How to deal with AIHA transfusion

[Yanxia]

We meet a patient, her diagnosis is AIHA.

We can't get the specificity of her autoantibodies.Fortunately she have not alloantibodies. Yeaterday we give 1 unit of 3 washed cells to her(not compatible), the Hb fallen . Today the doctor want 1 unit again, what can we do?

[Yanxia]

The doctor insist to transfusion, the patient been given 1 Unit 3 washed red blood cells. After transfusion ,her Hb from 39g/l risen to 55g/l. Although the blood is uncompatible. So I have a question: Is it significant to do crossmatch for the AIHA patients?

[bbbirder]

Yanxia,

I think the most important thing is your finding: that she has no allo-antibodies. If you did absorptions for this workup, you could use your absorbed plasma for the crossmatches.

Sometimes, you will be giving blood that is 'incompatible'. With AIHA, the patient is destroying her own cells. She will probably destroy the transfused cells the same as her own.

I don't know if there is much value to give washed cells. Some people think you need to get rid of complement from the transfused units, so you don't make the destruction worse. Others don't think washing is important or will make any difference.

To transfuse or not to transfuse? This depends on the patient, age, other conditions, how rapidly they are hemolyzing.

We once had a young man with a HGB of 2-3 g/dl and WAIHA. This had been a slow process for him. He did just fine without transfusions until IVIG and/or steroids helped. But someone else may need to get blood.

Linda Frederick

[David Saikin]

As long as there are no alloabs, like Linda has stated, your transfusions should be "safe". I like to give Rh phenotype specific blood to these pts so that they won't make any Rh system abs. I have found that these autoimmune pts are prone to sensitization so I try not to give them a good reason.

[Yanxia]

Thanks for your posts. For this kind of patients we usually give the least incompatible units to them. The first unit is the least incompatible one, but the result is not good; the second one is a random one, the Hb is risen. So I think the most important is not the crossmatch but the steroids her been used. The Hb risen is the result of weakened hemolysis.

[Rosemary]

We have room temp reacting antisera for Rh, K and Kidd. So if they've not been recently transfusied, we type and transfuse the patients their own phenotypes.

We send off our autoabsorptions to a reference Lab.

Can anyone recommend a simple autoabsorption method or kit for us to perform in our own lab?

[Yanxia]

Some doctor think to transfuse AIHA patients with washed cells because washing can remove allo- protein or something like this, those things can activate the recipients immunization, the factor will let the auto-immune gone worse.

Who can tell me whether it is necessary to choise the least incompatible unit for AIHA patients? Thanks advance!

[Eagle Eye]

We have room temp reacting antisera for Rh, K and Kidd. So if they've not been recently transfusied, we type and transfuse the patients their own phenotypes.

We send off our autoabsorptions to a reference Lab.

Can anyone recommend a simple autoabsorption method or kit for us to perform in our own lab?

Immucor has reagent called W.A.R.M. (warm autoantibody removal medium)which is a mixture of ZZAP and DTT. You treat your patient's cell with W.A.R.M. to remove autoantibody allowing more sites available for absorption. then you add patient's plasma and incubate @ 37...you can repeat the same using diffrent set of WARM treated cells.

[Rosemary]

Thank you aakupatku

[David Saikin]

Thanks for your posts. For this kind of patients we usually give the least incompatible units to them. The first unit is the least incompatible one, but the result is not good; the second one is a random one, the Hb is risen. So I think the most important is not the crossmatch but the steroids her been used. The Hb risen is the result of weakened hemolysis.

Just a comment on least incompatible . . . that's like saying someone is a little pregnant.

[Yanxia]

Sorry, my English is not so good, if my understanding is wrong, I beg your pardon.

The least incompatible is the least agglutination. I can't understand what is the same of the little pregnant as it, can you tell me?

[Olivia]

Finding compatible units for patients with a broad-specificity warm autoagglutinin is virtually impossible. I do not think least incompatible would make any sense at all because the transfused donor cells are likely to be destroyed as rapidly as the patient's own red cells.

[David Saikin]

Shilly - the blood is either compatible or incompatible. Least incompatible does not provide any guarantees of better survival . . . as Olivia aptly stated, the transfused rbcs will probably survive just as well as the patient's regardless of their reactions in vivo.

[bmarotto]

I always felt the purpose of giving "least incompatible" blood was not to improve survival of the transfused red cells but to make the blood bank tech (and the pathologist who approved the release of incompatible blood) feel better. Deep down, we know it probably makes no difference but I would guess it is still a fairly common practice. What we do is give Rh phenotype matched (and Kell neg if the patient is Kell neg). I agree with David that trying to prevent alloimmunization is the best thing we can do in these cases.