We have a patient who has both a cold and a warm autoantibody.  It has been difficult to get a complete adsorption.  Her HEA shows she is negative for Joa.  Has anyone had patients negative for this, and if so, what transfusion practices did you follow? 

Thanks.   

I have seen one in a hospital setting (she was pregnant).

Her antibody was very weak (and no Jo(a-) blood was available in the UK anyway, apart from a couple of units of Gy(a-) that we ahd frozen down) and, if she had required transfusion, we would have been quite happy to have given "least incompatible).

As far as I know, anti-Jo^a has never been implicated in a clinically significant transfusion reaction (and certainly not HDFN), although it was reported that one patient, when trialed with radio-labelled red cells, destroyed Jo(a+) red cells more rapidly than Jo(a-) red cells.