Hi everyone!!

 

Just wanted to pick some brains about his topic!  I am in a new position (about 1 year now) and I am noticing that the Massive Transfusion Policy does not state anything about how to approach a patient with an antibody.  I just want to get some feedback on what other facilities do - thanks

 

S

11. All necessary testing (antibody screen, immediate spin crossmatches) will be completed as soon as possible. For patients with a known clinically significant antibody, antigen negative red cells will be provided if time allows (if the need for blood is urgent with no time possible for antigen typing, antigen-untested units will be released. When bleeding is controlled, antigen negative units will be given). Also, complete crossmatches will be completed if time allows for the first 10 units of red cells issued. After 10 red cell units, the pretransfusion sample no longer represents currently circulating transfused blood, so only antigen typing of the red cells and immediate spin crossmatches will be performed.

12. Unknown Antibody: For a patient with a positive antibody screen, but there is not adequate time to perform antibody identification, if time allows, type-specific red cell units should be screened for K and Jka before release to prevent the most serious type of hemolytic reaction. As soon as the antibody is identified, refer to step 11.

That's what my policy says...the idea is don't worry about the antibody too much during the massive bleed, but as soon as they start to stabilize and the blood is actually planning on staying inside their body, that's when you want antigen negative units ready.

I thoroughly agree with everything Terri has posted here, but would, also, re-quote some very wise words from Dr. Brian McClelland MD ChB ND Linden FRCP(E) FRCPath, a now retired Consultant Haematologist of the Scottish National Blood Transfusion Service (with a world-wide reputation) that are,

 

"Transfusion has risks, but bleeding to death is fatal."

Corollary to "Transfusion has risks, but bleeding to death is fatal.": I was taught this in med tech school in reference to switching donor Rh type from Rh Neg to Rh Pos: "Better a live sensitized patient than a dead pure one." I don't know who said it first.

And "compatible blood for a corpse is not a triumph."  I think our policy says to make the best judgement possible based on the conditions, time and resources and to notify the pathologist. There are a ton of variables that can go into deciding the best course of action.  I once had a trauma with an anti-e.  That is different than one with anti-K. Even anti-E you can go to Rh neg blood and be pretty safe.

Had a massive transfusion decades ago . . . pt started out with anti-E,-K,-Fyb.   We started surgery with 3 compatible rbcs;  60 rbcs later (within 16 hrs) she was getting anything - no screening.  Eventually had a weak+DAT with the Fyb.  Pt survived to go home.

Had a massive transfusion decades ago . . . pt started out with anti-E,-K,-Fyb.   We started surgery with 3 compatible rbcs;  60 rbcs later (within 16 hrs) she was getting anything - no screening.  Eventually had a weak+DAT with the Fyb.  Pt survived to go home.

Just goes to show what we have experienced where rbc's transfused into an opened circulation does not give the immune system an opportunity to become sensitized.

Our policy is like Terri's.  If multiple antibodies and bleeding, we worry about those that will cause the worst problems with hemolysis and give least incompatible if we don't have time to find antigen negative for all antibodies.