sshel55

How many allo adsorptions do you perform before becoming concerned about diluting an allo-antibody to the point of non-reactivity?

Did you consider anti-LW?

I have a related question. Let's say you get a new sickle cell patient who has been transfused regularly at another facility. You call the facility and are given a list of antibodies identified and a RBC phenotype. What do you do with the phenotype information? Do you transfuse RH and K matched blood based on this information? Do you "try" to get a RBC phenotype even though patient has been transfused? Do you hypowash? How do you handle these cases? I'm writing a case study and would love to get some data on this. Thanks!

Crossmatch compatible group A RBC would be transfused in our facility.

I was going to post this very observation. The ITP patients given RHIG are D+ and therefore there will be an immune reaction to the anti-D and the D+ RBC. It isn't severe in most cases, and possibly non-hemolytic, but there is likely extra-vascular destruction of some D+ RBC that might account for the flu-like symptoms. This should be less likely in the D- post-partum recipient.

I hesitate to respond but here goes. You might want to look at the anti-A titer in the platelets the patient received. There are numerous papers (including ours) that address hemolysis from group O apheresis platelets transfused to group A recipients. The fact that he is negative with A1 lectin is suspect, especially if he has been receiving A RBC as `80% would be expected to be A1. That would mean he has cleared most of the transfused cells. Does he show clinical evidence of hemolysis? Regardless of the reason, group O RBC should be given until or if, group A RBC are crossmatch compatible again.

Agree with Dwharrell, the indicators are not dosimeters. They simply show that the unit was exposed to irradiation. So the placement on the unit should not matter. I believe the indications for use states this.

Good luck to you, Jana. Looking forward to the publication.

So I was answering the question. About titering an auto-antibody in a pregnant female. My concern is discerning an auto-D from an allo-D in a pregant female. I wasn't trying to cover every feasible option and lecture on partial and weak D phenotypes and resolving warm autos although our reference lab does all these techniques but we prefer EGA to CPD (yes it denatures Kell group antigens). Unfortunately, it seems that new opinions are not welcome here so I will refrain from posting and those of you who own the board can have at it.

Not each time, Malcolm. But for patients who have complicated serology that includes Warm Autos along with allo-antibodies or for African American patients with D-CE hybrid genes, it is well worth the cost. Many patients we see have been multi-transfused before we get them, so sometimes phenotyping is not an option and genotyping fits the need perfectly. We are in the process of genotyping all of our repeat donors.

Titers may be helpful in discerning allo vs auto antibodies when there is apparent blood group specificity. Also, keep in mind that some apparent auto-anti D may in fact be allo if the mom is a D variant.

I believe there is a parameter setting where you enter all your "ABO" tests so that Soft knows what test codes qualify as an ABO type for confirmation purposes. I agree that your implementation specialist should be a valuable resource for these questions.

Once an initial workup has been done and the patient is being chronically transfused, we perform an adsorption one every two weeks. We also utilize phenotypically and genotypically similar antigens matching of transfused units, particularly in patients who have formed antibodies.

That is my question as well (retype on unit). It is known that some ABO incompability will not be detected by the crossmatch test. That is why we have so many other checks in place including the confirmation of the blood group of units after labeling. Perhaps the unit was a subgroup of A which may help explain the compatibility especially if the anti-A titer in the patient was low.

Done! Which program are you affiliated with, Jana?