Good luck finding an E,e negative unit to transfuse in situation #1 you describe here. If it were me and the patient absolutely HAD to be transfused right now, which it sounds like she/he doesn't, I would go with E negative blood. It sounds like the e is a possibility, but not present yet. Yes, it's rolling the dice, so to speak, but what options do you have? In this situation we would call the attending physician and "Strongly Urge" the use of steroids to try to get the Auto antibody under control. Obviously we can't prescribe medicines, but we can "Suggest" their use when appropriate. The Doc's are normally very receptive to our "Suggestions". We have a patient that comes in from time to time that has the exact same scenerio. Sometimes when her Auto is strong enough, we just simply tell the Doctor there is no compatible blood and he/she will have to sign an Emergency release form for incompatible blood. Then it has to be OK'd by our Medical Director who has to sign the emergency release form also. He will call the attending physician personally prior to signing the form to ascertain true medical need. It's a pain, but sometimes what choice do you have? We have done this probably only twice in my years at my current facility. Odd how the urgent need for blood becomes a little less urgent when a MD has to put his/her signiture on a legal document.