Ruling out when HTLA present

[kirkaw]

We had a patient for whom an anti-Jkb and (presumed) anti-Kn was identified by the Red Cross in 2010. At that time, they could not rule out anti-K and it was recommended that we transfuse red cells negative for Jkb and K.

The patient has come in again and although some of her gel-crossmatched units were incompatible (neg for K and Jkb), K can be ruled out on her antibody screen.

Is it ok to now drop the K- restriction? Or should we honor that forever and ever, Amen?

Thanks.

[SMILLER]

The report from 2010 does not say she has anti-K, right? Only that they could not rule it out. So now she is no different than any other patient regarding anti-K. Unless it has been identified in the past, I can see no reason to worry about it now.

Scott

[kirkaw]

Scott, you are correct. Anti-K was never identified, just not ruled out in 2010.

Thanks for your input.

[Yanxia]

If he has anti-K but the antibodies below the test level this time, transfuse K pos cells can stimulate the memory immune.

[Malcolm Needs ☆]

I notice that the patient is female. If she is of "child-bearing potential" (as I've said before, a hateful phrase, but in vogue) then I would give her K- blood anyway, on the grounds that she is obviously a "responder" and you don't want her to make anti-K, as this is a pretty nasty antibody in pregnancy. If she is beyond "child-bearing potential" (a phrase that makes you sound like you are talking about cattle!), then it is not so important.

[Eagle Eye]

we would continue to give K- because 1st it is easy to find and second she is reponder.

Not based on her pregnancy status.

Malcolm, in US we do not practice giving K- to OB patients (as far as I know!!)

[Malcolm Needs ☆]

Thanks aakupaku. Malcolm, in US we do not practice giving K- to OB patients (as far as I know!!)

That rather surprises me, to be honest, particularly as K- is so easy to come by and anti-K can be so horrible in terms of HDFN.

[PAWHITTECAR]

Malcolm,

We are but a small backward nation where transfusion medicine is concerned.

[Malcolm Needs ☆]

Malcolm,

We are but a small backward nation where transfusion medicine is concerned.

I couldn't possibly comment Trish!.....but I don't happen to agree with you.

:highfive::highfive:

[Mabel Adams]

I have seen many OBs with anti-K through the years but so far, no HDFN. All babies have been K neg so far. It helps that they transfuse these ladies less readily than in the early 80s. Is there cost/benefit data on this practice in the UK? Or maybe they don't have to worry about cost so much. I wonder why it is not a practice in the US. Maybe once molecular testing of donors gets more affordable and common, they will label units as K neg/pos and it will be easier to implement.

[Changezi]

I notice that the patient is female. If she is of "child-bearing potential" (as I've said before, a hateful phrase, but in vogue) then I would give her K- blood anyway, on the grounds that she is obviously a "responder" and you don't want her to make anti-K, as this is a pretty nasty antibody in pregnancy. If she is beyond "child-bearing potential" (a phrase that makes you sound like you are talking about cattle!), then it is not so important.

Agreed with Malcolm , for female with child -bearing age we alway use K- blood

[Malcolm Needs ☆]

I have seen many OBs with anti-K through the years but so far, no HDFN. All babies have been K neg so far. It helps that they transfuse these ladies less readily than in the early 80s. Is there cost/benefit data on this practice in the UK? Or maybe they don't have to worry about cost so much. I wonder why it is not a practice in the US. Maybe once molecular testing of donors gets more affordable and common, they will label units as K neg/pos and it will be easier to implement.

The honest answer to your question about a cost/benefit analysis is that I don't know. What I do know is that they also do this in The Netherlands, so it is not just us, which makes me think that there must have been a cost/benefit analysis done at some point.

[R1R2]

We have some physicians that order K negative blood for women of child bearing potential. I think it is just a matter of time that this will be the norm in the US.