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Unidentified antibody noted on RBC &/or FFP/PFP from Blood Center


cmontgomery
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Do other Transfusion Services/Blood Banks receive products (RBC &/or FFP/PFP) from their blood center with a notation that the product has an unidentified antibody in it?

I have not come across this situation in the past 20 years of working in other hospitals where I receive products with this sticker on it. 

I have even received one O Negative RBC with a notation that the donor has Anti-D.

Has anyone else experienced this type of situation?

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Do other Transfusion Services/Blood Banks receive products (RBC &/or FFP/PFP) from their blood center with a notation that the product has an unidentified antibody in it?

I have not come across this situation in the past 20 years of working in other hospitals where I receive products with this sticker on it. 

I have even received one O Negative RBC with a notation that the donor has Anti-D.

Has anyone else experienced this type of situation?

 

For Red Blood Cell products this is a common occurence with many blood centers and is approved by the FDA if it includes the labeling with the antibody specifity.  Plasma products cannot be labeled/distributed for transfusion in the US if an antibody is detected regardless of the specifity..

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Thank you for your responses.

 

I will use the RBC labeled "Unidentified Antibody" unit for training and competency among students and 12 techs.    We get 5 or 6 of these labeled units in ~10,000 units received.

 

To clarify, the plasma that are labeled unidentified antibody are always used for research, student and tech competency and for a university upon request. 

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We have been known to use O negative RBC units with antibodies when the blood supplier can't provide units without antibodies. We would only use them when we absolutely had no other option, usually around a major holiday. Most would be Anti-D and remember there is not much plasma on a RBC. We need blood and the supplier can't give us with what we need. We used to wash these but we got rid of our washer years ago to keep the FDA at arms length.

 

We would place a note in the patient's BB comment so if the patient's screen was positive a short time later we would know it wasn't a real antibody. Not great but you do what you have to do for bleeders. I would rather give an Rh negative person a unit with anti-D which will be diluted in the body and not cause an issue than have to give them an Rh+ unit.

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We routinely receive red cell units from donors with antibodies. They are transfused to patients who have the same antibody (saves time screening for antigen negative units) or to patients who need a one unit top off and who are unlikely to be seen again within the next 2-3 months (avoiding the possibility of having to do an antibody ID for a passively aquired antibody). The O Neg units with antibodies are considered for trauma patients, based on the 'rules' below. You do want to make sure you get a specimen prior to infusion or as the first unit is just starting to run to avoid a possible positive antibody screen.

 

We do not transfuse these units to children or OB patients because we don't want to risk the possibility that there is enough antibody present to harm a patient with a very small blood volume (child or fetus). In adults, the small volume of antibody in an Adsol unit from one donor is going to be very dilute. We also don't give them to frequent fliers and oncology patients - again, we don't want to have to do an antibody ID workup for a passively aquired antibody.

 

We've been using these units for maybe 3 years. In that time we've gotten one patient back soon enough that we got a positive antibody screen (and we are using an Echo, so very sensitive method in use). We make sure that we document when patients receive an antibody positive unit with the identity of the antibody present, so we know what we've got in cases like that. Otherwise, no issues.

 

See Large-scale use of red blood cell units containing alloantibodies, Immunohematology, Volume 16, Number 3, 2000. This was published by folks at Duke University.

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  • 1 month later...

Why is your blood supplier even sending you those types of units? You cannot transfuse FFP from a donor who has an antibody, but aside from that, your blood d supplier should not be sending your facility those type of units. My old hospital had its own blood donation center, and we NEVER sent the other hospitals that purchased blood from us, units that came from a donor with an alloantibody.

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Our donor center will fax a list of their LR RBC inventory - listing the ABO/Rh of the unit, and the antibody(s) for each.

We can request any of these units, if we can use them and avoid wastage.

We have a test protocol, the patient must be negative for the corresponding antigen, and a full crossmatch is required.

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  1. I work at a blood center that collects thousands of donations a month. We have our fair share of antibody positive donors who are regulars.  Whenever we identify a positive antibody unit, we work hard to identify the antibody. If the antibody can not be identified, we discard the whole unit. We discard all plasma products from antibody positive donors.

We service multiple hospitals, some small and some very large ones. With that being said, only ONE of those hospitals will take these positive units for transfusion and it is frustrating. Thanks AMcCord for shedding light on your usage of such units. It was so very refreshing. :D

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