Sickle Cell Transfusion Patients

[pbaker]

Some of our city sickle clinics have closed so we have begun to see an increase in the number of sickle patients we are seeing.  A few of these patients are pregnant.  Some of our physicians are requesting phenotype matched red cell units, "because the patient is pregnant".  Many of these patients have been transfused for years as children with random units. 

What is your standard of practice regarding red cell transfusions?  Do you give full phenotype matched?  Do you give only C, E, K matched?  Do you stock up on their phenotype prior to the patient going into labor?

[Malcolm Needs ☆]

In the UK, we normally give Rh and K matched, as recommended in the BCSH Guidelines.  If the patient is Fy(a-b-), we do not match, as most of them carry the FYB gene, but are homozygous for the GATA-1 gene, which prevents the Fy^b antigen being expressed on the red cells.  Such individuals do not make anti-Fy3, as a rule.  Of course, if they turn out to be a true Fy(a-b-), and they make an anti-Fy3, we give Fy(a-b-) blood.  Similarly, quite a few S- s- individuals are U+, and so we don't give S-, s-, U- blood unless the patient makes an anti-U.

[amym1586]

We keep a shelf for special screened units.  I try to keep  2 O Pos and 2 A pos C E K and Hgb S negative.  

That helps a lot for us. 

[Malcolm Needs ☆]

Sorry, I forgot the HbS- bit!!!!!!!!!!!!!!!!!!!

[goodchild]

We provide Rh and K antigen matched, Hgb S-neg RBCs for every sickle cell patient.

We also conduct a quick history sweep with area hospitals/reference labs, covering at least as far back as the last encounter we had with the patient, or as far back as reasonable/possible for new patients.

We're lucky that we have access to our state's health information exchange, so we can log onto a website and see every hospital/ref lab encounter since 2012 and readily determine who to call.

[DeeMc]

We provide Rh and K antigen matched, Hgb S-neg for PRBC transfusion to all our sickle cell patients. Exchange transfusions also require units < 14 days old.

[Laurie Underwood]

C, E, K and Hgb S matched.

[bxcall1]

We match the Rh phenotype and K, unless the patient has been treated at one of the bigger centers then we'll continue with what they have done.

[goodchild]

Good point @bxcall1

We'll also match transfusion recommendations from the university hospitals who have the resources to simply genotype all of their problem patients.

[Auntie-D]

On 1/29/2016 at 1:09 PM, DeeMc said:

We provide Rh and K antigen matched, Hgb S-neg for PRBC transfusion to all our sickle cell patients. Exchange transfusions also require units < 14 days old.

We do the same for phenoypically matched blood but our policy is <14 days for top up (we always give fresh blood to transfusion dependent patients) and <5 days for exchange transfusion.

Pbaker - we phenotype any patient that is transfusion dependent for two reason. 1) so they don't develop a Rh/K antibody and 2) so that if they do develop an antibody it makes finding suitable blood a lot easier when you already know their phenotype.

On 1/29/2016 at 1:09 PM, DeeMc said:

 

 

[tbostock]

Rh and K matched; more if possible (Jka, Fya) and HgbS negative.