Hi Geniuses!

Please enlighten me - how do you do your initial xmatch for a patient highly suspected of PCH? (DL Ab test in progress as we had to send away the sample)

Do you perform IAT or electronic xmatch and call it a day? Thank you!

If it was that urgent a case, I can't see what else you can do, because thawing a pp unit that may not be necessary would be a terrible waste.

Edited August 1Aug 1 by Malcolm Needs
For some reason, I put Adult ii, rather than pp. I'm getting old!!!!!!!!!!!!!!

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

@Malcolm Needs thanks for the response I am thrilled! The ii confused me a bit 😅. Getting old but sharp as ever! Patient is a 2 yr old child with C3d strongly positive. Unfortunately we don’t have the means to type for P and the transfusion was deemed urgent. The true headache here is there is differing opinions on whether to perform IAT or proceed with an electronic crossmatch and my supervisor believes on the latter, hence, informing the haematologist that IAT is unnecessary.😪

Thanks for that @aurum79 . With those symptoms, unless you are using an anti-IgG, rather than a broad spectrum AHG, I think I would also go for electronic issue, rather than IAT at 37oC, because there may well be a lot of activated complement in the patient's plasma/serum.

@Malcolm Needs yes, sorry I missed the part of using anti-IgG for IAT @37deg.