Hi

I have a question about strong cold antibodies. Does anyone here, recommend blood warmer for transfusion on the floor, not OR? I understand in OR it is recommended because of the low temperature in OR setting, but a patient room is warmer. If you do not recommend, do you have any research on the topic, either for it or against it.

Thank You

I was involved in one very unusual case (Win N, Needs M, Rahman S, Gold P, Ward S.  An unusual case of an acute haemolytic transfusion reaction caused by auto-anti-I.  Immunohematology 2011; 27 (3): 101-103.  DOI:  10.21307/immunohematology-2019-182.  

This was caused by the unit being removed from the storage fridge and immediately transfused.  If I remember correctly, however, because of the reaction, blood was put through a blood warmer on the ward as a precaution after this.  I doubt very much though that it would be something that would be done on a regular basis.

If they are so strong that we must use the pre-warmed technique to resolve them, and/or the patient is significantly hemolyzing from CAD, we would recommend using a blood warmer.

If the antibody does not react at 37 or antiglobulin phase, we would not recommend a blood warmer.  Agree that in patients with cold agglutinin disease or hemolysis after exposure to cold, would use a warmer.  Remember that our techniques in the lab routinely detect antibodies of no clinical significance.  For one thing, we never centrifuge patients at 170g to enhance binding of red cells to antibody :).  So on balance, unless you have an antibody of known clinical significance historically (antibodies in the Rh, Kell, Duffy, Kidd, S, etc. systems) and it reacts at body temperature, it's probably not significant.  Cold antibodies of wide thermal range may be significant but usually not if they don't react at body temperature in vitro.

On 5/30/2024 at 3:57 PM, Mabel Adams said:

If they are so strong that we must use the pre-warmed technique to resolve them, and/or the patient is significantly hemolyzing from CAD, we would recommend using a blood warmer.

This is also our policy. If the cold antibody is so strong (3+ to 4+) that we must use pre-warm tube testing in order to do the workup, we advise them to use a blood warmer regardless of the location where the transfusion is being given. 

Just out of curiosity, do you test papain- or ficin- treated cells when working up cold agglutinins?

We do not use enzyme treated cells when trying to detect or work up cold agglutinins.  No reason to enhance their reactivity in vitro.  If they are not detectable by routine LISS at body temperature or antiglobulin methods they are not of clinical importance.

14 minutes ago, Neil Blumberg said:

We do not use enzyme treated cells when trying to detect or work up cold agglutinins.  No reason to enhance their reactivity in vitro.  If they are not detectable by routine LISS at body temperature or antiglobulin methods they are not of clinical importance.

Could NOT agree more Neil.

21 hours ago, Malcolm Needs said:

Could NOT agree more Neil.

Same here.  At that point it has become an academic exercise with no clinical value.  

I think the only reason to test an enzyme cell is if you are doing a cold agglutinin workup already (by request or to clarify test interferences), to see if anti-Pr is present. Sometimes is assoc with CAIHA. It is the only cold agglutinin I can recall that will be negative with enzyme cells, rather than strengthened. 

1 hour ago, Texas Tea TMC said:

I think the only reason to test an enzyme cell is if you are doing a cold agglutinin workup already (by request or to clarify test interferences), to see if anti-Pr is present. Sometimes is assoc with CAIHA. It is the only cold agglutinin I can recall that will be negative with enzyme cells, rather than strengthened. 

Auto-anti-M is VERY rare, but is negative with papain/ficin treated red cells.

Lol, I somehow knew Malcolm would know one (or many) more this is true for :-D