Hi there, I would be really interested to hear other blood bankers opinions on the following scenario: We have a patient with an autoantibody who is transfused 2 units red cells approx once every 2-3 weeks. I have always understood that patients with autoantibodies should have the autoantibodies adbsorbed from the sample (either in house or by a reference lab) in order to detect any underlying red cell antibodies that may be produced, and that this should be perfromed on every occasion that the patient requires blood to ensure that the lab is detecteding any recently produced red celll antibodies from recent transfusions. Some colleagues of mine have stated that this does not need to be done and that you can cross match red cell units against the patients plasma and as long as they are less reactive than an auto then it is OK to issue units to the patient. They do not do panels on this patient as the autoantibody results in psoitive reactions in all panel cells so 'it is of little use'. What do other labs do in this scenario? I am not happy to issue units in this way and would prefer an adsorbtion to be done first and then run a panel to determine the presence of any other underlying masked red cell antibodies and then do a cross match. If the patient has a very weak underlying red cell antibody that is masked by an autoantibody and the unit that is selected for xm has a heterozygous expression of the corresponding antigen, surely this weak reaction in the xm could be masked by the presence of the autoantibody and the reaction may well be as weak as the auto leading to the issdue of the unit and a possable delyed transfusion reaction? Would be very interested to hear others opinions I