hi for all

we have a patient 17y old had a RTA and got a a fracture in the neck of right femur and he is a known case of IDDM-INSULIN DEPENDANT DIABETES MELLITUS-

O POSITIVE ,we did a x-match for morw than 80 units but all shows incombatible ranging between weak+ and 1+

we did a panel but it showed positive in all

my quistion is , is there any policy for transfusion the least incompatible blood to the patient and how can we deal with situations like this?

thank you

Did he have a positive DAT and auto draaa?

If he had a life-threatening haemorrhage, you would have to give least incompatible.

If not, you have time to investigate.

Firstly, you could perform a titration, to see if he has what used to be called a high titre, low avidity (HTLA) antibody. If this is the case, you could then try and see if the antibody could be inhibited by ABO compatible plasma. If this is the case, then the antibody is almost certainly anti-Ch or anti-Rg. Neither of these specificities are clinically significant, and so, as long as there are no other underlying antibodies, incompatible, let alone least incompatible blood can be safely transfused.

The other thing you could do is perform a full phenotype to see if he lacks a high frequency antigen, such as Lu(.

To be honest, with these weak reactions, whatever the specificity, the chances are that this time the antibody will not be cliniczlly significant, and that least incompatible can be safely transfused, but not necessarily next time.

:):)

What about the AC and the DAT???

are they positive or negative????

When you did the typing there was no discrepancy???

Please answer these questions then we can say something

have a nice day

Hi ashshaq

It showed a clear O positive in the gel card

DCT was negative and ICT was positive +1

I always felt that "least incompatible" was like saying you are " a little bit pregnant".

We no longer call units least incompatible for that reason.

With a negative DAT, I would be more concerned about either a HTLA or an antibody to a high frequency antigen, as Malcolm has already suggested.

I always felt that "least incompatible" was like saying you are " a little bit pregnant".

Great analogy, David! We got rid of the term "least incompatible" a long time ago. It really only gives the physician a false sense of security that "this" unit would be less risky than "that" one, which has yet to be scientifically proven. We call it incompatible and have them sign.

In the case of a massive bleed, this is the least of this patient's problems, have the physician sign, and give the units.

After reading this thread I need to look at our SOP's to check the terminology. We have in place a release that must be signed by the attending physician before issuing incompatible units. Might need to change the mind set a bit for some of the techs here.

After reading this thread I need to look at our SOP's to check the terminology. We have in place a release that must be signed by the attending physician before issuing incompatible units. Might need to change the mind set a bit for some of the techs here.

Here's a good discussion about the term "least incompatible", see attachment.

Least incompatible.pdf

If the titer is > 64, it's most likely a HTLA antibody. At that point we given phenotype specific (same as with warm autos)

Doing a plasma neutralization for Chido or Rogers is a waste of time. It is not necessary to distinguish one HTLA antibody from another, as they are all cllinically insignificant..

If not a HTLA antibody, you should run cells negative for high incidence antibodies, or send to a Reference Lab.

another thing to consider:

If the patient is Black and S=s=, it's most likely anti-U.

I just realized there is no mention of whether this patient has been transfused before, or if female and been pregnant.

If never transfused or pregnant, could be interference from cold antibodies.

Doing a plasma neutralization for Chido or Rogers is a waste of time. It is not necessary to distinguish one HTLA antibody from another, as they are all cllinically insignificant..

I would totally agree with this comment, and it is particularly a waste of time ditinguishing between anti-Ch and anti-Rg, but I work in a Reference Laboratory, and so we tend to be a bit pedantic (okay, very pedantic) about specificities and, of course, our referring hospitals also like to know the true specificity, if possible.

You are quite correct, however, that all such antibodies are clinically insignificant.

:):)

, or if female and been pregnant.

If never transfused or pregnant, could be interference from cold antibodies.

Sorry, but it is mentioned that the patient is a male, so I doubt if pregnancy comes into it!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

:D:D:D:D