ABO Incompatibility- Important Concepts.

 

ABO Incompatibility- Important Concepts.            Pradeep Alur, MD.

 

1.  ABO incompatibility exists only when mother is “O” and the baby is A or B blood group. Why?
2. As all those with O blood group will have anti-A and anti-B antibodies in their serum, why do we still do Coombs (Indirect) test for antibodies in the mother?
3. If the mother with O blood group has positive Coombs test, do we still need to do Coombs in the baby?
4. If the mother is Coombs test negative with O blood group, do we still need to do Direct Antibody (Coombs) test in the baby with A or B blood group?
5. Is there relevance in doing Coombs test in both the baby and the mother? Should we restrict it to the baby alone?

 

 

 

 

ANSWER 1-- ABO incompatibility occurs only when a mother has blood type O and the baby has either blood type A or B.

• Explanation: In nature, individuals with blood types A and B produce anti-B and anti-A antibodies in their serum, respectively. These antibodies are of the IgM type, which do not cross the placenta. However, about 50% of people with blood type O have IgG-type anti-A and anti-B antibodies in their serum. Unlike IgM antibodies, IgG antibodies can cross the placenta, potentially leading to hemolysis in the baby.

 

 

 

ANSWER 2- Since all individuals with blood group O possess anti-A and anti-B antibodies in their serum, why is the Coombs (Indirect) test still performed to detect antibodies in the mother?

• The Coombs test is designed to identify IgG-type antibodies against A and B blood groups, which are found in about 50% of individuals with blood group O. Since IgG antibodies have clinical significance, an Indirect Coombs test is conducted on the mother.

 

 

 

 

ANSWER 3- If a mother with O blood group has a positive Coombs test, is it still necessary to perform a Coombs test on the baby?

• Explanation: IgG has four subclasses: IgG1, IgG2, IgG3, and IgG4. The G2 and G4 subclasses do not bind to the antigens on red blood cells (RBCs), while only G1 and G3 subclasses can adhere to these antigens. Since the Coombs test does not differentiate between the subclasses of IgG, it is essential to perform a Coombs test on the baby as well.

 

 

 

ANSWER 4- If a mother is Coombs test-negative and has an O blood group, is it still necessary to perform a Direct Antibody (Coombs) test on her baby if the baby has an A or B blood group?

• Explanation: Studies have demonstrated that babies who test positive on the Coombs test often come from mothers who have only a one-third chance of also testing positive. This is due to the fact that the direct Coombs test is more sensitive than the indirect Coombs test. Therefore, it is advisable to conduct a direct Coombs test on the babies, even if the mother’s Coombs test result is negative.

 

 

 

ANSWER 5-  Is there relevance in performing the Coombs test on both the baby and the mother, or should it be restricted to the baby alone?

The studies show that when the Coombs test is positive for both the mother and the baby, the risk of severe jaundice requiring phototherapy is high.

 

 

 

Transition phase of nutrition—optimizing nutrient administration

 

Frontiers | Transition phase of nutrition—optimizing nutrient administration

his discussion explores the complex aspects of managing nutrition for preterm infants during the critical transition from exclusive parenteral nutrition (PN) to full enteral feeding (EN). The primary objectives of nutritional care in this very low birth weight infants (VLBW) population are to promote growth rates comparable to those in utero and enhance key neurodevelopmental milestones. The transition phase is characterized by the gradual increase of enteral feeds concurrently with the reduction and eventual cessation of parenteral nutrition. This period presents several key challenges in clinical practice, marked by notable variability: (A) determining the appropriate timing and criteria for initiating enteral feeds; (B) optimizing the rate at which enteral feed volumes are safely increased; (C) deciding the specific enteral volume threshold when to initiate human milk fortification to meet increasing caloric and protein demands; (D) establishing the optimal timing for discontinuing intravenous lipid emulsions (ILE); and (E) identifying the precise enteral volume threshold that dictates when to cease parenteral amino acid administration. To navigate these complexities and ensure seamless nutrient administration, practical recommendations for effective management are crucial. These include advocating for early fortification of human milk, judicious use of concentrated parenteral nutrition to provide adequate nutrients in lower fluid volumes, and strategically minimizing the overall duration of the transition phase. .....

A Dream Vacation- But Whose?

 A Dream Vacation- But Whose?

 

For 38 glorious years, my wife and I have been celebrating our wedding anniversary in some exotic locales. This year, I wondered, "How do we top this?" My research delved into those lesser-known resorts, the kind whispered about in travel forums. Many were impressive, but for the travel time? We’d spend more time getting there than being there. Then, I saw this resort clinging to a mountain cliff. It looked surreal! My excitement exploded instantly, and my expenditure followed suit concomitantly!

The combination of images and our imagination of our destination set our expectations higher for this dream vacation.

