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Policy for use of blood Kell Positive


javvcr
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hi

I´ll like to know that is ur policy about the use of blood Kell positive?

In my country there are many blood bankers, think that red blood cells with this phenotype should be eliminated, but other like me, think that this should be used in specific cases, so a policy should be developed

Please, tell me what u think!

greetings from Costa Rica!

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We don't do special antigen typing of our units unless we do it specifically for a patient who has the corresponding antibody. Do they do this because the Kell antigen is very antigenic? It would seem to me, that it would be costly to type units for Kell to avoid using Kell positive units, unless of course the units are for a patient with anti-Kell.

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We also would not consider discarding these products. We transfuse about 25,000 rbc's a years, with a guess of 9% pos, we'd need to discard 3,600 units of blood, and eliminate them as donors. I can't imagine that.

We do have certain groups of patients we give K neg to even if they don't have the antibody, but we still use the units for other patients.

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in my country, exist 35 blood banks: 28 are part of the National Secure System and 7 are private.

The National Secure System named: CCSS (Caja Costarricense del Seguro Social), adquiered for all this 28 blood banks Diamed Targets, for IAT, and for RH-Kell phenotype.

By Now, every blood bank is phenotyping all donors and pacients, and creating a huge data base.

Costa Rica has a anual donation of about 55000 donors, and my blood bank aport 46%, it means 26000 donor by year.

We distribute all our blood to the 27 blood bank of the National Secure System. Privete ones, find his own way to be keep their stock.

My problem is that the most important blood banks are asking me for blood Kell negative exclusively and i am trying to give them facts and razons, that suport my point of view.

In Costa Rica almost 3-4 % population is K+K+ or K+k+. so we will be deferring almost 1700 donor .

That´s why i`m asking our opinion, so i can improve my own criteria.

TNX

PD: i hope make my self clear, sometimes comunicate in other language can produce misundertandings.

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Your communication is very clear:). It sounds like you have quite a system in Costa Rica. Children's Hospital here in Detroit does antigen type their patients,especially the sickle cell patients who will receive a lot of blood in their lifetime. I attended a lecture at the MABB last year that discussed giving antigen negative units to certain populations of people. In the hospital where I work, it would not be cost effective but in specialty areas such as a Children's hospital it is a good idea. I hope you find the information you need to support your criteria.

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I dont find any reason, to defer any Kell positive donor, and not eather refuse to use this blood, i think some population should be protected like children girls, women in pregnacy age, and multitransfused people like thalasemic or drepanositic ones. And of course, any person with anti Kell.

All other people can be transfused with Kell positive red blood cells.

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My opinion is, if you are going to single out a certain blood group antigen like K, then Ds are even more immunogenic, so why not say you can only accept Rho(D) negative donors or select out only E- donors? Perhaps that's because it's just not feasible to manage a blood supply of D- or E- only. Point is, a practice of selecting out only K- donors opens up that concept of selecting out other donors negative for other antigens as well and we can on and on with wanting to select preferred antigen negative combinations in our inventory. I'd much rather take all the donors I can and let the scientists work on methods to erase those antigens off the red cell surface!!

-c

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Even though Kell is considered to be highly immunogenic, it is nowhere near 100% likely to cause antibody production. Removal of the 9% of the donor population that is positive for the antigen is very inefficient use of our donors, who are rare enough as it is!

Even if a woman develops anti-Kell from a blood transfusion during her childbearing years, the father of any child she carries would have to be in that 9% of the population in order to cause a problem pregnancy. If he is K+/K-, it is only a 50% chance that a pregnancy he engenders will produce a Kell positive child.

Given that we do not Kell type our blood on a routine basis, we see very few instances of anti-Kell. We have had no instances of HDN due to anti-Kell from transfusion (that I know of) in any facility I worked in during my 20 year career. Maybe it is luck...or maybe the chances are low enough to take the risk. Just my opinion! :)

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  • 10 years later...

