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Does a history of transient passively acquired anti-D from receipt of RhIG disqualify a patient for an electronic crossmatch? |
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A colleague in New Zealand reports that in their hospital most of the donor Red Cell units are issued using an electronic data management system. Their SOP states "a computer crossmatch may be used.....when clinically significant antibodies are not currently detectable or there is no history of clinically significant antibodies". Recently, a debate has centered over the need to use an antiglobulin crossmatch versus an electronic crossmatch when dealing with a patient who in the past tested positive for anti-D as a result of having received anti-D immunoprophylaxis. The inquiring New Zealander would like to know how other blood banks deal with this group of patients in terms of using a computer crossmatch. In other words, can a patient who received passive anti-D and tested transiently positive in the red cell antibody screen and showed anti-D in a panel workup still qualify for a computer crossmatch when their antibody screen reverts to negative? The following responses have been received. ADDENDA June 23, 2004 1. A colleague in Kansas reports that in her laboratory they take note when anti-D is due to passiveadministration following a documented history of RhIG immunoprophylaxis in association with pregnancy. They consider the passive anti-D from RhIG to be a clinically significant antibody so long as it is detected in the patient's plasma during which time an antiglobulin crossmatch is required. Once the anti-D is no longer detectable in subsequent samples, the passive anti-D to no longer considered to be of concern. At that point in time their policy allows the patient to become eligible for an electronic crossmatch, provided the patient has two concurrent blood types are on record, a current antibody screen is negative, and there is no record of the patient having had any other clinically significant antibodies. 2. A colleague in Ontario, Canada reports that at her institution they consider a "passive Anti-D" as if there were no alloantibodies present. Consequently, in their laboratory they would perform an immediate spin crossmatch as opposed to a crossmatch that included an indirect antiglobulin test phase. In their system a "passive Anti-D" is not entered as a 'real' (i.e., clinically significant) antibody into the patient's history. Therefore, when a patient returns months or years later they would not even know about this transient passive antibody. |
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Please submit comments to the e-Network Forum. Ira A. Shulman, MD |
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