Jump to content
Sign in to follow this  
John Eggington

What to transfuse?

Recommended Posts

Patient is D-C+c-E-e+, Hb of 70g/L. Llikely to need on going transfusion support. The patient has had one previous transfusion episode (when no antibodies were detected), about 3 weeks ago. They now have anti-c, anti-Fyb and anti-M (the anti-M is reacting at 37C, but only with M+N- cells, at the moment). There are 2 frozen units that are r'r' Fy(b-) M+N+, after that there are no more r'r' Fy(b-) units. Do you transfuse R1R1 Fy(b-) M- that are fairly easily found, or use the r'r' Fy(b-) M+N+ units?

Edited by John Eggington

Share this post


Link to post
Share on other sites


I would go for the r'r', because that gives us time to get in more r'r' donors.  If you give R1R1, sounds like the patient will make an anti-D (as they appear to be a strong responder), and then we could be in trouble.  Have you tried any other frozen blood banks other than ours John?  Amsterdam?

Share this post


Link to post
Share on other sites

Not tried other blood banks, yet. There appear to be only 5 r'r' Fy(b-) K- (all M+) UK donors, all eligible to donate now (most haven't donated since last year). To 'complicate' matters, the patient appears to be a partial D, rather than straight forward D-. The strong DAT pos (eluted anti-c and anti-Fyb), made the ALBA panel results a little difficult to interpret (haven't CD treated cells, just sent it straight to IBGRL). ALBA results make it appear to be a DVI, but (limited) genotyping of D gene, looking for D exons, 1, 5, and 10, shows all 3 are present. So if it is a DVI, it's not a straight foward one! I guess the real problem is, how will transfusion support be managed in the longer term. Maybe it'll turn out there are 2 variant genes, and one is a weak D type 1, 2 or 3 (with even weaker antigen expression because of the 2 Ce genes)!

Edited by John Eggington

Share this post


Link to post
Share on other sites

The best way to describe this a 'Friday afternoon case', so I'm sure that option will be looked in to. The problem here is that it doesn't involve the usual type of rare problem, like a high frequency negative phenotype or a null phenotype, where family members are likely to be good candidates for having the same phenotype.

Share this post


Link to post
Share on other sites

This is way out of my league but if you avoid exposing him to the D antigen (and he is negative or partial D) then you always have that as a backup plan if he is ever in a life-threatening emergency.  Once he has made anti-D, in an emergency, you would just have to choose which antibody the blood you give him would be incompatible with.  The main problem with this logic is that I have almost never seen my chronic transfusion patients become traumas or bleeding emergencies.  The one exception was a guy who got stress ulcers and started GI bleeding right before he died after years of transfusion support. Fortunately he had only an anti-Chido as I recall.


What did you end up giving him?

Share this post


Link to post
Share on other sites

No transfusion, so far. I believe that EPO is being administered. It does seem likely the patient will need transfusion at some point, the clinicians have a bit more time to think about it. Still awaiting full resolution of the D type for 'fully informed' decision. Hopefully we'll have all the information in place before transfusion is required.

Share this post


Link to post
Share on other sites
On 18/10/2014 at 6:30 PM, John Eggington said:

The strong DAT pos (eluted anti-c and anti-Fyb), made the ALBA panel results a little difficult to interpret (haven't CD treated cells, just sent it straight to IBGRL).

Can anyone explain what the CD treated cell test is ? Thanks

Share this post


Link to post
Share on other sites
On 2/3/2018 at 11:11 AM, Tabbie said:

Can anyone explain what the CD treated cell test is ? Thanks

CD = chloroquine diphosphate. A chemical treatment to remove immunoglobulins from red cells, in the hope of getting a negative DAT, thereby allowing the use of antiglobulin-reactive antisera without interference from a positive DAT.

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now
Sign in to follow this  

  • Advertisement

×