The K antigen is the most immunogenic of the Kell Blood Group System antigens because the Thr193Met mutation voids an N-glycosylation site (asparegine 191), exposing a highly immunogenic area devoid of an N-linked sugar, and so I would be amazed if there had not (Lee S, Wu X, Reid M, Zelinski T, Redman C.  Molecular basis of the Kell (K1) phenotype.  Blood 1995; 85: 912-916.).

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We always found one or two patients with a new anti-K every year.  The good thing is that K= blood is easy to find.  Oddly enough my wife, a nurse of course, has an anti-K which was one of the first antibodies I identified while still in school.  Luckily I am K= so that was never an issue with our children.  Her anti-D on the other was a much more significant bother.  Her anti-S has not been an issue either.  Some how I suspect she is what we fondly refer to as a "responder".   

 

Edited by John C. Staley
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I work in a transfusion laboratory at a major metropolitan hospital in Sydney, Australia.  Our area policy is to provide K negative red cells to females of child bearing age (<50 years old).  Also all Haematology patients require RH/K compatible and irradiated red cells.

Cheers

Annan

 

Edited by Annan
Spelling error
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I work in a transfusion laboratory at a major metropolitan hospital in Sydney, Australia.  Our area policy is to provide K negative red cells to females of child bearing age (<50 years old).  Also all Haematology patients require RH/K compatible and irradiated red cells.

Cheers

Annan

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22 minutes ago, ANORRIS said:

We screen units for Kell only for those with Anti Kell and Sickle Cell recipients. 

This is what we do as well. In my 35+ year career, I haven't seen very many patients with anti-K and only one was pregnant. Hopefully my luck will continue to hold.

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I have been biting my tongue, trying not to say anything, but I have just got to!

Kell is the name of a Blood Group System, but the first antigen within the system is named K, and the antibody against it is named anti-K.

Those of you who screen for "Kell" and find negative donations are finding an awful lot of Ko donors (whereas the rest of the world is trying desperately to find some to freeze down), and those of you who are finding all these examples of "anti-Kell" are finding an awful lot of examples of anti-Ku, and in 43 years working in Reference Laboratories, I have only seen one example!

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1 hour ago, Malcolm Needs said:

I have been biting my tongue, trying not to say anything, but I have just got to!

Kell is the name of a Blood Group System, but the first antigen within the system is named K, and the antibody against it is named anti-K.

Those of you who screen for "Kell" and find negative donations are finding an awful lot of Ko donors (whereas the rest of the world is trying desperately to find some to freeze down), and those of you who are finding all these examples of "anti-Kell" are finding an awful lot of examples of anti-Ku, and in 43 years working in Reference Laboratories, I have only seen one example!

Malcolm isn't the first Kell antigen also referred to as K1 or is that another Kell anitgen?

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30 minutes ago, John C. Staley said:

Malcolm isn't the first Kell antigen also referred to as K1 or is that another Kell anitgen?

Sorry John, but you are incorrect - and correct!  The first antigen within the Kell Blood Group System is, under the ISBT numerical system 006 001 (006 being the number of the Blood Group System, and 001 being the first antigen within that system) and, indeed, the 006 is never used in terms of Blood Group Systems (except on computers), and the "00" bit of the "001" is redundant, so you would think that K is equivalent to K1, but it isn't!  To quote from Reid ME, Lomas-Francis C, Olsson ML.  The Blood Group Antigen FactsBook."  3rd edition, 2012, Academic Press, page 3-7, "It is incorrect to refer to the K and k antigens as, respectively, K1 and K2; in the numerical terminology they should be referred to as KEL1 and KEL2."

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17 hours ago, Annan said:

I work in a transfusion laboratory at a major metropolitan hospital in Sydney, Australia.  Our area policy is to provide K negative red cells to females of child bearing age (<50 years old).  Also all Haematology patients require RH/K compatible and irradiated red cells.

Cheers

Annan

To clarify K1 (Kell) negative red cells

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