Does your facility give antigen negative blood prophylactically?

We are a pediatric hospital and we have a 2 tier matching protocol for all chronically transfused patients: (e.g. sickle cell, thal, hgbopathies, etc.) We initially match for Cc,D,Ee,K. If the patient makes an antibody in spite of this basic matching, we then move them into the 2nd tier where we also match for Kidd, Duffy, and S.

Do you have a policy to RH and K phenotype all sickle cell patients?

here's an excellent review of what they do internationally

Vox Sang(2004)87,210-222-International Forum-Red Cell Transfusions and blood groups

Hi Monique

St Lukes and Roosevelt hospital antigen screen for all thier Sicklers and Thal patients. At Beth Israel it's not done unless needed. My problem is that I am responsible for 5 site and standardizing practice. Have you tried explaining this to a Medical Director. Bonnie

We perform such typing on the following patients:

Sickle Cell

WAA

Patients with Anti-E are typed for c. If negative, R1R1 blood is supplied.

All of these great intentions go down the tubes if life saving urgent blood transfusion is needed.

We antigen type our sickle cell patients for all of the major red cell antigens. However we give only Rh and K matched red cell products.

Patient's known to have sickle cell disease are given blood phenotypically matched for the Rh and Kell antigens (antigens most likely to produce a response). The remainder of the phenotype is used as baseline information in the event that the patient does produce an antibody.

If the patient has an antibody and they are found to be R1R1 or R2R2, we match the Rh. :-(

We currently do not prophylactically transfuse antigen negative units but are consideriing doing it for Rh and Kell for children who are sicklers. Appreciate all the comments and the poll

We currently give sickle patients C-,E-,K- units. This is only fairly successfull as other hospitals in our area do not give prophylactic, phenotypically matched units. We have provided phenotypically matched units for two of our sickle patients since they were small children and had been successfull at limiting exposure and antibody formation. All it took was an admission at a facility in our area that did not provide this service and one of them is now sensitized and has formed antibodies to Kell.

We also check patients for little c antigen if they have formed anti-E. If they are negative for little c we provide R1R1 units. I believe it is easier to provide the little c negative units now rather than having to identify any other antibodies that may form after Anti-c. Once that anti-c has formed it can be difficult to find sufficient cells (in our facility) to rule out other antibodies.

I would find it interesting to see what the current practices are in other transfusions centers. Some of my coworkers believe these practices are a waste of their time.