Like any exotic place, there was a dearth of direct flights. We chose the beloved airlines of America. The check-in was a breeze, and with extra fees, the seating was easy on the knees. The flight attendant walked down the aisle like a bride, graciously moving and smiling. She returned to her seat with poise, and the passengers watched without a noise. We all waited for her to be up on her feet to pass on a sweet treat! The smile she wore was not a bore, but we all expected something more. The bride never left the smile or the seat. The two-hour journey was filled with smiles and miles of hope and optimism. It appeared she analyzed our BMI and felt that the need to feed would indeed be a depraved deed. As the plane descended, so did our hopes. We got up easily as we were lighter and deplaned like a hungry tiger.

Our dome-shaped cabin was perched on a cliff with phenomenal valley views. The gentle, invigorating mountain breeze filled the air with the soothing chirping of birds. It was instantly enticing. Even those who never meditated may enter into a trance with this tranquilizing atmosphere!

We relished the slowly drifting clouds beneath us as our spirits soared above them! The two delightful days zipped by us so fast that we wondered if climate change was making the Earth spin quicker.  It was captivating and fascinating.

Then came the "upgrade." We were moved to a cabin that was artistically, and somewhat alarmingly, wedged between two massive boulders, seemingly floating over a crevice. The structure was enigmatic, but my wife was ecstatic, and my instincts said it might be problematic! The maintenance crew, bless their hearts, helped us lug our stuff to this new wonder blunder: a cabin constructed entirely of mirrored glass.

The moment we stepped inside, the panoramic view was breathtaking – we could see everyone and everything outside. It was stunning. Wait a minute! Could outsiders see us, too, I wondered? The cheerful maintenance assured us that nobody can see us in the morning, only at night when we turn on the lights inside! Was that a reassurance or an assurance of an impending privacy mishap? I was puzzled. There were no water cannons outside the cabin to drive away the curious creatures. The safest place to change would be under the beds, if privacy is a priority, perhaps.

Even the bathroom is completely mirrored glass! Should I wear a Mardi gras mask in the bathroom to remain anonymous, or should I wear a bathrobe and shower to maintain my modesty? Never did I have to make such a tough decision in my career, let alone during a vacation. I had taken moral classes as a kid, but never about modesty! No curtain can be hung as it is smooth glass. Were we expected to fully embrace nature and attend to nature’s calls… out in nature? The cheerful maintenance cheered us that it was the most expensive newly constructed cabin and that we were the first to experience it. Hmm! Was that inspiring or merely a conspiring note?  I was perspiring already. He reaffirmed that they are fully booked, and hence, this was the best choice we had. The gravity of the calamity of the reality began to sink in on us.

For the next three perplexing days, we lived amid Nature; what we saw was all nature, and what others saw was all natural! I did not dream of living this transparent life!

 We chose perfect shower times when no one could see us and no one was around. The whole beautiful cabin was a microcube. The shower was a standing-only affair, and they meant it literally. You could stand. That’s it. Bending down to scrub your feet? Forget it. I noisily bumped my head on the glass wall, attempting that very maneuver.  I had to support myself on the wall with one hand, carefully flex my knee upwards, and apply the soap with the other hand. However, after going for the yoga class the next day, I realized that yoga's tree pose perfectly suited this type of showering. Though it took several attempts to maintain the perfect balance, the goal was achieved by the final day. It’s a dream come true. Yoga and shower in one sitting, I mean, standing!

Even brushing in the morning required yoga. Clearly an afterthought, the faucet was tiny enough to be shoehorned into this nano-bathroom beside the shower. To spit the toothpaste, you must gradually squat and carefully aim the minuscule faucet lest you decorate yourself. Was this brushing ritual also meant to tone the girdle? Brushing would have been a breeze if I had learned the ara mandi pose in Bharatanatyam.

The bedspace was undoubtedly squeezed. The moment you slide out of the bed, you are practically in the nano bathroom. I suspect this design caters to two types of couples: the madly-in-love, inseparable kind, or those teetering on the brink of separation. There was not much square footage to remain separate in this micro-nanocube. You have to practice detachment in attachment to survive. Wow! It induced a spiritual angle to this micro living. When someone said that yoga should be part of life, I wondered if he lived in this microcosm to proclaim that transparent truth!

As we began to adjust and enjoy this beautiful cliffside living, we received an emergency alert for a tornado warning. Maybe we should have also taken some paragliding safety classes, lest we experience free paragliding thanks to a tornado on this cliff! Well, fortunately, the warning waned without a warning. Ironically, we found a sign for a cliffside paragliding adventure. Curious as we were, we immediately turned onto that road.

Strange enough, there was no building other than just the one to our right. We wondered if other buildings just glided down the cliff! Inquisitive enough, we parked our car and tried to enter the front porch to talk to someone. Before we realized, a pack of dogs started to approach us viciously. They were surrounding us and barking ferociously. I frantically tried calling the paragliding company, but it went straight to voicemail. I don’t know if the staff took to paragliding to escape this relentless, murderous-looking pack of dogs. There was no stick or a twig even to shoo them away. Even an atheist would instantly believe in God at this point, I suppose. We both started chanting every prayer we could collectively remember, our voices rising in a desperate, off-key crescendo. Our chanting volume soon soared to pitches even higher than the dogs' barking, a vocal shriek in peak that might have confused and slightly distracted the calamitous canines. They retracted slightly. We took that minuscule window of opportunity and jumped into our car from frailty to safety! Even if my voice couldn’t qualify for American Idol, I am sure it could for America's Got Talent!

