PHENOTYPE MATCHED BLOOD

FOR A PATIENT WITH WARM AUTOANTIBODIES: A CASE REPORT

Rashmi Sood, Prashant Srivastava, Anoop Sharma.

Department Of Transfusion Medicine And Blood Bank , Artemis Health Institute, Gurgaon ,Haryana , India. KEY WORDS: Extended red cell phenotying, Prophylactic antigen-matched blood. BACKGROUND: Serological safety is an integral part of the overall safety for the blood banks Alloimmunization results from disparity between the donor and patient antigens. Prior exposure to donor antigens can lead to anamnestic or secondary response where even very small amounts of donor antigenic RBCs can elicit an alloimmune response resulting in increase in antibody production leading to red cell destruction since the patient is already immunized.[1] Development of alloantibodies complicates and limits transfusion therapy, contributing not only to technical complications but also to morbidity and mortality.[1] .Benefits of extended red cell phenotying to minimize alloimmunization have been debated in literature. To provide blood safe for transfusion and to avoid adsorption studies, the provision of prophylactic antigen-matched donor blood,where feasible,for patients with warm autoantibodies, is advocated. OBJECTIVES : The present report deals with the issue of blood to a 45 year old male patient from Madagascar ,a patient of small cell neuroendocrine carcinoma with adenocarcinoma lung , admitted for chemotherapy cycle 3 ,having Hb 5.5% at the time of admission and recieving chronic RBC transfusions,after detection of complete phenotype profile i.e., C, E, c, e, K, Jk(a), Jk(b), Fy(a), Fy(b), S, and s of the patient. The patient had developed warm autoantibodies without underlying alloantibodies. MATERIALS & METHODS : Column Agglutination Technology(CAT bead technology by J&J Auto Vue Innova) was used for forward reverse grouping, antibody screening and antibody identification .Reagents used included anti A, anti B, anti D antiseras by Digast and rare antisera for rh (d, C, E, c, e) kell (K),(k ) , Jk(a), Jk(b), Fy(a), Fy(b), S, and s antibodies by J& J. Reagent Red Cell panel (Surgiscreen three cell panel by J&J) and Resolve Panel A (Eleven cell panel by J&J). A, B, and O pooled cells were prepared in house. The criteria for antibody specificity were based on the recommendations of AABB.[2] RESULT: Patient of blood group B positive had developed autoantibodies without any underlying alloantibody at the time of initial investigations. Donor RBCs matched with the patient's phenotype, leucoreduced, were issued to the patient for transfusion. On subsequent transfusions,the patient sample was evaluated by panel studies and DAT. The serology remained consistent with previous findings.Thereafter prophylactic antigen-matched, leucoreduced RBCs were transfused safely and conveniently without further testing. CONCLUSION: Determining complete phenotypes should be a routine component of the serologic evaluation of patients with warm

autoantibodies. Definitive advantages of RBC phenotying include identification of the RBC antigenic profile for the ease of availability of compatible blood for multiply transfused patients.[3] The practice for providing prophylactic antigen-matched RBCs to such patients,when a complete phenotype can be determined,provides an alternate way for their transfusion management. This maintains safety and circumvents pretransfusion adsorption studies. REFERENCES: 1. Domen RE, Ramirez G. Red cell alloimmunization in chronic renal failure patients undergoing hemodialysis. Nephron 1988;48:284-5. 2. Brecher E. Technical Manual. Chap 18,19. 12th ed. United States: American Association of Blood Banks; 2009. p. 389-91,407. 3. Blumberg N, Ross K, Avila E, Peck K. Should Chronic Transfusions be matched for antigens other than ABO and Rho(D)? Vox Sang 1984;47:205-8.