Unit selection for suspected partial D paient

[jmicallef]

Hi, I am in Australia and wondering what people do when they get a patient who they suspect to be partial D - would you issue them with Rh(D) Negative or Positive units. The patient groups as a 0.5 (1-4 scale) with one liquid reagent and grade 4 with our CAT cards on our analyser. This patient repeatedly groups this way, and one staff member suspects that she is a partial D or weak D. We are sending her away for partial D typing, but given that partial D patients can make anti-D would most people opt for issuing Rh(D) Negative blood - in the meantime, only after confirmed partial D, or never????

[Malcolm Needs ☆]

Under the circumstances, we would encourage the use of D Negative blood, with the caveat that, if the patient is male or a post-menopusal female, D Positive blood is okay. Even under these circumstances though, if the patient is either transfusion dependent, or likely to become transfusion dependent, or is going to have multiple transfusions over a fairly short time scale, the use of D Negative blood would be encouraged.

[David Saikin]

We would give Rh(o)D negative red cells.

[Deny Morlino]

Same protocol as Malcom suggests

[adiescast]

We don't even perform weak D typing on most patients, so we give Rh negative also.

[Mabel Adams]

We don't do weak D typing on anyone but babies for the Mom's RhIG determination. When we find a patient that reacts less than about 2+ in tube IS testing we usually try to give them Rh neg units, although I agree with Malcolm's limitations on that. Of course, we don't know if they are a partial D or not, so it may not be necessary. In fact, I think most of the partial D's that are most likely to make anti-D to the epitopes they lack are more likely to come up at AHG with the current reagents on the market rather than being weak at IS. Still, they are so rare, it isn't usually much problem to give them Rh neg. If they are a "regular" you will be glad not to cause antibodies, and if they are not, well, you probably won't see them again for at least a few years if ever.

[EDibble]

We also only do weak D testing on the babies of Rh neg moms, so a partial D in an adult would not be detected, and this person would be typed as Rh negative. They would of course receive Rh negative blood.

[Mabel Adams]

Remember that partial D's sometimes react 4+ at IS and some cells that react only at the AHG phase have the entire D antigen, just in lower quantity. The weak D test is not a surrogate test for whether someone is partial D or not.

With current monoclonal reagents the category VI partial D's are likely to react only at AHG and they are considered fairly likely to make anti-D. Thus it is good to not detect them for transfusion purposes. It is useful to be able to detect them as a (albeit weak) source of sensitization for Rh neg moms. Hence the need to do weak D tests on cord samples. There are starting to be anti-D reagents intended for donor centers (pick up VI partial D's at IS) so be careful that you choose one that does the job you need done.

[silverblood]

Our hospital no longer does weak D testing except on Rh neg. babies with Rh. neg moms to determine need for RhoGam. We would issue Rh negative blood to this patient.

[ejsommers]

Same as many above. We only do Du testing on cord bloods and RhIG moms.

[jmicallef]

thanks for your replies....

Our problem is we dont do weak typing either.... we only suspected this because it gave a weak reaction in tube. if it had been done twice on the analyser it would probably have gone undetected and we would have called it Pos and issued Pos blood.......

[Dr. Pepper]

Many years ago we had a patient who gave a questionable reaction with a routine D typing. We did a weak D which was positive. We followed recommended protocol at the time and gave him D+ blood. Months later he went to another hospital for major sugery and had several family members donate for him as directed donors (a service that they had to pay for). Trouble was, he now had anti-D and all the relatives were incompatible! They weren't very pleased.

We do as Malcolm, David, Deny etc. have outlined.

Edited May 17, 2011 by Dr. Pepper
spelling

[Malcolm Needs ☆]

Did they not test the patient for antibodies BEFORE the donations, and come to that, the family members BEFORE donation??????????!!!!!!!!!!!

I wouldn't have been pleased either under the circumstances; my blood is precious. It helps to dilute the alcohol circulation!!!!!!!!!!!

[Dr. Pepper]

Did they not test the patient for antibodies BEFORE the donations, and come to that, the family members BEFORE donation??????????!!!!!!!!!!!

I wouldn't have been pleased either under the circumstances; my blood is precious. It helps to dilute the alcohol circulation!!!!!!!!!!!

Good question. I just called our local blood center. They don't test the recipient. They rely on a historical patient type (in the case of our unfortunate patient, just "O Pos"), then type the prospective family member donors and just draw the ABO compatible. This could be done several days before surgery to allow time for processing and distribution, and could in fact be done before the intended recipient has an antibody screen performed at the hospital. Putting the cart before the serological horse.........

I sympathize with the strategy of conserving one's blood supply for dilutional reasons.

A friend once asked, "Is it true you get drunk easier after giving blood?"

I said, "I heard that too, so I did a little experiment the last time I donated and went to the bar after."

"What happened?" he asked.

"I don't remember." I replied.

And don't we all have some relatives whose blood we might be less than eager to receive?

[Malcolm Needs ☆]

And don't we all have some relatives whose blood we might be less than eager to receive?

I'm sorry to say that I've got some relatives to whom I would be reluctant to give blood!

You can choose your friends.............

:chainsaw::chainsaw:

[momie]

We only do weak D testing on cord bloods and RhIG moms.

[momie]

Thats the thing i am wondered aboout......since if a lab is not performing a weak D on adults the if a case comes up like u stated above...it gave a weak reaction in tube.....so what should the protocol be for those hospitals who dont do weak D testing on adults............does they always give RH-neg blood to those who are Rh-positive?????

[momie]

what if u get a weak reaction for D in the tube...but a strong one in the card.....what would be the RH typing of the patient...wil we call it a weak D?

and what about if we get a weak reaction for D antigen in the card?.........Do we need to repeat with tube testing or with the card?............or we will directly give a Rh-neg blood to this patient to have a safe side?