I know that when faced with patients with autoimmune hemolytic anemia, we should be doing absorptions (either auto or allo) to rule out underlying alloantibodies and/or antigen typing (preferrably by DNA analysis) and providing antigen matched units.... but what of the realities of incomplete/poor absorptions, time constraints, etc. for a patient who needs blood now?

We can do absorptions (but they take hours). Autoabsorptions are 'easy', but alloaborptions are more difficult to interpret (and I don't really want off shifts doing them). Antigen typing with AHG antisera is of no help if the DAT is positive, and DNA antigen typing takes days.

(Personally, I think the 'dilution' technique is nonsense.)

We are 2 hours from our blood supplier/reference lab, just to get the specimen to them.

How many of you are providing units that are not crossmatch compatible and are using "least incompatible" units in urgent situations? Especially if you know the patient history, and they have not been recently transfused.

Thanks,

Linda Frederick

We will provide units that are incompatible with a patient who appears to have a warm auto antibody. We call them "incompatible", not "least incompatible." If we have not performed a complete adsorption (either because of lack of time or the adsoption was not successful), we will emergency release the products. If we have performed an adsorption and ruled out all the major antibodies, we will provide the incompatible blood without requiring an emergency release signature from the physician.

We do the same . . . least incompatible is like being a "little pregnant"!

We also do it this way.

We call them incompatible too...get rid of "least", it gives the MD a false sense of security that the reaction may not be so bad.

Great tip,

doing away with the "least" seems good to me.

Eoin

Petz LD. "Least incompatible" units for transfusion in autoimmune hemolytic anemia: should we eliminate this meaningless term? A commentary for clinicians and transfusion medicine professions. Transfusion 2003; 43: 1503-1507. Editorial.

This is well worth a read - to say the least!

:D:D:D:D

Thanks for that Malcolm.

Good article

Cheers

Eoin

Thanks for everyone's input. It seems that you are providing incompatible units for transfusion, just not calling them "least".

I have read Petz's ideas, and agree with him in theory... however, he lives in a different world from me.

The last place I worked we called the "serologically incompatible" to indicate that they were incompatible in the test tube but not necessarily incompatible in the patient.

I like the idea of doing away with the term "least," in favor of "serologically" incompatible. For those of you who occasionally have to issue blood this way, does the patient's physician sign a form or does your pathologist? Thanks for your input.

we require a special consent signed by the patient(or his/her representative) and the physician before issuing that indicates that they understand the risks involved in receiving "least incompatible" RBCs. we still use the term "least" because we avoid, if possible, using units that react more than 2+wk with the patient serum. i fall in the "incompatible is incompatible" camp but what our medical director wants, he gets. we do try to phenotypically match the units as closely as possible if we have a history (our WAIHAs tend to be frequent flyers with us).

Edited July 18, 201014 yr by BrianD