Patients with red cell autoantibodies: selection of blood for transfusion

Abstract

The provision of blood for transfusing patients whose sera contain red cell autoantibodies requires considerable expertise. Over 8 years, 3888 samples from 2149 patients were examined; the varying clinical presentation necessitated a flexible investigative approach. The autoantibodies showed evidence of blood group specificity in 706 patients (32.9%), usually within the Rh system for warm reacting antibodies, whereas cold antibodies were mostly anti-I. Concomitant alloantibodies were detected by noting varying reaction strengths during antibody investigation and compatibility testing, and by absorption techniques using autologous or selected allogenous red cells. Alloantibodies were found in 294 patients (13.7%); the most frequent were anti-E and anti-K. Compatibility tests were performed on SAG-M donor blood of suitable ABO group, similar Rh genotype, Kell negative and lacking antigens to any alloantibodies detected. All units of blood were incompatible by at least one technique and were issued as 'not compatible but considered suitable'. A total of 7052 units was issued for 1685 patients; no haemolytic reactions were reported. It was concluded that blood can be safely given to patients with autoantibodies, even in serologically complex cases, providing adequate investigations are carried out.

Intensive plasma exchange for severe autoimmune hemolytic anemia in a four-month-old infant

“…Usually, crossmatchcompatible RBCs cannot be found and "least incompatible" units will be transfused [5,14,15,16,17,20]. Unfortunately, the benefit of transfusion is only temporary since transfused RBCs will be destroyed at the same accelerated rate as the patient's own RBCs.…”

Current treatment strategies in autoimmune hemolytic disorders

“…Alloantibodies are known to occur in 12-40% of AIHA patients, and may be responsible for severe hemolytic reactions; in particular, undetected alloantibodies could be the cause of increased hemolysis following transfusion, which might falsely be attributable to an increase in the severity of AIHA [1]. Some authors recommend ignoring the specificity of the autoantibody and this indication has been demonstrated to be safe and effective in a great number of transfusions [76,77]. In less urgent cases, an extended phenotyping is advisable and the best compatible red cell units should be selected [78].…”

Immune Hemolysis: Diagnosis and Treatment Recommendations

“…Some authors recommend ignoring the specificity of the autoantibody, and this indication has been demonstrated to be safe and effective in a great number of transfusions. 68,69 In less urgent cases an extended phenotyping is advisable and the best compatible red cell units should be selected. 70 To minimize risks of febrile non-hemolytic reactions due to anti-leukocyte antibodies, leuko-depleted red cells are nowadays recommended in AIHA patients.…”