Can anyone share policies regarding transfusing donor units that contain alloantibodies?  We just got a unit in that is labeled as containing anti-M.  We don't usually get in units with antibodies, but I am not very concerned about using this one as long as we avoid giving it to a small child, because most anti-M antibodies aren't very significant.  Am I missing anything? 

Back in the days before Adsol, we used to get units with anti-D sometimes which we made sure went to D negative recipients.  Additive solutions should dilute the plasma somewhat, so there should be less antibody in the unit than in those days.  Then it would get diluted further in the recipient.  Thanks for any modern guidance.

Our policy is to not transfuse to patients with the corresponding antigen (obviously  ) and to wash the unit with Plasmalyte (our standard washing solution).  I realize most places do not have the capability for washing or even centrifugation to remove most plasma.  In that case, I would simply not use it for a patient. If you don't wash it, you then have to make sure the patient isn't transfused with an antigen positive unit later in their course, or at some other hospital.  Too much opportunity for misadventure to my way of thinking.

We do not accept units from our regional supplier from donors with alloantibodies. 

We used to, when I first started working in a hospital, but, since the advent of vCJD, after which we could never be certain whether an allo-antibody had been caused by a transfusion or pregnancy (well, in a female anyway!!!!!!!!!), and so we no longer use a unit for transfusion if an allo-antibody is present in the circulation of the donor.

3 hours ago, Malcolm Needs said:

We used to, when I first started working in a hospital, but, since the advent of vCJD, after which we could never be certain whether an allo-antibody had been caused by a transfusion or pregnancy (well, in a female anyway!!!!!!!!!), and so we no longer use a unit for transfusion if an allo-antibody is present in the circulation of the donor.

Is this approach applied to rare units ? For example, a donor who is Kp(b-), with anti-Kpb in their circulation. Granted, such a unit would probably only go to someone who already had anti-Kpb, so technically there would be no impact (analogous to Mabel's anti-D scenario). Just curious.

25 minutes ago, exlimey said:

Is this approach applied to rare units ? For example, a donor who is Kp(b-), with anti-Kpb in their circulation. Granted, such a unit would probably only go to someone who already had anti-Kpb, so technically there would be no impact (analogous to Mabel's anti-D scenario). Just curious.

In the UK, such a unit would be offered to the National Frozen Blood Bank, and would only be frozen AFTER a thorough aseptic wash, followed by addition of a chemical to prevent the formation of sharp ice crystals, and then  more washing upon thawing.  There would be no allo-anti-Kpb left!

At this facility, we do not have the readily available option of washing units that contain plasma antibodies. The policy has been to only transfuse these units to patients that already have the identical antibody (anti-D in patient and unit). Even though Adsol units contain less plasma, I have seen several examples of passively acquired antibody in post-transfusion samples from recipients of units containing antibodies.

8 hours ago, applejw said:

At this facility, we do not have the readily available option of washing units that contain plasma antibodies. The policy has been to only transfuse these units to patients that already have the identical antibody (anti-D in patient and unit). Even though Adsol units contain less plasma, I have seen several examples of passively acquired antibody in post-transfusion samples from recipients of units containing antibodies.

Just curious but how long did those passively acquired antibodies remain detectable?  We're they ever responsible for a transfusion reaction?  Did they ever cause anything more serious than an inconvenience for the staff?  I really am just curious what the ramifications were, if any.

12 hours ago, John C. Staley said:

Just curious but how long did those passively acquired antibodies remain detectable?  We're they ever responsible for a transfusion reaction?  Did they ever cause anything more serious than an inconvenience for the staff?  I really am just curious what the ramifications were, if any.

By 1967, there at least two examples of an allo-antibody in a unit of blood causing a transfusion reaction with a unit transfused that expressed the cognate antigen, so this phenomenon is not unknown, as Neil Blumberg intimated above (Zettner A, Bove JR.  Hemolytic transfusion reaction due to inter-donor in compatibility.  Transfusion 1963; 3: 48-51, and Franciosi RA, Awer E, Santana M.  Interdonor incompatibility resulting in anuria.  Transfusion, Philad 1967; 7: 297-298, both cited in Race RR and Sanger R.  Blood Groups in Man, 6th edition, 1975, p.302, Blackwell Scientific Publications, Oxford).
Unfortunately, I am no position to answer your other questions.

 

 

1 hour ago, Malcolm Needs said:

By 1967, there at least two examples of an allo-antibody in a unit of blood causing a transfusion reaction with a unit transfused that expressed the cognate antigen, so this phenomenon is not unknown, as Neil Blumberg intimated above (Zettner A, Bove JR.  Hemolytic transfusion reaction due to inter-donor in compatibility.  Transfusion 1963; 3: 48-51, and Franciosi RA, Awer E, Santana M.  Interdonor incompatibility resulting in anuria.  Transfusion, Philad 1967; 7: 297-298, both cited in Race RR and Sanger R.  Blood Groups in Man, 6th edition, 1975, p.302, Blackwell Scientific Publications, Oxford).
Unfortunately, I am no position to answer your other questions.

 

If I'm not mistaken, both of those examples were whole blood units, not packed RBCs or RBCs resuspended in ADSOL. That would impact the amount of antibody transfused.

25 minutes ago, Marilyn Plett said:

 

If I'm not mistaken, both of those examples were whole blood units, not packed RBCs or RBCs resuspended in ADSOL. That would impact the amount of antibody transfused.

Absolutely correct Marilyn.  In those days (1963, I was in infant/junior school and 1967, I had JUST started secondary school) I THINK we were only using whole blood for red cell transfusions, but I wouldn't know for certain.

Malcolm, my questions were directed specifically to applejw and the several examples mentioned.  I was assuming they were fairly recent, at least in the last couple of decades and that info might be available.  In 1967 I was in Jr. High and did not even know there was such a thing as blood banks!

My experience came from transfusing a patient with an Adsol unit that was unwashed containing plasma antibodies.  The patients were transfused with the unit and subsequent sample showed demonstrating antibody - it was more than 5 years ago so I can't remember how long the reactivity lasted. There was no transfusion reaction as the recipient, as I recall, was Rh negative and transfused with a unit containing anti-D.  We could come up with no other reason for the patient to have a sudden appearance of anti-D when only transfused with Rh negative RBC - record check revealed that one of the transfused units contained anti-D.