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Thanks for those suggestions, but PLEASE, don't call it anti-Kell and anti-Cellano!

Hemo bioscience sells Polyclonal anti K and Anti Cellano, both are FDA approved potency and could probably be diluted in a 6%BSA solution to be used for this purpose. info@hemobioscience.com for pricing info... Also your local American Red Cross may have donated units of Anti Kell plasma you might use but obviously watch out for the ABO types as these are not adsorbed.....

If you have done the alloabsorption, do you not elute and test the absorbed abs? I find it hard to believe that a patient would be sensitized to all the ags except C and E. (The most abs I've ever encountered were 10).

if the DAT and auto control are both negative, what are you adsorbing out? An antibody to a high freq antigen? A cold? This would need additional work/perspective. A history of WAA doesn't mean it's a WAA forever. Does the patient have a history of anti-C and anti-E or everything else? Everything but Rh antibodies seems unusual to me.

Blood products that were taken into isolation are never returned to us. If they are not used, they are discarded in the room.

For platelets you can cut the dose in half with no worsening of clinical outcomes. Randomized trial in NEJM called the PLADO (platelet dose) study some years ago (Sherrill Slichter was the senior author). Most platelets do little or no good, so this is actually a good idea for patients and helps with inventory in times of shortage. Try to give ABO identical as the increment is higher, the duration of increment is longer and the patients bleed less.

I must admit, we always used to use polyclonal antibodies, and there is a reason for this. Even blended monoclonal antibodies will still only recognise certain epitopes within the antigen, and while the K and k antigens tend to be single amino acid substitutions of methionine at position 193 for the K antigen, and threonine at position 193 for the k antigen, this is by no means universal. A weak expression of K is seen when either an argenine or a serine residue replace the methionine residue at position 193. As with amino acid substitutions leading to weakened expression of the K antigen, so the same can happen with the k antigen, but these substitutions may not actually be at position 193. A recent publication has shown that a substitution of Leu196Val weakens the expression of the k antigen (see Uchikawa M, Onodera T, Tsuneyama H, Enomoto T, Ishijima A, Yuasa S, Murata S, Tadokoro K, Nakajima K, Juji T. Molecular basis of unusual Kmod phenotype with K+wk-. Vox Sang 2000; 78 Suppl. 1: Abstract O011, Poole J, Warke N, Hustinx H, Taleghani BM, Martin P, Finning K, Crew VK, Green C, Bromilow I, Daniels G. A KEL gene encoding serine at position 193 of the Kell glycoprotein results in expression of KEL1 antigen. Transfusion 2006; 46: 1879-1885 and Millard GM, Lopez GH, Turner EM, Lizarazu ME, Roots NM, Liew Y-W, Flower RL, Hyland CA. Modified expression of the KEL2 (k) blood group antigen attributed to p.Leu196Val amino acid change three residues from the K/k antigen polymorphism site: implications for donor screening. Transfusion 2019; 59: 1156-1158.). Therefore, it is more likely that you may get a false negative result using a monoclonal antibody in adsorption/elution tests, than by using a polyclonal antibody, with its wider breadth of specificity to the antigen's epitopes.

The new AABB standard 1.4 entitled “Operational Continuity” is timely in that it forces us to take a look at our existing processes and have a plan for situations we could not have anticipated, just like COVID-19.