Emergency Release of Blood to a Patient with multiple Antibodies

[BloodBank101]

Just a nightmare scenario! What if you have a patient in critical condition needing transfusion with multiple antibodies. All Antibodies have been identified but have difficulty finding antigen negative units.Which of the Blood Groups should one try to find first. Which one would cause more damage.

[Malcolm Needs ☆]

Just a nightmare scenario! What if you have a patient in critical condition needing transfusion with multiple antibodies. All Antibodies have been identified but have difficulty finding antigen negative units.Which of the Blood Groups should one try to find first. Which one would cause more damage.

I sympathise, but it is difficult/impossible to answer until we know the spacificities involved???

:confused::confused:

[BloodBank101]

let's say Antibodies to K, Fya. Jka and Le(a)

[Malcolm Needs ☆]

In that case, you can totally disregard the anti-Lea, but you would need to give K-, Fy(a-), Jk(a-) blood, without a doubt.

That must have been fun!

:):)

[David Saikin]

I have been in this scenario - patient had anti-E,-K,-Fyb. By my next shift the patient was going to the OR for the 3rd time and we weren't screening for anything ( we had about 300 ABO compatible units). These abs will not kill your patient. There will be decreased red cell survival, a positive DAT and probably some dialysis, but they will/should survive the incompatible red cells. As long as you give ABO compatible you will probably not kill them with transfusions (there are very rare exceptions). In your case, I would worry about the Kidd and Duffy abs. If they are going to use a lot or red cells, it will become a moot point due to the frequency of those ags. This is what makes Blood Bank great!

[Deny Morlino]

Similar situation here as well. Patient presented with only an Anti-E identified by our reference lab. We transfused E-negative, ABO/Rh specific units. Four days later the patient returned through ED with Anti-E not reacting, but three other antibodies previously identified by the hospital where she was to be transferred reacting strongly (Fya, Jka, and K I think; memory is getting foggy). Surgeon called in signed a "Release of Incompatible Product" form the situation was so dire. It caused us to poll other area hospitals and tweak our policy (and a couple of other blood banks to do so as well I believe) to help our blood bank staff understand the scenario a bit better. As David indicates, the fallout from an incompatible transfusion can be addressed when the situation is known and can be prepared for (dialysis, pulmonary issues, etc.). As much as we want blood to "always" be compatible prior to transfusion, sometimes situations arise where an incompatible transfusion is the lesser of the evils available.

[Malcolm Needs ☆]

I agree with you both there David and Deny.

I was thinking more from an ideal situation, rather than a pragmatic situation; and there are times when only pragmatism will do!!!!!!!!!!!!!!!!!!

:D:D:D:D

[John C. Staley]

Here's a general rule of thumb in an emergency situation. Try to find antigen negative units for any antibody which will routinely set complement, ie Jka, these can and will cause intra vascular hemolysis. Those that don't set complement are less of an immediate concern.

As David said, the bottom line is get the ABO right and you can probably survive the rest.

:eyepoppin

[tbostock]

In a massive transfusion situation (truly urgent), I also agree with David...get the blood type right and get unscreened/uncrossmatched units out the door. Start screening units for when the bleeding slows, then start giving the "good stuff".

[BloodBank101]

a very good discussion! A lot of hospitals do go through this experience and a lot of times the most inexperienced techs have to deal with it. Thank you

[tricore]

Reminds me of a saying by the Chief Tech (dating myself-I don't think they are called that anymore) when I was in Med Tech school "Better a live patient than a dead "pure" one.

[PURVIS1031]

In massive transfusions, the patient is not very likely to have a reaction. Most pathologist feel safe in releasing units that are ABO compatible in this situation. Get the release signed by the MD and hope for the best.

[PURVIS1031]

happy lab week!

[L106]

I agree with all the comments that have been posted so far.

Now, let's say you have been issuing uncrossmatched ABO (and perhaps also Rh) compatible donor units and you finally have your head above water: If you are asking exactly where to devote your time in this urgent situation, I would concentrate on crossmatching scads of donor units to find compatible units to issue to the patient towards the end of the episode (ie: once they have the trauma and/or surgery under control and it appears that the patient has survived.) I'd worry about doing the special antigen typings on the donor units later when time permits.

[Dr. Pepper]

Good advice, all. Another consideration with an ED patient who's bleeding out is that, for the short term at least, he's bleeding out his antibodies as well, minimizing the hazard of an immediate acute reaction.

[Eoin]

Love this one Folks,

Most of us with a few (Oh alright - heaps) of years in BG Serology under our belt will have seen this situation. John's advice to prioritise to avoid complement setting ABs is very true. A wise old transfusionist once told me when we were in the middle of just such a situation that "You can treat a patient with complications from an incompatible Tx (not ABO obviously), but it's impossible to treat a patient who has exsanguinated".

ALways remembered that and CYA (cover your ass) by the appropriate authorisation according to your protocol FIRST, no matter how dire the situation (an authorising signature takes a fraction of a second".

Cheers

Eoin

[rravkin@aol.com]

This case reminds me of situations where we were supporting a liver transplant and the initial PC's were type O Pos and the later PC's were ABO/Rh specific. The rational is that the initial units would bleed out during surgery and the later units would remain in the circulation. I'm not sure if this practice is applicable here. Perhaps some of our more experienced posters can comment.

Additionally, Donna, fantastic advise!