Dealing with Anti-A1

[Regina Castor]

How others are handling transfusion needs for patients with anti-A1.

Do you type the units for A1 or just give O units?

Do you then do an immediate spin or coomb's crossmatch?

Our facility is curious what the majority of others are doing.

[Mabel Adams]

It's just easier to give O units so we usually do that (or B to an A2B patient if we have shortdates to use up).

I think our computer will see that the patient has an "antibody" and want us to do an AG xm. Sometimes it is easier not to argue with your computer or confuse the generalist techs with special rules for certain antibodies. It is especially bad to expect my night generalists to argue with the computer. Getting crosswise of it could take them (or me) all night to fix.

[rcurrie]

I am with Mabel. Convenience overrides correctness here. We know most anti-A1 produced by the A2 or A2B person is clinically insignificant, but try telling that to the computer.

BC

[jhaig]

Our policy is to transfuse crossmatch-compatible group O units. Why mess around with an anti-A1 regardless of its significance? And if you think fighting with a computer is tough, try arguing with a nurse about the fact that a group A patient can indeed safely receive group O blood.

[Mabel Adams]

I always explain to them why it is so and thank them for questioning us because I would much rather explain to them why it is okay than file a fatality report with the FDA because they assumed the lab must be right.

[Sandy Jo]

Hey Regina - how's it going?

We generally give type O units. We also perform an AHG crossmatch, although perhaps not required, it helps maintain consistency when you have generalists rotating into Blood Bank.

Sandy

[OPUS104]

Have any of you (Cliff, Rob,Mabel) ran into anyone not wanting to give O to Anti-A1 patient due to H? I have two of the hospitals that we supply products for that actually pay us to find and label "non-A1" units for them. Is this common? I worked in a large level one trauma center before coming to this blood center and we never thought twice about giving Os or others.

[rcurrie]

No. I can't see their reasoning for this. Anti-A1 doesn't react with the H antigen.

BC

[OPUS104]

They claim they do not want to expose the patient to high levels of the H atigen by transfusing O units...........

[adiescast]

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[adiescast]

A patient with an A subgroup has more H antigen on their cells than a type A1 patient. Perhaps you could explain this to the people who are making the request and tell them that the presence of H antigen on the patient's cells makes it unlikely that they will have a problem with the H antigen on the type O cells.

[Yanxia]

We will give A2 or O type cell. (Though I don't think anti-A1 which is not reactive at 37C and coombs testing is clinical significance)

I don't think we should worry about the H antigen ,too.

Bcause a lot of anti-H or in Chinese people anti-HI is cold reactive and there have not warm reactive induced in A1 people, maybe have but I haved not read it.