We have a 63 year old female, never transfused, 4 children, generally healthy until a few weeks ago, who came in with a 6.7 hemoglobin. Our work up looked like a warm auto, so off it went to the reference lab. It’s not a warm auto. She has anti-Sciana 3! We tested 2 sisters, a brother, and a son and she is incompatible with everyone. Meanwhile samples are in process for MMA testing as well as a search of the rare donor registry. Her hemoglobin has dropped to 5.1 and doc wants to perform a bone marrow to try and figure out what’s going on. She also has a DVT that needs  a procedure but doc won’t touch her until she can get some blood. The MMA results will not be available for another 5-7 days. We have 2 phenotypically matched (except for the Sc3) units that they want to give her under close observation (in ICU). I have read where there have been no reports of hemolytic transfusion reactions with this antibody, but that it may cause a mild delayed transfusion reaction. I’m trying not to lose sleep over this, but as I’m writing this I SHOULD be sleeping, so…..  I do have a question about issuing the blood, IF in fact, we give it to her. We cannot issue it “Least Incompatible,” (which I don’t like anyway) because there is no warm auto. The units are negative by tube at 37 but 3+ at AHG. We have a Special Methods form which we mainly use for warm autos but there is a comment section which would include the units are phenotypically matched (except for Sc3), and a comment regarding the rarity of finding compatible donor blood. The form is sent with the blood when issued. It seems clear to me to issue the units as emergency release because we would knowingly be giving incompatible blood (and they can’t wait for antigen negative donor blood). Does this seem reasonable or is emergency release not warranted in this type of rare situation? I’m getting a little push back about wanting to do emergency release.

Thanks!

Vis-a vis Sc:-3 blood, I remember when I was working as a VERY junior member of staff in the IBGRL Red Cell Reference Laboratory of Dr Carolyn Giles and Joyce Poole, we did a family study following the relatives of an Sc:-3 female in a small village in Papua New Guinea (PNG), and we found six others.  This was at least 40 years ago now, but it may be worthwhile contacting the PNG Blood Service to see if any of them are still donors, or, indeed, if they have found any other such donors.

Wow, thanks Malcolm! I shall give this info to my supplier.

1 hour ago, butlermom said:

Wow, thanks Malcolm! I shall give this info to my supplier.

My pleasure.