Jump to content

Do you antigen type for the entire group?


 Share

Recommended Posts

When you have a patient with an antibody, do you antigen type them for the entire antigen group, or just for the specific antibody antigen? At my previous blood bank, if we had an anti-Jka, we  would only antigen type the patient and donor for Jka. If we had an anti-c, we would type the patient for c and E. If we got an anti-e, we would type for C and e. At my current blood bank, the policy is to antigen type for the entire group. If a patient has anti-c, they get typed for C, c, E, and e. If they have anti-Jka, they get typed for Jka and Jkb. What do other labs do? And can you direct me to the reference that led you to your policy? Thank you!

Link to comment
Share on other sites


When I was working in the Reference Laboratory at the NHSBT and, come to that, when I was working for a short time in a Hospital Blood Bank, we would ALWAYS test for the C, c, E and e antigens, together with the K antigen, both for patients and donors, and we would also test for the antithetical antigen, as well as the cognate antigen (in other words, as in your example, the Jk(a) and the Jk(b) antigen.  We ALWAYS did this, except when the grouping reagent was exceedingly rare (e.g. anti-Dib) or the antibody AND the antigen were extremely rare (e.g. anti-Kpc).

The reason we did this, particularly in the NHSBT Reference Laboratory, was because we wanted to identify very rare phenotypes, such as Kp(a+b-), or even rarer (in most cases), null phenotypes, but there was also a paper that showed that people who were transfusion dependent, such as sicklers and thal patients tend, once they have made an initial atypical antibody (particularly anti-C, anti-c, anti-E, anti-e or anti-K) to make all sorts of specificities (I'll try to look up the paper and get back to you on here).  Other papers comparing their findings actually agreed with them.

I say ALWAYS, but then, of course, the Bean Counters, who know nothing about Blood Group Serology, or about Patient Requirements, and care even less, came along, and we were banned from doing this as, apparently, IT COST TOO MUCH MONEY, except in special circumstances, such as patients from the Black populations, where we were privileged to be able to test for both Fya AND Fyb, in case they were Fy(a-b-) - and, of course, most of those who were found to be Fy(a-b-) had the FYB gene, so would very rarely produce an anti-Fy3,  as they were homozygous for the GATA1 gene mutation.

Unfortunately, what these "suits" seem to forget, despite counting beans for a living, is that, if the patient goes on to produce other, clinically significant, atypical alloantibodies, they will occupy a hospital bed for longer while suitable blood is identified, including, sometimes, cryopreserved units, ALL OF WHICH IS FAR MORE EXPENSIVE THAN THE INITIAL TYPING WAS IN THE FIRST PLACE - but what do we professionals know!

RANT OVER!!!!!!!!!!!!!!!!

Link to comment
Share on other sites

We only type for the actual antigen corresponding to the patient's antibody for anything other than Rh. For those Rh antibodies, we will type for the C, c and E as appropriate genetic-inheritance wise, as you described above. We don't typically type for e unless the patient has an e antibody (to prove it's creation) or is E positive (checking for heterozygosity), since 98% of people are e positive (we assume e pos unless given reason to check that). We would do a full pheno with whatever sera we have in house (pretty much all common antigens) for those patients where it might be useful (sicklers, WAA, etc.). 

Link to comment
Share on other sites

22 hours ago, Bet'naSBB said:

we only do for Rh.....and Lewis...  Otherwise it's usually individual

It's highly unusual, to put it mildly, to worry about antibodies to Lewis antigens. What's your institution's logic for this approach ?

Link to comment
Share on other sites

  • 1 month later...

@exlimey if a Lewis antibody is identified - we type the patient......  it's just how our protocols are written.  The only time we would be required to provide Lewis antigen matched units would be if the antibody demonstrates hemolysis at AHG otherwise just XM compatible.  Do I know why?  not really - I've just been doing what I was told......for almost 35 years. :plotting:

 

Link to comment
Share on other sites

50 minutes ago, Bet'naSBB said:

@exlimey if a Lewis antibody is identified - we type the patient......  it's just how our protocols are written.  The only time we would be required to provide Lewis antigen matched units would be if the antibody demonstrates hemolysis at AHG otherwise just XM compatible.  Do I know why?  not really - I've just been doing what I was told......for almost 35 years. :plotting:

 

Understood. There are many things laboratories do because they've "always done it". Those in the decision-making roles probably saw a "bad case" somewhere along the way and it stuck in their brains. I will concede that there are a smattering of cases of Lewis antibody-mediated transfusion issues to reference, but most workers consider them an insignificant nuisance.

Link to comment
Share on other sites

11 hours ago, Bet'naSBB said:

@exlimey Do I know why?  not really - I've just been doing what I was told......for almost 35 years. :plotting:

Over my many years I have come to realize that inertia is the most powerful, driving force in the universe and the most difficult to over come!!!

:coffeecup:

Link to comment
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now
 Share

  • Advertisement

×
×
  • Create New...

Important Information

We have placed cookies on your device to help make this website better. You can adjust your cookie settings, otherwise we'll assume you're okay to continue.