It was always my understanding that for "clinically significant" Antibodies for which a commercial Antisera is available, you were expected to screen the units; not just perform crossmatch-fo-compatibility. The antibody is demonstrating W+ only.

I know there are some Antibodies for which you just "crossmatch for compatibility" (i.e. Leb, P1, N; sometimes, Lea, M. But Kpa is clinidcally significant and I feel it best to screen." Problem is, we do not store that antisera.

But then there is always an argument to be made for the fact that not all panels even have a Kpa+ cell on them; so we could be missing them every day unless they are demonstrable and lead to an incompatible crossmatch.

As an aside; I did call the Donor Facility we received the blood from, asking them if they kep the pilot tube so they could screen the unit (we had) for Kpa. First, they said they did not keep pilot tubes. Then I asked, "what about a segment?" They have got to keep something until it expires!

Am interested in feedback for this.

Thanks

Brenda Hutson, MT(ASCP)SBB

I have a few pts with anti-Kpa in the area so I keep the antisera on hand. The Red Cross used to keep segs on units but when they consolidated, that particular benefit disappeared (all the blood goes to Dedham - you might try contacting them to see if they save anything).

Good luck.

It was always my understanding ...........As an aside; I did call the Donor Facility we received the blood from, asking them if they kep the pilot tube so they could screen the unit (we had) for Kpa. First, they said they did not keep pilot tubes. Then I asked, "what about a segment?" They have got to keep something until it expires!

Am interested in feedback for this.

Thanks

Brenda Hutson, MT(ASCP)SBB

Sample retention requirements for red-cell containing components apply to the facility performing the transfusion-service-related activities and the requirements are for 7 days after transfusion not until expiration of the product (see AABB BBTS Standard 5.11.4). There are no requirements for a collection center to retain samples of units collected and distributed (unless the colletion center is also performing the test of record transfusion-service-related activities, e.g., compatibility testing).

Like David, we have some repeat customers with the antibody so we keep the antiserum on hand. I also have some homemade antisera (anti-Wra) that we will use with pos and neg controls as with any other antiserum. If we lack the antiserum, but the patient's antibody is reacting with an antigen-positive cell, we go with crossmatch compatible. If the patient's serum is not reacting, or, more frequently, we don't have an antigen-positive cell to test, we see if we can get an antigen-negative unit from our local blood center, which is just a few minutes away. If they can't help, we give crossmatch compatible after the MD has signed a release form. So we do what we can within our resouces to ensure the safest transfusion possible.

The point is well taken that we "miss" a lot of antibodies anyway because the screening cells are negative for Wra, Kpa, Jsa etc, and we do electronic or IS crossmatches.

Brenda, could you do a little co-op with your neighboring hospitals and take turns buying the vial of anti-Kpa? Or define it as "rare" according to CAP and use it past its expiration date?

In the UK, it is NOT regarded as a clinically significant enough antibody to require tested Kp(a-) blood.

In other words, the BCSH Guidelines state that cross-match compatible blood is perfectly sufficient.

By the way, I know that there was a case of delayed haemolytic transfusion reaction due to anti-Kpa reported in Immunohematology not so long ago, but from what I can remember, in this case, the anti-Kpa was not detected in the screen (screening cells Kp(a-)), and the units were not fully cross-matched (although my memory could be playing me tricks).

Here is the link:

http://a1881.g.akamai.net/7/1881/26640/v0001/redcross.download.akamai.com/26640/pubs/immuno/25_2_09.pdf

Thanks aakupaku.

I was going to look for it this morning. You have saved me a job!!!!!!!!!!!