mei @jimmeiah23]

Don't want to start arguments, but I would like to start QuIBBLEs - Questions in Blood Banking, a Learning Exchange. I present a short scenario and/or question that I encounter or get asked while I'm on Transfusion or Coagulation service.

[Zhen Mei @jimmeiah23]

Thanks for the views and the replies @Rakxt - Check in tomorrow for our next QuIBBLE!

[Zhen Mei @jimmeiah23]

anti-A1 is usually an insignificant antibody that reacts at lower-than-body-temperature conditions. This unit was AHG crossmatch compatible and issued to an A recipient who responded with an appropriate hemoglobin bump and no subsequent signs of hemolysis