A British blood banker wishes to ask the following question about current policies for informing patients when pre-transfusion testing has shown that their blood contains red cell antibodies. Is it standard practice to give patients an information sheet/antibody card? If antibody cards are provided are they given only when the antibodies are clinically significant or for all antibodies? The British blood banker would also like to know whether donors who are found to have red cell antibodies are informed.

1. In reponse to the above question, a blood bank physician in California reports that his blood collection center informs all of their donors if they are found to have clinically significant red cell alloantibodies. Notification is done via a letter explaining to them the significance of the findings (and including the specificity(ies) of the antibody(ies)). With regard to the hospitals that the blood center services, the hospital policies vary regarding patient notification of clinically significant red cell antibodies. Some hospitals do not routinely inform their patients who have such antibodies, although most will make an exception for patients with certain very rare antibodies (e.g., anti-Gerbich). When the blood center's reference laboratory identifies very rare alloantibodies in samples referred by local hospitals, it is always recommended, in writing, that the patients be notified of these findings, and that other appropriate follow-up (e.g., autologous blood donations) be carried out, if medically indicated.

ADDENDA April 29, 2002

2. A blood banker from the United Kingdom wrote that she was surprised that no-one has raised the issue of white cell antibodies in donors, especially since the web site has been highlighting the issue of TRALI recently.

3. A US Navy blood banker reports that at his institution, all patients and donors with a positive antibody screen are notified in writing by the medical director whether the antibody is clinically significant or not. In addition, a card with the antibody that was identified is enclosed in the letter for day-to-day carrying purposes.

ADDENDA June 8, 2006

4. A transfusion medicine technologist in Canada reports that at each of four acute care sites within her health region they prepare 'antibody cards' for patients with identified allo-antibodies.  These cards are then mailed so that the patient can present their antibody card whenever they are admitted to a hospital.  The inquiring Canadian wonders if this is a practice in other health regions within Canada, in the USA, or elsewhere.

5. A colleague in Rochester, New York reports that his hospital sends a letter and a card to the attending physician to pass on to each patient that they discover to have an unexpected red cell antibody. As far as the respondent knows (and they have followed this practice for over 30 years) there is no regional database of patients and their antibodies in the greater New York community.

ADDENDA June 9, 2006

6. A colleague in Port Jefferson, New York reports that several years ago his hospital contacted the New York State Department of Health and asked if it would be permissible for the laboratory to inform patients regarding their antibodies, especially if the patients might visit other facilities. He comments that they were told that the laboratory could NOT directly notify patients of these results, but that the information needed to be reported to the patient's physician. Consequently, the respondant's laboratory instituted a practice where every new antibody identified in their facility was reported to the patient's physician by way of two reports. One of the reports was for the physician's records. The other report was designed so that the physician could give it to their patient, so that the patient could show it to other healthcare providers, if they went to another facility. The respondant acknowledges that in his region there is no database of patients who have unexpected red cell antibodies, but he believes that such an 'antibody database' would be a wonderful idea. He acknowledges that compliance with HIPAA would have to be addressed.

7. A Canadian colleague reports that her institution issues 'antibody cards' to patients either by mail or in person when a clinically significant antibody is identified. They are moving to a more generic card because they also issue cards when a patient requires irradiated and/or anti-CMV negative blood products, when a blood warmer is needed for transfusion, or when a patient has had significant transfusion reaction that requires 'premedication', etc. They refer to the cards as a transfusion alert. Each card is accompanied by a letter that is sent to the patient’s primary/family physician. If the patient does not live in their local area, we also notify their "home" hospital.

8. A colleague in Oregon reports that their hospital started to notify patients with clinically significant alloantibodies about three years ago. They send a letter and enclose a wallet card.

ADDENDA June 12, 2006

9. The transfusion service director at a trauma hospital in Minneapolis reports that they have been sending out antibody cards directly to patients along with a cover letter for decades. Transfusion service physicians have met to discuss trying to establish a central registry, but alas, computer connectivity and HIPAA pose tremendous hurdles. In the meantime, their blood center reference lab acts as a central repository for those patients who confirmatory workups are sent to it. This helps immensely when patients with rare or multiple antibodies are admitted to different hospital systems.

ADDENDA June 16, 2006

10. A colleague at a hospital in Northern California reports that being in a public health setting they do not rely on mailing the cards. Many of their patients do not have reliable mailing addresses. Consequently, the patients are given the cards when they are in the hospital or at clinic follow up appointments. Typically a blood bank resident speaks to the clinician to determine if the clinician wants to give the patient the card or if the clinician prefers that the laboratory physician give the patient the card. He acknowledges that in the past they had some 'misgivings' on part of the clinical team when the blood bank residents gave out these cards without first checking with the clinicians. Only if they miss the patient and there is no scheduled follow up do they mail the card.

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Ira A. Shulman, MD
CBBS e-Network Forum Editor & Moderator