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Posted: May 1, 2002

Addenda: May 2, 2002; Feb. 21, 2007; May 16 & June 25, 2008

Link Updated: Nov. 29, 2011

 

Transfusing donor RBC units obtained from individuals whose plasma contains unexpected antibodies

A blood banker reports that his supplier has recently said that they will be providing donor units from individuals whose plasma contains unexpected antibodies. The inquiring blood banker is wondering what kind of "problems" (e.g. post-transfusion positive DATs/IATs) are typically seen when using antibody-containing donor units? According to the inquiring blood banker, the supplier says that these units can be used without any concern to patients, except infants.


  1. Editor's note: Several blood bankers have expressed discomfort with the idea of using blood products whose plasma contains unexpected antibodies. However, at the editor's institutions, occasionally during severe group O shortages, group O negative RBCs donated by individuals with anti-D have been accepted from the regional supplier. Since these units are only given to Rh negative patients, we have not been concerned about incompatibility, although the possibility of interdonor incompatibility is always a consideration, in the event the group O negative supply is exhausted and group O positive RBCs must be used. Although the use of antibody-containing blood products rarely occurs, the bottom line is that it has occurred, and it most likely will occur again should we experience severe shortages in the future. In our lab we would take the extra step of physically attaching a note to any unit that contains anti-D with a remark to remind the technologist to issue such a unit ONLY for an Rh negative patient. In the past, in addition to using RBC units containing anti-D, we accepted donor units that contained a significant antibody other than anti-D, taking the precaution to wash the red cells in saline. However, since we stopped manufacturing saline-washed RBCs we no longer accept such RBC units.

  2. In response to the above question, a blood banker from the Duke Transfusion Service in North Carolina reports that for the last several years, their regional blood supplier has been sending antibody-containing blood products to the Duke Transfusion Service. This blood banker says that this policy has proven to be not only safe but also cost-effective, as the units were received at a discount. Most importantly, the willingness to take these units has prevented the unnecessary wastage of these units because other institutions often refuse to accept them. Their experience has been published in Immunohematology "Large-scale use of red blood cell units containing alloantibodies". Vol. 16, No. 3 pg. 120-3. 2000 (PDF file, abstract only). For more information about this approach, feel free to contact Martha R Combs.

ADDENDA May 2, 2002

  1. Dr. Peter L. Page, Senior Medical Officer at ARCBS-BHQ responded that several years ago it was found that when testing a neat sample corresponding to a volunteer whole blood donation, 0.4% tested positive in screening for unexpected RBC antibodies and that 46% of these red cell units were Rh negative (34% of all units positive on the screen had anti-D or anti-D,-C alone). Testing the supernatant from the additive red blood cell unit itself for unexpected RBC antibodies was negative in 46% of those donations with a positive screen on the neat sample (i.e., the neat sample antibody titer would be diluted out by 70 mL anticoagulant in the 500 mL whole blood unit, but primarily by the 100 mL of additive solution in the red cell unit). It has been estimated that a CPDA1 red cell unit contains about 60 - 80 mL of plasma, whereas an AS-1 red cell unit contains 20 - 50 mL of plasma (lower in that range if a Platelet Concentrate was not prepared and higher in that range if a Platelet Concentrate was prepared). While the sensitivity of antibody detection is purposefully less in donor testing than in patient testing, it is this donor testing that is relied upon when transfusing platelet and plasma components. Especially in places where few, if any, platelet concentrates are prepared from whole blood collections, and where additive solution red cell units are involved, perhaps the concern regarding possible deleterious effect of antibody in red cell unit transfusions could be less than elsewhere or prior to the advent of the additive era. The above data are referenced as follows: J Nobiletti, S Badon, R Cable, M Greene, S Nance, and P Page. Unexpected red cell antibodies are not detected in 46% of additive red cells from antibody positive donors. AABB abstract 11/98. (Presumably the e-network forum readership knows that a blood provider must label the unit with the antibody and its identity. When this procedure is followed, a hospital transfusion service will not receive an antibody-containing unit unknowingly.)

ADDENDA Feb. 21, 2007

  1. A medical technologist at a blood collection center in California reports that one of the facilities that they supply will no longer accept RBC units that were obtained from donors with a positive antibody screen. The reason given for refusing to accept these units is that some of the recipients who receive these units exhibit a positive antibody screen after the transfusion, and the workup of these newly discovered antibodies causes a lot of work. The inquiring medical technologist wonders how widespread is the practice to refuse donor RBC units that have been collected from individuals who have a positive antibody screen. In addition, she wonders if the detection of passively acquired antibodies has been enhanced by the transition from tube to Gel or Microwell-based testing.

ADDENDA May 16, 2008

  1. A pathologist who practices in the Philippines wonders how blood collection agencies around the world currently manage apheresis and whole blood donors who have a positive antibody screening test for unexpected red cell antibodies. If a donor has such an antibody, what happens to a donated product? If an apheresis donor is found to have a positive antibody screening test and on a subsequent donation after several months the antibody screening becomes negative, for the subsequent donation would the donated product be used for transfusion based on the current negative antibody screen result or would the donated product be managed based on historical records? Also, what if the antibody in question was a non-specific cold or auto-I?

ADDENDA June 25, 2008

  1. The medical director of a midwestern hospital-based donor collection program and transfusion service reports that her facility recently switched to Gel testing for antibody screening of patient samples and donor units. They have a 60 year old woman who has been a regular platelet donor for many years. On the most recent donation using the Gel method, a weak anti-E was detected in her sample. They repeated the test using the Gel methodology with the same result; however, the anti-E was not detected by manual tube testing. The donor has never been pregnant or transfused. The inquiring colleague would like to know if others have had a similar experience and if so, how they handled it. The options that the inquiring colleague is considering include converting the donor to become a whole blood donor, temporarily deferring the donor and the retesting before the next scheduled donation, permanently deferring the donor, or giving her platelet donations to E-negative patients. Although the latter option would not cause harm to the recipient, the inquiring colleague does not like to impose restrictions on their units because the chance for error increases when exceptions are made to standard operating procedure.

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Ira A. Shulman, MD
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