Trying to find out what everyone else does:

 

Patient has a history of Anti-e with being unable to rule out C and Kell 5 years ago.

Presently, patient's antibody screen is negative. We would transfuse with e neg full crossmatch compatible units.

Do we also need to give C and K neg units? (It was not identified 5 yrs ago, just unable to rule out). 

Although the e neg units would statistically be K and C neg also, I wanted to know if we HAVE to give those antigen neg units because I think we could charge for the time and cost for the testing if so. 

 

Any thoughts on this? Thanks in advance.

I probably would not worry about the C and K but then, on these kinds of issues, I find that I am usually the outlier and not the norm. 

 

Most of the blood bankers I have known over the years tend to lean more towards the philosophy of; "what can happen will happen therefore what can be done must be done".  I am fairly certain you will not find any hard and fast rules or regulations for this particular situation.

If the patient's antibody screen is currently negative, then that automatically rules out C and K even though they weren't ruled out 5 years ago.  Therefore it is not indicated to give C and K negative units now.  Was the patient transfused at that time (5 years ago?)

What would you do today for a patient with a positive antibody screen and anti-e is identified, but cannot rule-out C and K?

I think you have to select e-neg, K-neg and C-neg red cells for crossmatch/transfusion regardless of the results of the antibody screen.

Edited February 8, 201510 yr by Dansket

I agree with Dansket, patient will receive e,C,Knegative blood forever and ever regardless of what is "showing" or "not showing" now.       

Current screen is negative so e- AHG crossmatch compatible unit.

 

If screen was positive today I would give C-,K-,e-  AHG crossmatch compatible units.

I'm sorry Whitney Poplin, but I disagree with your post.  Just because the antibody screen is currently negative does not automatically rule out anti-C and anti-K, for the very reason that it does not rule out the known anti-e; that is also not detectable at present.  From the logic of your post, you could, therefore, also rule out the known anti-e, and give e+ units.

 

No, the anti-C and anti-K should have been ruled out properly in the first place in my opinion.

 

Now, because this was not done, you would have to honour the potential anti-C and anti-K, in case either of these "phantom" antibodies cause a transfusion reaction, due to an anamnestic responce - and, of course, the same applies for the "real" anti-e.

See!!!!  What did I tell you!  

I would think that the likelyhood of a patient, given e negative blood, would develop anti-C is slim.  However, I agree with most here that it does not matter in this case.  If any significant antibody cannot be ruled out, you must screen for it.

 

Scott

I would also give negative for all three; at least to prevent them making new ones.

Me too, screen for all three and do the usual full crossmatches. You have only your own behind to kick if anything at all goes wrong with the transfusion whether immediate or delayed.

Yeah ..... I obviously didn't think that one through. Probably hadn't had enough caffeine yet.

I would give C- e- K- units forever!  you don't want this guy making more antibodies

To play devil's advocate.

 

So let's say this patient's initial AB ID panel where they were unable to rule out anti-C and anti-K also had those randomly positive panel cells for Jsa and Kpa. Should they have sent samples to the reference laboratory for Jsa/Kpa to be ruled out; should they be required to always get C-, e-, K-, Kpa-, Jsa-neg RBCs for all future transfusions?

Personally, I would say no godchild, although I can see your point.

 

I base my answer on a paper/editorial written some years ago by the late, great George Garratty on the subject of whether we should worry about such antibodies when performing electronic issue after a clear antibody screen.  I don't have the paper to hand at the moment - they are all at work, but I am at home, and out at a meeting tomorrow, but will post the reference as soon as I can - but he clearly didn't think there was a need.

 

I know there was a paper in Immunohematology not too many years ago about anti-Kpa causing a severe delayed haemolytic transfusion reaction, but, iif you read it closely, the word "severe" was a little bit of an exaggeration!

Was antigen typing done on the patient for K and C at the time the anti-e was identified? When was the patient last transfused? Can you antigen type them now?

Stupid question possibly, but has the patient been phenotyped?

I would assume if someone says unable to rule out C and K that phenotyping was done, but the patient was negative (but you know what they say about assuming!!!).  But, I would give any patient with an anti-e phenotypically matched blood for Rh and K - even if ruled out. 

I would assume if someone says unable to rule out C and K that phenotyping was done, but the patient was negative (but you know what they say about assuming!!!).  But, I would give any patient with an anti-e phenotypically matched blood for Rh and K - even if ruled out. 

 

Why? If you have a known K-positive patient why not just get rid of the K-pos blood on them, rather than giving it so a K-unknown male/older female?

Why? If you have a known K-positive patient why not just get rid of the K-pos blood on them, rather than giving it so a K-unknown male/older female?

 

I don't believe AuntiS meant to give antigen negative if the patient was positve for those antigens, but rather if cells weren't available to rule the antibodies out. That is our practice too, especially with the C, considering most units that are e negative will also be C negative.

 

If the patient is K positive we would not of course not worry about giving K negative units.

Yes  pt was typed C, K neg and was given 2 units (5 years ago). Thank you all for the posts and I did end up giving e,C,K neg units but wasn't sure if I was overdoing it or not.

 

But like Malcom Needs said I wish the C and K would have been ruled out initially!

I don't believe AuntiS meant to give antigen negative if the patient was positve for those antigens, but rather if cells weren't available to rule the antibodies out. That is our practice too, especially with the C, considering most units that are e negative will also be C negative.

 

If the patient is K positive we would not of course not worry about giving K negative units.

That's exactly what I meant Teristella.  Thanks for clarifying it for me

s

Hi godchild,

 

The Editorial to which I was referring was;

 

Garratty G.  How concerned should we be about missing antibodies to low incidence antigens?  Transfusion 2003; 43: 844-847.

 

It's well worth a read, in my opinion.

I'm inclined a bit to lean with John and Whitney.  I have read that there are probably many patients who make antibodies which are no longer detectable by the time we next test them so we blithely give units, not realizing that we could be stimulating an anamnestic response because we have no record of them ever having a positive antibody screen from the primary response.  In such a case we would not be honoring any antibodies, but serologically it is similar.  The patient was transfused and is thought to lack antibodies and yet we did not test them every day for 3 months after their transfusion to make sure that they did not make an antibody which is now not detectable. 

 

I probably would honor the C and the K because it is easy to do so in this case and it is worth avoiding additional antibodies in someone so hard to find blood for.

 

Still, it is good for the soul to disagree with Malcolm occasionally.

Did you antigen type the patient 5 years ago for C and K? 

We would give e, C and K negative units if they are antigen negative regardless antibody screen results now.