Arno

If a transfusion is required and urgent (severe symptomatic anemia), a X-match in IAT at 37°C may be tested. You do not necessarily need P-negative blood (very scarce) unless severe transfusion refractory anemia which would support the need of P negative units. For transfusion, patient should be placed in a warm environment and ensuring that the transfused blood is (pre)warm as well. Hereunder are some references: Clinical and epidemiological features of paroxysmal cold hemoglobinuria: a systematic review - PMC Autoimmune Hemolytic Anemia and Red Blood Cell Autoantibodies | Archives of Pathology & Laboratory Medicine

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Is there any risk of contamination of the screening red blood cells (stroma) with proteolytic enzymes (e.g., papain, ficin) on these systems ? From a diluent used for other assays (some antigen typing tests or antibody screening with enzyme treated cells)?

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For acquired maternal IgG antibodies (which may also be transferred postnatally through breast milk), assessing the antibody specificity (AbS) in the newborn, as previously mentioned, appears to be a reasonable approach. In addition, the Direct Antiglobulin Test (DAT) remains key, and performing an elution is important (even if the DAT result is negative). In your case, the negative DAT suggests that either the anti-N antibody did not cross the placenta, possibly due to being a naturally occurring IgM, and/or the baby is N-negative.

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