My (fairly) small hospital has several oncology services which send over a fair number of patients with warm AIHA. We do the usual work-up including DATs, Ab ID, and elutions to establish a putative diagnosis. We autoadsorb with PEG when applicable, if the patient has not been transfused within the last 3 months, but since the crossmatch is still incompatible "in vivo" we have MDs sign for transfusions. My question is: how often do you think it necessary to repeat elutions showing a panagglutinin...72 hours post transfusion, weekly, monthly? Advice will be much appreciated.

In order to follow the KISS thought process, we stick to the 3 day rule for repeat of antibody workup. Might be expensive but adds peace of mind for the techs and physicians.

My (fairly) small hospital has several oncology services which send over a fair number of patients with warm AIHA. We do the usual work-up including DATs, Ab ID, and elutions to establish a putative diagnosis. We autoadsorb with PEG when applicable, if the patient has not been transfused within the last 3 months, but since the crossmatch is still incompatible "in vivo" we have MDs sign for transfusions. My question is: how often do you think it necessary to repeat elutions showing a panagglutinin...72 hours post transfusion, weekly, monthly? Advice will be much appreciated.

We would only do them about once a month, unless there was a decrease in the time between transfusions suggesting an acceleration in red cel destruction. Even then, I cannot remmeber us detecting a de novo alloantibody in the eluate that we have not detected in the alloadsorbed plasma.

I assume you mean the xm's are incompatible "in vitro", unless you are doing an in vivo xm. . . After you transfuse, do you still do elutions? I would not think that even a "fairly small" hospital would be in a position to perform allogeneic absorptions/elutions using phenotyped R1R1, R2R2 and rr cells. I would repeat every 3 days, but not absorptions.

Edited September 29, 201014 yr by David Saikin
poor grammar

Malcolm,

Thank you. It 's a rare advantage to gain access to the data gained from the number of AIHA patients that your lab has seen.

David,

It's true that we are not a reference lab and don't have the cells needed for allogeneic adsorptions.

We autoadsorb with the PEG procedure, discovered in this forum. We much prefer it to Immucor's WARM which we had been using for years. XM's for warm AIHA patients are usually incompatible with unadsorbed plasma and we call them incompatible. My 'in vivo' reference describes the reality that transfused RBCs cannot be expected to survive normally because of the patient's autoantibody.

Autoadsorbed plasma may give negative antibody screens and XM's. While this information is valuable, XM's are compatible only 'in vitro' and could be misleading to primary care physicians. Our release form states: Incompatible transfusion/compatible with autoadsorbed plasma, and we give each physician a copy of 'A physician's guide to transfusion in autoimmune hemolytic anaemia, written by Lawrence Petz, M.D. Sorry about the confusion.