 Apart from a few yoga lessons, sprint training is high on our list for now to survive safely. Even more dogs surrounded our vehicle and would not let us move forward. I had to move extremely slowly to move the dogs from our path. They followed us for a distance and finally let us off. Our heart rates were in the peak exercise range, and we were sure we would pass any stress echocardiogram tests.  It is time to amend the old saying “curiosity is the mother of invention” to “curiosity is the mother of tension in the fourth dimension.” This is probably not the age to venture into any adventure lest we end up with dentures.

An Ode to My First Guru

You are my first Guru, oh Mother dear,

No other can match you, you’re always near.

The love you bestowed is a radiant star,

Resonating within me like the strings of a sitar.

When feelings were bruised

And the mind was confused

Like a gentle butterfly, you graced my brow,

Turning my low spirits into joy somehow.

 

When hunger pangs were gnawing away

You shared the last crumb, chasing my blues far away

My pain you'd soothe, with a smile,

That selfless love, a vast stockpile,

Removed my glum more than the crumb!

 

The foolish tantrum I threw,

hurting the divinity that I knew...

For denying what I didn’t deserve

Yet the soothing snuggle you sweetly serve

Was a song to calm my every nerve

 

You brushed away my doubts and fears

Exemplifying love, you wiped away my tears

You shaped me with your gentle grace

Worthy of everyone’s embrace

 I bow to my guiding star

 My beloved first Guru and superstar!

 

Dedicated to all mothers!

By Pradeep Alur, May 9, 2025. 

If Fate had a date!

 

When you get a premium extra legroom on a long flight, you are instantly reminded of LG's slogan, "Life is good." Well! I paid a premium to experience that prime feeling. However, when I was about to treasure that short-term pleasure, the Casio slogan reminded me, "Expect the unexpected." A baby in the backseat, as if rigidly following Harley Davidson's "American by birth, but Rebel by choice," felt envious of my pleasure in leisure and began to express it with a deafening cry. The helpless mom, trying to be considerate to others and to herself, picked her up and meandered into my cherished, premium leg space as if it was Disneyland's "Happiest place on earth (or was it on flight!). I had no choice but to retract my reveling limbs from my luxury space. The cry now transformed into a mocking smirk on that intolerant infant.

Mother, pleased with her baby's newfound happiness, decided to linger longer than an hour. This procreator and cry creator combination instantly inspired similar pairs on the flight. One after another, I began to savor the Shangri-La with my begrudging benevolence. It seemed my premium space had a Sony Playstation tag: "Live in your world, play in ours." I was made to sit and feel like McDonald's. "I'm loving it!". I could neither evade the child's charming smile nor reconcile with my aching, recoiled legs. I finally had to settle with Burger King's way: "Have it your Way!"  

It was time to enjoy the joy of the ocean. As we landed on the island of seafood, vegetarians like me had sea, but not food! The resort's chef had personally handpicked several fallen leaves and decoratively arranged them on a tiny plate sprinkled with drops of dressing.

When asked if there was any other variety of vegetarian food, he promised that he would have grass the next day, perhaps coinciding with lawn mowing tonight. Having had no yummies in our tummies, we decided to venture out to see the creatures of the coral world. After forfeiting my biweekly paycheck for the entrance fees, we zoomed in to the coral park. We were then asked to buy some honey to feed the lorikeets. We gladly obliged and eagerly awaited to satiate the culinary needs of this lorikeet. None came. Environmentalists excitedly informed them that if they were not hungry, they wouldn't feed. We waited. The honey was very tempting since we had just plant leaves for lunch.

Neither birds would have it, nor we could have it. I wished we were standing at the back of the crowd to cherish the nectar, which looked like a loaf of meat for a hungry lion. Social constraints lead to extreme self-restraint.   

We then proceeded to the turtle feeding. We didn't realize that they ate carrots, broccoli, etc. It seemed they had a better vegetarian menu than ours at the resort. I offered with the pretext of feeding the not-so-hungry turtles. However, the staff showed no interest, thus depriving me of the option to satisfy my growling stomach. Interestingly, I saw a couple with some enticing vegetarian snacks trying to feed the beastly looking Iguanas.  Out of sheer curiosity and bare necessity, I approached the couple and asked where they got it? The naïve couple couldn't remember the place or the name, much to my chagrin. But offered the delicious dessert to me. My face gleamed, and my appetite beamed until my esteemed couple screamed, "Please, feel free to feed the iguanas." I glanced at them as gloom began to bloom and muttered: "Of course, thank you."   

As we boarded our long flight back, we couldn't carry food from the airport, as it was small and had no vegetarian options, which was not surprising. We were happy to see the cheese platter on the flight menu. We asked for a platter and water, and the attendant thought it would make us fatter and gave us the latter to shatter the prospect of eating veggie matter. I asked for peanuts, and she explained to me the cost cuts.

My initial hope was great, but as fate had its date, I was left without a plate and continued my hunger state.