Is a patient who forms a clinically insignificant antibody considered a responder?

[jmphil4]

Our current policy for transfusing our sickle patients is to honor their Rh and Kell phenotypes until they form a clinically significant antibody. At that point we will honor their full phenotype as they are considered a responder. But if they form a clinically insignificant antibody, we continue to honor only the Rh and Kell phenotype. Are only patients who form clinically significant antibodies considered responders?

 

This has become a topic of conversation at our hospital and no one is sure what the correct answer is. If any one has any info that would shed some light is would be greatly appreciated!!    

 

Thanks!!

 

(Also, if you have any articles siting this it would be even better!!)

[Mabel Adams]

Oh, that we understood the immune system well enough to make a good judgment--and even more so could assume that "one size fits all" when making predictions of how a patient's immune system will react.  Your policy sounds like something that is intended to broadly separate the extremes knowing that it won't be perfect for people in the middle--like those that make insignificant antibodies.  But I am no expert--maybe there is more known than I think.

[jmphil4]

I know we can't know how each individual will respond to each unit, but is there any research out there that says patient with clinically insignificant antibodies don't usually form a clinically significant antibody?

[SportsFan]

There was a recent paper in Transfusion May 2013 which discussed antibody of undetermined specificity. There was also an accompanying editorial. May be useful and help answer your question.

[jmphil4]

Thanks!! I looked at the article and am not sure it applies. We treat our antibodies of undetermined specificity as clinically significant and will always provide AHG crosmatched blood even if the antibody is not showing (for our sickles we would honor their full phenotype). But in the case of an identified clinically insignificant (M, Lea, etc) we would not honor the full phenotype and I'm curious if there is any clinical evidence that confirms that. Since the point of honoring the phenotype of a patient with a clinically significant antibody is that they're a responder and now that they've formed one you don't want them to form any more, why would the formation of any antibody (significant or not) not indicate the patient is a responder.

 

My thought is that the immune system doesn't know we label certain antibodies as clinically significant, so what's the difference?

 

Thanks!

Edited October 8, 2013 by jmphil4

[Auntie-D]

All our sickle patients have fully phenotyped blood from the start. The resoning for this is that due to the ethnicity, often there are of a blood group that we have low levels of stock. To further compound this with uneccessary antibodies seems silly... We ABO K and CDEcde them