We've transfused 2 scary ones, hemolyzing their cells and the transfused cells faster than you could say Warm Autoimmune Hemolytic Anemia. Neither had alloantibodies that we or the reference lab could find. Neither had any underlying medical problems that could explain what was happening other than their immune systems just felt like going crazy. Both were worked up extensively for infection, malignancy, etc. Neither were on any medication. No treatment worked. They just stopped hemolyzing as suddenly as they started and both survived, but barely. We transfused another one with 3 alloantibodies identified before the auto problem started. The first time we saw her, the auto was fairly weak, so we and the reference lab got a full phenotype on her (and we agreed, too!) and found no additional antibodies and managed to get a clean crossmatch with LISS. The next time we saw her, her auto was 4+++++++. Sent that one straight out to reference, who tried 3 absorptions for the book and 2 more for fun and her antibody screen was still all reactive 4++++++++. We gave her phenotypically similar red cells. 3rd time we saw her, same story. 4th time, reference lab begged us to persuade her to move out of state - we assured them that we had already tried that to no avail. Anyway, we transfused her 4 times uneventfully over about 3 months. Saw her 6 months later and her DAT was only weakly positive and haven't seen her since. Go figure! There have been many more who have received multiple transfusions here with no apparent reactions. Problem is, there is no good way to tell which one will hemolyze and which one won't. Thankfully, most will do OK. It's always nice when these patients are referred for a consult with the hematologist or an oncologist. Those folks generally do a good job of discouraging transfusion. cassiepenn, the medical director of your blood center (or ARC reference lab - if they are not the same) could be helpful to you. They will talk to your medical director or to the patient's physician about your patient's case and offer some good advice.