Anti-E and c negative blood

[DOGLOVER]

Wondering what most people are doing in the scenario where the patient is c negative and has made anti E. Are you providing E neg, c negative blood or just E negative. What about if the patient has anti-c, do you worry about E? Thanks for the input.

[Malcolm Needs ☆]

Wondering what most people are doing in the scenario where the patient is c negative and has made anti E. Are you providing E neg, c negative blood or just E negative. What about if the patient has anti-c, do you worry about E? Thanks for the input.

As a Reference Laboratory, if the patient is female and under 60, or is of either sex, but is, or is likely, in the near future, to become transfusion dependent, we would advise giving them c-, E- blood (or, on the rare occasions we do it, would cross-match such blood). In all other circumstances, we would advise E- blood only.

:):)

[MsDuffy]

At one hospital were I worked if the patient developed an Anti-E and was (little) c negative then the red blood cell units that were transfused would be negative for both E and (little) c. The hospital where I work currently would transfuse only E negative to the same patient.

With regard to worrying about E if the patient has an anti-c, I've never worked anywhere that would provide both E and (little) c negative units in this scenario.

The AABB Technical Manual, 16th Edition, pg. 404 states "Some Rh antibodies are often found together. For example, a DCe/DCe (R1R1) patient with Anti-E most certainly has been exposed to the c antigen as well. Anti-c may be present in addition to anti-E but may be weak and undetectable at the time of testing. Transfusion of seemingly compatible E-negative blood will most likely be c-positive and may elicit an immediate or delayed transfusion reaction; therefore, some advocate the avoidance of c-positive blood in this situation. In contrast, pursuing anti-E in serum containing anti-c is not warranted because the patient will likely have been exposed to c without being exposed to E; additionally, the vast majority of c-negative donor blood will be negative for E."

Edited April 28, 2010 by MsDuffy
Typographical error

[Steven Jeff]

As a small hospital laboratory as Malcolm indicates we would idealy give c-negative blood to c-negative patients who have developed Anti-E. This is in the UK guidelines somwhere.

Regards

Steve

:)

[Malcolm Needs ☆]

In contrast, pursuing anti-E in serum containing anti-c is not warranted because the patient will likely have been exposed to c without being exposed to E; additionally, the vast majority of c-negative donor blood will be negative for E."

That's true. You would have to be pretty unlucky to transfuse a c-, E+ unit of blood (RzRz, ryry, Rzry) and your blood supplier should be shot for nor offering such units to the Frozen Blood Bank in the first place!

:):)

[Malcolm Needs ☆]

As a small hospital laboratory as Malcolm indicates we would idealy give c-negative blood to c-negative patients who have developed Anti-E. This is in the UK guidelines somwhere.

Regards

Steve

:)

Believe it or not, and sensible as it may sound, it is in the Guidelines about patients who are transfusion dependent (or who are likely to become transfusion dependent in the near future), but it is not in the Guidelines about females under the age of 60. This was following a poster at an AABB Meeting by Edmund Lee and Mahes de Silva (or the other way round author-wise). I give an argument against not doing so in an essay I submitted to this site under References about giving patients phenotyped blood (I can't remember the actual title).

:eek::eek:

[Steven Jeff]

Well Malcolm, I have just read your essay on 'Phenotyped red cell transfusions' under the educational materials section in the reference section where you have developed your argument. So am I right in thinking that unless the patient is going to become transfusion dependent then perhaps we should not be overly concerned about transfusing c-positive cells to c-negative patients who have developed anti-E, or is that too simplistic?

My own lab guidelines encourage the issue of c-negative cells to c-negative patients to patients with anti-E whatever their gender, age or diagnosis for the sakes of one rule to cover all.

As always I am indebted to your academic knowledge base, and what a massive contribution you have made to the educational materials section on this website as I know you do locally within the UK

Regards

Steve

:)

[Malcolm Needs ☆]

So am I right in thinking that unless the patient is going to become transfusion dependent then perhaps we should not be overly concerned about transfusing c-positive cells to c-negative patients who have developed anti-E, or is that too simplistic?

Regards

Steve

:)

Well, with the caveat that all females under 60 who have anti-E and are c- should be given c- blood (because anti-D, anti-c and anti-K usually cause the most severe and most common HDN), as well as those patients you mention, then yes, I would not be too concerned about giving other c- patients with anti-E, c+ blood. The vast majority of them will only ever receive blood on this one occasion, and so, even if they produce an anti-c, it will not matter. For those that do produce an anti-c, and require blood on another occasion, R1R1 blood will be readily available (and the more so, if it is not given to everyone with an anti-E who happens to be c-).

:D:D:D:D

[Steven Jeff]

Well, with the caveat that all females under 60 who have anti-E and are c- should be given c- blood (because anti-D, anti-c and anti-K usually cause the most severe and most common HDN), as well as those patients you mention, then yes, I would not be too concerned about giving other c- patients with anti-E, c+ blood. The vast majority of them will only ever receive blood on this one occasion, and so, even if they produce an anti-c, it will not matter. For those that do produce an anti-c, and require blood on another occasion, R1R1 blood will be readily available (and the more so, if it is not given to everyone with an anti-E who happens to be c-).

:D:D:D:D

Thanks Malcolm,

And yes I hadn't quite got my brain in gear to remember about the ladies under 60 fom your essay (it was a lot of reading with my glass of wine too!!!), but you have made it very clear.

Steve

:)

[John C. Staley]

I'm curious, for those of you who antigen type units for c when the patient has only anti-E and does not currently express anti-c, do you charge for the additional "unnecessary" antigen typing and if so, how would you justify it to an insurance auditor? If you don't charge for the testing how do you justify the extra expense incured by your laboratory for such testing?

:lonely:

[Malcolm Needs ☆]

I'm curious, for those of you who antigen type units for c when the patient has only anti-E and does not currently express anti-c, do you charge for the additional "unnecessary" antigen typing and if so, how would you justify it to an insurance auditor? If you don't charge for the testing how do you justify the extra expense incured by your laboratory for such testing?

:lonely:

IN the UK, of course, John, all units are tested for ABO, D, C, c, E, e and K, so this does not arise.

:)

[LaraT23]

I have a lot of repeat transfusions or frequent flyers here so I always give E and c negative blood. Err on the side of caution. Also, I do not look forward to explaning another position to the docs. Even though I have all the frequencies and can justify testing only for E, it makes many of the physicians nervous. If we can get reimbursed for the testing, it works fine.

As far as John's question , I only antigen type for what the patient has an antibody to, and I charge for the number of units I had to screen in order to find them. This does not apply in the case of a strong warm auto with no apparent specificity of course!

[adiescast]

We do not automatically type patients for c if they develop anti-E (or e if they develop anti-C, for that matter). We do type all of our sickle patients and anyone else we KNOW will be transfused often. I will sometimes do extra typing as possible for patients with a warm auto antibody so we have an idea of what they could be brewing underneath. Amazingly, we have had few patients develop the companion antibodies and I have seen it more often in the reverse of this discussion (person with anti-c develops anti-E).

I sometimes wonder if the good ole U.S. melting pot has assisted by creating lots of people with lots of antigens present and accounted for!