Looking for others in smaller hospital settings encountering DARA patients in blood bank; we plan to send affected antibody screens and crossmatches to our blood center's reference lab for workup and have them send us crossmatched units.  Currently we do not plan to add DTT to our in-house testing, just rely on the reference lab due to the size of our blood bank.   Curious if this is working for others.  In event of emergency, do you release uncrossmatched?  try to do IS XM?   Would like to know what others are doing and how it's working.  Thanks in advance!

Are you planning to request antigen negative units for these patients, assuming that you have antigen typed the patient prior to the DARA treatment initiation?  If so I think this would definitely be the way to go.  If you are not requesting antigen negative units, then you have units already in your blood bank that would be just as compatible as the ones sent from your blood supplier.  As for a true emergency situation, I would think that you would have to do the same as for any patient with incompatible crossmatches.

We'll be sending those problem patients to the reference lab. Our plan is to send a patient sample out for molecular typing prior to administration of DARA so we (and our reference lab) have that information in hand. When we receive a crossmatch order we'll try it on the Echo, then step it down to LISS to see what happens. If we can't rule out the common clinically significant antibodies, it goes to reference. In an emergency, I would try to phenotype match for Rh and K antigens if possible.

After reading a little more on here from reference labs who said not all DARA patients have positive screens right away, we will run a gel screen first, then a LISS screen if the gel is positive and then send it off to the reference lab if the LISS screen is positive.  We only have one patient so far and we got a screen before he started treatment and I was able to type him here for most antigens.  If the screen treated with DTT at the reference lab is negative, we will use electronic crossmatch to issue blood.