Managing neonates whose mothers have identified red cell antibodies

A colleague in Spokane, Washington would like to know how transfusion services manage neonates whose mothers have identified red cell antibodies with regards to the selection of RBCs for transfusion. Their practice has been that if the infant does not have demonstrable maternal antibody, they do not screen for units that lack the corresponding antigen. In other words, if a mom has anti-D and her child is D-positive with a negative antibody screen, they would provide D-positive red cells if the child needed an RBC transfusion. If the child's antibody screen is positive due to anti-D, they would administer D-negative RBC at least until the antibody screen becomes negative. The Spokane colleague wonders how others handle these cases.

The following comments have been received.

ADDENDA July 9, 2007

1. A transfusion medicine specialist with over 30 years experience at a children's hospital reports that in her experience infants are frequently transfused based on having performed only an antibody screening test with an infant's specimen. In such cases a mother's specimen is not tested. The responding colleague's laboratory follows the AABB Standard 5.16.1.3, as reportedly does the laboratory in Spokane Washington (see above). If a child's antibody screen is positive, the responding colleague's hospital transfuses red blood cells lacking the antigen corresponding to the identified antibody; specific antigen negative red cells are used until the child's antibody screen becomes negative.

ADDENDA July 16, 2007

2. A transfusion medicine physician in Atlanta reports that in her pediatric practice, if a neonate has a positive antibody screen, RBC units are administered that lack the antigen corresponding to the maternal antibody. The RBCs are crossmatched with antiglobulin test which must be compatible. The antibody screen is repeated in 7 days to determine if there is still a need to continue transfusing RBC units that lack the antigen corresponding to the maternal antibody. If the initial antibody screen is negative, or once a maternal antibody is no longer detected in a neonate's plasma, RBC units for transfusion are merely selected to be ABO/Rh compatible. She acknowledges that some more conservative blood bankers in her area may 'honor' the maternal antibody status (maternal antibody screen) even if the antibody is not detectable in a neonatal antibody screen, antibody ID, or eluate. She points out that this more conservative approach is to cover for the possibility of an undetected low level transplacental maternal antibody.

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Ira A. Shulman, MD
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W. Tait Stevens, MD
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