Our blood supplier wants us to use packed red cell units from donors with known, clinically significant red cell antibodies. What do we need to do to be able to use these units? Should we type our recipient for the corresponding antigen? Should we crossmatch the units thru AHG? Should we even accept these units?

If the units are just plain ol' rbcs I would not want to use them - too much residual plasma. If they are additive solution rbcs the residual plasma is very small - I don't think there would be a problem with transfusion. If you do use them you might want to document the ab on your pt record.

I agree with David.

And don't give them to babies?

We will wash it before use.

Ok, so you know these have antibodies, what about those units that you do not know about.

I am not sure, but we do not usually worry too much about these units. We once asked our blood center about it once, and it has more to do with labeling requirements than otherwise. The point being that plasma from these "known AB" patients is not to be used for transfusion.

I believe that the little bit of residual plasma is not supposed to be an issue with patients even if they are Ag positive for a particular AB. If I am mistaken about this, I would like to see a reference.

Scott

Ok, so you know these have antibodies, what about those units that you do not know about.

FDA requires units from donors with abs to be labeled with the ab.

Blood centers often do antibody screens in pools of 5 or 10 donors so the antibodies have to be pretty strong to be detected to begin with. I am sure there are weaker ones that aren't detected. Maybe that is what is meant by those that you don't know about. I guess there could also be antibodies to low frequency antigens, but the odds of the patient being antigen positive are, by definition, low.

One blood center I worked at labeled pRBCs from antibody-positive donors with a tie tag indicating "contains small amount of anti-_". Customers did not complain or return those products.

I'm pretty sure it was a talk at AABB where an organization shared the fact that they actually kept antibody-positive plasma for transfusion as well. The product was labeled with the antibody it contained, and they just made sure the patient was negative for that antigen.

Agree with many of the other responses....most units these days are drawn in Adsol; there is "for all practical purposes," no plasma left on these units (but may be a tiny bit so not for babies; but them many Pediatricians don't want Adsol units anyway).

If drawn in CPDA-1, would wash them.

Brenda Hutson, CLS(ASCP)SBB