1), one reference lab claims like this: because the new anti-E was identified this time which is not showing in 3 days ago workup, this is a delayed transfusion reaction. Note: pt transfused red cell 2 days ago, this time DAT negative. no elution done at reference lab due to neg DAT.

2) One prestigious author in AABB publication claims like this: delayed transfusion reaction occurs only if the new allo antibody shows in eluate.

Which is right? I prefer to the 2nd.

Only the formation of a new antibody can not be the definition of a transfusion reaction.

For a reaction you need clinical signs.

I my experience you speek of a delayed reaction, when there is a drop in Hb 7 to 10 days after transfusion because the antibodies are formed on these units. Mostly they will be pressent in the eluate but they dont need to be.

Peter

I agree with Peter. The definitions that you quote seem to be more in tune with a delayed serological reaction, than a delayed haemolytic reaction.

If a new antibody specificity has been identified, even in an eluate, but there are no clinical sequalae, such as the drop in Hb that Peter cites, then it is not a delayed haemolytic transfusion reaction.

It can, however, be defined as a transfusion incident or accident

I agree with Peter. The definitions that you quote seem to be more in tune with a delayed serological reaction, than a delayed haemolytic reaction.

If a new antibody specificity has been identified, even in an eluate, but there are no clinical sequalae, such as the drop in Hb that Peter cites, then it is not a delayed haemolytic transfusion reaction.

I agree whole heartedly with Peter and Malcolm, without clinical symptoms all you have is a delayed serologic reaction.

What reporting should be done for a serologic response only?

Acute transfusion reactions are noticed/ordered from the nursing unit. How do people order and report delayed transfusion reactions which are discovered by the laboratory?

Right now we only report clinical delayed transfusion reactions when clinical symptoms and/or errors in pretransfusion workup and/or when suspicious specimen obtained from new Crossmatch specimen is received.

What reporting should be done for a serologic response only?

Acute transfusion reactions are noticed/ordered from the nursing unit. How do people order and report delayed transfusion reactions which are discovered by the laboratory?

Right now we only report clinical delayed transfusion reactions when clinical symptoms and/or errors in pretransfusion workup and/or when suspicious specimen obtained from new Crossmatch specimen is received.

We just say that there is a possibility that there could be a DHTR, and suggest that the patient be monitored for such parameters as Hb, bilirubin, haptoglobins, LDH, etc, and to watch for clinical signs.

In other words, we put the thought into the clinician's mind, but leave it up to him or her as to whether they want to go down that route or not. It is up to them to make a diagnosis - we can only point out the possibility.

It can, however, be defined as a transfusion incident or accident

I'd go with incident Anna, but not sure I'd go with accident.

If it were a delayed serological transfusion reaction, I see it as no more than an incident.

If it were an anamnestic response, resulting in a mild (or even severe) DHTR, then I would call it an accident (on the grounds that the antibody was not detected during pre-transfusion testing - unless the testing was badly performed - in which case it is actionable).

Mind you, it could be argued (and probably will be!!!!!!!!!!!!!) that I am being semantic.

Edited October 12, 201113 yr by Malcolm Needs
I wrote a load of rubbish!

I agree with Malcolm.

The formation of antibodies after a transfusion is a side effect of transfusion that is hapening in some patients. In a normal transfusion practice (where everybody is doning what he/she has to do) the formation of antibodies can only be seen as an incident, no accident.

Beside reporting the findings to the MD, in the Netherlands it is common to report new antibody formation to the TRIP registration (the dutch version of SHOT in the UK).