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What to transfuse?


John Eggington

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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
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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?

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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
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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.

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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?

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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.

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  • 3 years later...
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

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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.

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  • 1 year later...

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