Hi everybody I hope you are all well

when there is no antibody detected in a patient we can transfuse blood by electronic crossmatch that's mean with complete crossmatch.

and if we do complete crossmatch with out doing antibody screening and even the complete crossmatch is compatible this technique is not acceptable because the possibility of producing booster dose for undetected antibodies when we didn't do the antibody screening.

the question is if we give the patient unit of blood without complete crossmatch when there is no antibody detected in the antibody screening, is it possible to produce antibody to antigen which is not found in the screening cells or even acute transfusion reaction to antigen which antibody is actually present?

Thanks

Hi everybody I hope you are all well

when there is no antibody detected in a patient we can transfuse blood by electronic crossmatch that's mean with complete crossmatch.

and if we do complete crossmatch with out doing antibody screening and even the complete crossmatch is compatible this technique is not acceptable because the possibility of producing booster dose for undetected antibodies when we didn't do the antibody screening.

the question is if we give the patient unit of blood without complete crossmatch when there is no antibody detected in the antibody screening, is it possible to produce antibody to antigen which is not found in the screening cells or even acute transfusion reaction to antigen which antibody is actually present?

Thanks

sorry in the first line i meant without complete crossmatch

Donna has explained in reply to your previous thread.

Risk of missing an antibody is very little by AB screen (by commercial cells esp 3 cell panel) vs cross match. Frequency of missing an antibody due to dosage effect in cross match is higher than missing a low frequency or private AB by AB screen.

Few years ago I had a meeting with a German University Hospital Transfusion chief, he was in favour of AB Screen+IS cross match+AHG Cross match, but he had not good reasons to perform AHG cross match, just he said he did not want to leave any chance/risk. Still in some countries it is necessary to do AHG (Major cross match) beside ABS. Some of our senior (old) consultants also wants to perform ABS+IS+AHG, but they agree that AB screen+IS/Computer is sufficient.

I sort of agree with the last poster. I think the answer has to be, it depends where you are. There are strict rules governing which antigens have to be present on antibody screening cells - and these rules are pretty much based on antigens that are relevant to a white European population. So, yes, in Germany, or France or the UK the chances of a problem arising because the patient has a clinically significant antibody to a low frequency antigen that just happened to be present on the unit of blood that was transfused are extremely extremely small. However the screening cells probably won't have antigens like Dia, Jsa, "Mia" on them and in some countries these antigens have a higher frequency, and the antibodies can be clinically significant. Previous posts have discussed this at length, in particular, I remember some very relevant posts by TimOz. My advice would be, if in doubt, perform both the serological crossmatch AND the antibody screen. then, it is important to try and identify the causative antibodies and their frequency

I sort of agree with the last poster. I think the answer has to be, it depends where you are. There are strict rules governing which antigens have to be present on antibody screening cells - and these rules are pretty much based on antigens that are relevant to a white European population. So, yes, in Germany, or France or the UK the chances of a problem arising because the patient has a clinically significant antibody to a low frequency antigen that just happened to be present on the unit of blood that was transfused are extremely extremely small. However the screening cells probably won't have antigens like Dia, Jsa, "Mia" on them and in some countries these antigens have a higher frequency, and the antibodies can be clinically significant. Previous posts have discussed this at length, in particular, I remember some very relevant posts by TimOz. My advice would be, if in doubt, perform both the serological crossmatch AND the antibody screen. then, it is important to try and identify the causative antibodies and their frequency

Thanks, Your explanation justified our ABS+AHG (GEL) but we miss IS at present, considering to add IS since CLIA requirement.

I also completely agree with you Anna, but there are some worries still in the back of my mind (although I know of no cases yet to justify my worries).

As the world shrinks, with air transport becoming much more affordable to all, and we become a "global village", people of differing ethnicities are populating what was once, to all intents and purposes, an area that use to have single ethnicity.

To give you an example, within the UK, we now have a large Black population. Amongst these, obviously, are a certain number of people who suffer from sickle cell disease, and some of these people require regular transfusions. What worries me is not the possibility that they will produce an anti-U or an anti-Fy3 (as these will easily be detected by our screening cells, albeit that providinig blood may be more of a problem), but that one of them produces a strong anti-Jsa (or a similar antibody) that will not be detected by our screening cells. If there are no other alloantibodies present, these patients are eligible for transfusion be electronic issue. The chances are that they will receive blood from a Black donor (as we try to give Ro, K- blood when the patients themselves are Ro, K-) who may express the Js(a) antigen, reulting in a transfusion reaction.

I do wonder if we should serologically cross-match blood for ethnic minorities within our population for just this reason. That having been said, "political correctness" has gone wild, and it is extremely rare to get an ethnic code on a request form (if they are sicklers, one can make an assumption, but if they are "pre-op", one may not), and when the patient also has a "Europeanised name", this may be impossible to do in practice.

Just a thought.

:fear::fear:

In over 30 years of Blood Banking I have not had a problem with the protocol of doing an IS xm when the 3 cell screen is neg. The last 12 years have been where there are large sickle cell populations. The sicklers that I have seen with antibodies to low-freqs always have had multiple other antibodies so one would be doing a full xm anyway. I remember one lady (106 years old) many years ago with anti-Kpa and no other antibodies (not a sickler) but thats about it. So an electronic crossmatch would fit the same critieria.

I sort of agree with the last poster. I think the answer has to be, it depends where you are. There are strict rules governing which antigens have to be present on antibody screening cells - and these rules are pretty much based on antigens that are relevant to a white European population. So, yes, in Germany, or France or the UK the chances of a problem arising because the patient has a clinically significant antibody to a low frequency antigen that just happened to be present on the unit of blood that was transfused are extremely extremely small. However the screening cells probably won't have antigens like Dia, Jsa, "Mia" on them and in some countries these antigens have a higher frequency, and the antibodies can be clinically significant. Previous posts have discussed this at length, in particular, I remember some very relevant posts by TimOz. My advice would be, if in doubt, perform both the serological crossmatch AND the antibody screen. then, it is important to try and identify the causative antibodies and their frequency

Thanks Anna

Thanks for All

In over 30 years of Blood Banking I have not had a problem with the protocol of doing an IS xm when the 3 cell screen is neg. The last 12 years have been where there are large sickle cell populations. The sicklers that I have seen with antibodies to low-freqs always have had multiple other antibodies so one would be doing a full xm anyway. I remember one lady (106 years old) many years ago with anti-Kpa and no other antibodies (not a sickler) but thats about it. So an electronic crossmatch would fit the same critieria.

During a visit to an Emergency department Lab we found that they were issuing red cells by IS x-match only even to sickles, thalassemia and dialysis etc (HB 8-10) patients under the umbrella "it is emergency/stat transfusion "; the pathologist there replied that he is observing this practice from last 20 years and no problem was raised????? Later on pre-transfusion compatibility testing was shut down at that Lab.

Sorry, I have delete my post , because I think it is not relate to this question, I am very sorry.

Edited January 16, 201114 yr by shily

Sorry, I have delete my post , because I think it is not relate to this question, I am very sorry.

To Shilly, I believe such areas do not have hemo-vigilance.