A colleague at a very prestigious institution in Bethesda, Maryland was wondering how other people handle transfusions to patients with antibodies to low incidence antigens. Specifically, do colleagues antigen-type donor RBC units if antisera is available? If so, what is your policy? e.g. Only if licensed antisera is available or do you use human source 'reagents', i.e. previously identified samples, or what?

If no antisera is available and you must go with crossmatch-compatible units, do you include a control test in which you also crossmatch a red cell sample that bears the corresponding antigen, to demonstrate that the antibody is detectable in the crossmatch method being employed? And what if it is not demonstrating? What other approaches are colleagues employing? Finally, what if a patient has a warm autoantibody plus an antibody to low incidence antigen? The inquiring colleague reports on a recent patient with a warm autobody plus multiple alloantibodies, including an anti-Js(a). They ended up using adsorbed plasma [which contained the anti-Js(a)] to 'screen' units. But the inquiring colleague is not certain if this could have been done if the anti-Js(a) was not demonstable in the adsorbed plasma.

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