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gagpinks

Rh phenotypes

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Hi all

Just want to know would you always  perform Rh phenotype whenever patient has any antibody other clinical significant antibody and provide Rh and Kell phenotype  match blood? e.g if patient develop anti M or Anti Jka in this case would you do Rh phenotype?. My understanding is you only give Rh and Kell phenotype match blood if patient is sickle, thal, haem patient , AIHA or whenever they develop Rh antibodies.  What does other do?

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According to BSH Guidelines (and work performed by such luminaries as the late Prof Patrick Mollison - who knew a bit about blood transfusion!), those who have already made a clinically significant atypical alloantibody are more likely than others to make other specificities.  It is for this reason that a patient who has made such an antibody is no longer eligible for a transfusion of blood selected by electronic issue (or, as people STILL insist on wrongly calling it, computer crossmatch - GRRRRRRRRRRR!!!!!!!!!!!!).

The more antibodies in a person's plasma, the more difficult it is to sort out all the various specificities, and the more difficult it is to supply antigen negative blood.  As a (former) Reference Laboratory Chief, I prefer either to work on really easy samples, or really, really complex samples, but not on samples with two or three antibodies present, particularly where one or more are avoidable Rh and/or Kell Blood Group System (BGS) antibodies.

Therefore, although not mandated by either the BSH Guidelines, or, indeed, the UK Transfusion Services as a whole, as a personal preference, I would advise that Rh and Kell BGS,antigens are matched (particularly as, if the individual has already produced an antibody - probably from a previous transfusion - although other stimuli are "available" - and needs another transfusion, the chances are that this individual will require further transfusions in the future, if not actually become transfusion dependent).

I fully admit that this is a purely personal point-of-view, however, I would be more than a little annoyed if I was to be sent a sample at 3 o'clock in the morning, to sort out an additional, but avoidable specificity.  It is, however, down to you.

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Malcolm - while I totally understand where you are coming from, in the trenches of the small hospitals antigen typing prophylactically can lead to very increased pricing of red cells (if done from the blood center).  Also, most smaller institutions do not carry reagents for antigen typing, which, if they perform it - albeit rarely - they are supposed to enroll in surveys that demonstrate competencies in doing so (another exhorbitant expense).  Such typing is not mandated in the US of A though I do note that institutions with active sickle programs do perform extended typings due to the fact that these patients are going to be transfused periodically. 

Good question for sure.

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22 minutes ago, David Saikin said:

Malcolm - while I totally understand where you are coming from, in the trenches of the small hospitals antigen typing prophylactically can lead to very increased pricing of red cells (if done from the blood center).  Also, most smaller institutions do not carry reagents for antigen typing, which, if they perform it - albeit rarely - they are supposed to enroll in surveys that demonstrate competencies in doing so (another exhorbitant expense).  Such typing is not mandated in the US of A though I do note that institutions with active sickle programs do perform extended typings due to the fact that these patients are going to be transfused periodically. 

Good question for sure.

I agree entirely David, for the USA and others, BUT, have a look at the flag besides gagpinks' name; it is the Union Flag.  This means that she is working in the UK.  In the UK, all of the units are typed for ABO, D, C, c, E, e, K and, now, Hep E by the various blood services, so there is no added cost to selecting Rh and Kell antigen matched units of blood.

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Yes it's not hard to get Rh and Kell match blood in UK. But sometime it cause delay in providing blood. For instance if patient develop Anti Fya and so if we perform Rh and Kell phenotype as a precaution  , in that case we might not find exact match blood and have to order blood from blood services. We also have some inexperienced staff who don't understand when there is an emergency situation it is not necessary to provide Rh match blood if patient hasn't develop any Rh antibody. It cause unnecessary delay by contacting clinician and Haem reg. 

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33 minutes ago, gagpinks said:

Yes it's not hard to get Rh and Kell match blood in UK. But sometime it cause delay in providing blood. For instance if patient develop Anti Fya and so if we perform Rh and Kell phenotype as a precaution  , in that case we might not find exact match blood and have to order blood from blood services. We also have some inexperienced staff who don't understand when there is an emergency situation it is not necessary to provide Rh match blood if patient hasn't develop any Rh antibody. It cause unnecessary delay by contacting clinician and Haem reg. 

I agree that you should NEVER hold back blood in an emergency situation, just to get the correct Rh and K type when there are no such antibodies present, however, be aware that the next time there may well be Rh and/or K antibodies present too, and the situation could be even more of an emergency.  What do you do then????????!!!!!!!!!!!!!!

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Malcolm, while philosophically I understand the rational to avoid potential future problems, as a general rule I didn't worry about it if it wasn't there.  Of course if an antibody had been identified and then had dropped below detectable levels it was honored (excluding RhIG injections).  I always figured I would worry about it when it showed up. Like you, this is a personnel opinion.  I know lots of blood bankers in the US that would c type (little c) a patient with and anti E and provide c= blood if the patient was c=.  A few facilities even had it written into their protocols.  We had only the rare patient that would require long term transfusion support so unlike areas with a large number of sickle patients it was really not an issue for us to worry about matching phenotypes to avoid future problems.  We simply played the odds.    

Edited by John C. Staley

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Yes I understand if patient is transfusion dependent then of course you give Rh phenotypes matched blood. We use IH1000 and it pick lots of AntiM and nonspecific reaction. In this case it would unnecessary to provide Rh phenotypes matched blood. It is hard draw a line when you have to explain junior staff. 

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23 minutes ago, gagpinks said:

Yes I understand if patient is transfusion dependent then of course you give Rh phenotypes matched blood. We use IH1000 and it pick lots of AntiM and nonspecific reaction. In this case it would unnecessary to provide Rh phenotypes matched blood. It is hard draw a line when you have to explain junior staff. 

I agree.  It is a little "sensitive", and under those circumstances, it can be very difficult.

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On 1/20/2018 at 8:03 AM, Malcolm Needs said:

I agree that you should NEVER hold back blood in an emergency situation, just to get the correct Rh and K type when there are no such antibodies present, however, be aware that the next time there may well be Rh and/or K antibodies present too, and the situation could be even more of an emergency.  What do you do then????????!!!!!!!!!!!!!!

That time on you start honoring them...

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What if the emergency o negs are taken for a patient with an anti-c antibody ? What protocols do you have for patients with antibodies who maybe are from another hospital (not on your system) and want for example group specific uncrossmatched ? Do you use concession/declaration forms before they take the O negs/group specific or can they just take them ? 

Thanks

Edited by Tabbie
Adding more

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History is part of the workup--it doesn't matter if the info is from my own system or another hospital's--I would try to get those concession/declaration forms signed after a consult with the attending.

Scott

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