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TRANSFUSING CELLS THAT HAVE ANTIBODY ID'D


LIMPER55
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Our supplier has suddenly decided to provide our transfusion service with Leuko-reduced red cells that have antibodies.

Anti-K, anti-c, anti-D some with anti-E.  No titres have been provided.

We do NOT have an SOP about using this product-

Would you please site the literature or standards for using this product?

Edited by LIMPER55
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Before I retired, we used leuko-reduced RBCs with antibody. When we began, we kept extensive records to study if the use of such RBCs caused subsequent problems; they did not. I certainly think O neg RBCs with antibody are suitable for trauma patients since much of the antibody will bleed out. Using these units increases the number of available O neg RBCs. Like David, I wouldn't use them for NICU patients. I might also avoid using them for patients with sickle cell anemia. Since these patients make so many antibodies, I wouldn't want to do anything that could potentially complicate subsequent antibody ID. We had a poster session at the 2010 AABB meeting discussing the impact.

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Having also used them in an earlier life (i.e. when I used to work in a hospital laboratory some time from about 1978 to about 2000 BR [before reference]), I agree entirely with Marilyn in every respect (except, perhaps, I would include any transfusion-dependent with a haemoglobinopathy, as some patients with thalassaemia are also "experts" in producing antibodies)!

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On ‎10‎/‎7‎/‎2016 at 7:20 AM, LIMPER55 said:

thanks, David

I would like to put something about this into an SOP --

Are you also comfortable giving anti-D to a Rh Positive patient? 

We do have a trauma center-stocked with O NEG's--ok to use them their?

appreciate your help.

wouldn't bother me at all

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Our previous blood center used to send us RBC units with antibodies when things were tight, usually around holidays. They asked us before they sent them and we had to OK it. We did not antigen type the patient prior to giving to the patient. The amount of plasma is generally very low and even if the person was positive for the antigen, it shouldn't cause much problem.  We tried very hard not to give to "frequent fliers." We tried to give to patients that were about to be discharged and probably wouldn't be back, e.g. ortho patients. We would also make a note in a comment box that a RBC with "XX" antibody was given on XX date. We could also put in a comment that is attached to the unit when we brought it into inventory.

It can get confusing if you give a unit with an antibody to a patient and then that patient hangs around long enough to need a second crossmatch. It can appear that the patient receiving one of these units has developed an antibody. Then the question becomes "Is this the passive antibody from the unit we gave 3 days ago or is this person building their own antibody?" This didn't happen often since we issued these units to people on the way out of the door if at all possible.

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Many years ago when I was a baby tech, I remarked to the BB supervisor about this. I asked her why I would want to use these units when I had units available that did not have antigen typings available. her response was "Why be concerned because what would you do if you had the same unit but you did not know the antigens on the units?" I have used that thought for approximately 30 years now, but not for my NICU babies.

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On 10/10/2016 at 8:57 AM, DebbieL said:

Our previous blood center used to send us RBC units with antibodies when things were tight, usually around holidays. They asked us before they sent them and we had to OK it. We did not antigen type the patient prior to giving to the patient. The amount of plasma is generally very low and even if the person was positive for the antigen, it shouldn't cause much problem.  We tried very hard not to give to "frequent fliers." We tried to give to patients that were about to be discharged and probably wouldn't be back, e.g. ortho patients. We would also make a note in a comment box that a RBC with "XX" antibody was given on XX date. We could also put in a comment that is attached to the unit when we brought it into inventory.

It can get confusing if you give a unit with an antibody to a patient and then that patient hangs around long enough to need a second crossmatch. It can appear that the patient receiving one of these units has developed an antibody. Then the question becomes "Is this the passive antibody from the unit we gave 3 days ago or is this person building their own antibody?" This didn't happen often since we issued these units to people on the way out of the door if at all possible.

This is pretty much what we do, though we also avoid giving these units to kids and pregnant women. Literature says that hemolysis is unlikely even if the patient has the antigen corresponding to the antibody. As others have said, the amount of antibody present in any given packed cell unit is likely to be quite small.

Only once have we been burned when a patient who received an antibody positive unit was quickly readmitted and showed a positive antibody screen for his next crossmatch.  No problem for him, just a little extra work for us to make sure he didn't have another 'real' antibody and to give antigen negative units. Because we document which antibody the unit had, we know exactly where we need to go with the workup.

A big plus is when your patient has an antibody and needs antigen negative units - Bingo! if you have a unit with maybe anti-Jka, then you've got yourself a nice antigen negative unit without  screening a bunch of donors.

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