Which antibodies would you ignore first and last and in between in an emergent transfusion and why?

[NightCrawler]

anti-Fya

anti-K

anti-c

anti- S

Thank you for your input.

[Mabel Adams]

Of those four, I would probably try to honor the one that reacted most strongly first. You might want to give Rh pos blood so there is a chance of the unit being c neg or at least single dose for c. We keep 5 min. anti-K so it would be pretty easy to get K neg units both because the test is fast and the odds are good but I am not sure it would be worth the time until you were getting near the end or the anti-K reacted 4+. "Save the best wine for last" and try to fill them up with the most compatible you can come up with at the end when the bleeding has slowed. Depends on your inventory and how close you are to your supplier. If you can get compatible units in an hour and you only keep 20 units of blood, that is very different than if you keep 150 units of blood but can't have units shipped to you in less than 4 hours.

[NightCrawler]

Thank you for your input :-)

Another question in relation to this is what if all were reactive w+ to 1+? Do you think ignoring the S first then the little c then the K and last would be the Fya a reasonable one?

Thanks again.

[David Saikin]

If I had to ignore (and I have had a case like this) - I would ignore - S, then K, then c, then Fya. Actually had an open heart with Anti-K,-E,-Fyb. Pt went to OR. I came in at midnight and she was going back for the 3rd time - we weren't screening for anything. A few days later she had a +DAT with the Duffy. No other sequelae.

[Mabel Adams]

Is your logic based on likelihood to fix complement or antigen frequency or testing difficulty or ...?

[Liz]

In order of importance: c, K, S and Fya. S can be rather mean. BUT and thats a BIG "BUT" my order of priority on paper may not reflect the actual immune status of a certain patient.

[David Saikin]

Is your logic based on likelihood to fix complement or antigen frequency or testing difficulty or ...?

I don't have much logic to this . . . no reason for S first except that the others will tend to be more dynamic in vivo (I think) and K is easier to ignore than c because of its frequency (or lack of).

[Mabel Adams]

If they are all that weak and not from the Kidd system, does it really matter much? Try to have some compatible stuff at the end to fill them up with.

[VPearce]

Take a look at article Transfusion 2002 42: p. 1435. The discussion is related to WAA patients, but you may find the information helpful. In our institution we would drop S, then Fy(a).