Prophylactic Rh phenotype matching for patients demonstrating anti-E or anti-c; update

A Blood Bank System Coordinator at a hospital in Florida would like to know if colleagues use 'c' negative red cells prophylactically for 'c' negative patients who have made anti-E. What about the patient who is E-negative and has formed anti-c. Should those patients prophylactically receive E negative red cells? There were only a few responses to the previous discussion from 2004.

The following comments have been submitted in response.

ADDENDA May 31, 2010

1. A transfusion medicine physician at an academic medical center in Ohio reports that they do not use c-negative RBC prophylactically for c-negative patients who have made anti-E nor E negative RBCs for the E-negative patient who has formed anti-c.
   
   
2. A transfusion medicine physician physician at a University Hospital transfusion program in the Northeast reports that when selecting units for a routine transfusion recipient, they would NOT prophylactically select c-negative RBCs for a c-negative recipient with an anti-E, nor select E-negative RBCs for E-negative recipient with an anti-c. However, if the patient were assigned to a prophylatic-matching restriction, as for example with sickle cell patients, then they would select c-negative units for c-negative recipients and E-negative units for E-negative recipients.

ADDENDA June 9, 2010

3. In the opinion of Dr. George Garratty (Scientific Director of the American Red Cross Blood Services, Southern California Region - attribution used with permission), it is good practice to use E and c negative RBCs for c-negative patients who make anti-E. If an E negative patient makes anti-c, you will probably select R1R1 RBCs to cover the anti-c, so will automatically cover possible anti-E formation.
   
   
4. A colleague at an academic medical center in Baltimore reports that it has been shown that R1R1 patients with anti-E frequently develop anti-c (Transfusion 1994;34:756-758 and Immunohematology 2005;21(3):94-6). Consequently, their laboratory provides c-negative blood for transfusion in these cases to prevent possible DHTR due to anti-c. However, they do not routinely provide E-negative donor blood to patients with anti-c alone. However, it is likely that the units selected for patients with anti-c are E-negative, since most donor units that are c-negative are also E-negative (e.g.,R1R1).
   
   
5. A colleague at an academic medical center in Los Angeles reports that at her institution they transfuse R1R1 cells to R1R1 individuals with anti-E, even if anti-c is not detected in the patient's serum since these patients are likely to develop anti-c. They also believe that R1R1 patients with anti-c should be given R1R1 red cells since anti-E may develop in sera containing anti-c.

ADDENDA July 2, 2010

6. A colleague affiliated with the National blood center in Sri Lanka comments that their recommended practice for patients who are R1R1 phenotype and who have developed either anti-E or anti-c, to transfuse donor RBC units that lack both "c" and "E" antigens.

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