1. Preparation of RBCs for Thalassemia patient with multiple antibodies Detection and Identification of Alloantibodies to Red Cell Antigens Iranian Blood Transfusion Organization Mostafa Moghaddam MS, CLS ( ASCP ) BB Head of Immunohematology Reference Laboratory ISBT member of RARE Donor Working Party ISBT member of Immunohematology Working Party

2. Requirements of IBTO (AABB) Standards for an
Detection and Identification of unexpected Antibodies to Red Cell Antigens جستجو و شناسائي آنتي باديهاي غيرمنتظره عليه آنتي ژنهاي گلبول قرمز خون
Requirements of IBTO (AABB) Standards for an
Antigen negative Blood Transfusion Request
1.Positive identification of the recipient and the recipient blood samples.
2. ABO group and Rh (D) typing of the recipient's blood
3. Red cell antibody detection tests for clinically significant antibodies using the recipient’s serum/plasma ( Antibody Screening )
4. Comparison of current findings on the recipient’s sample with records of previous results

3. 5. Confirmation of the ABO group of red cell components .
Detection and Identification of unexpected Antibodies to Red Cell Antigens جستجو و شناسائي آنتي باديهاي غيرمنتظره عليه آنتي ژنهاي گلبول قرمز خون
5. Confirmation of the ABO group of red cell components .
6. Confirmation of the Rh type of Rh negative red cell components
7. Selection of components of ABO group / Rh type and appropriate antigen negative RBC unit for the recipient
8. Performance of a serologic or computer cross match
9. Labeling of products with the recipient’s identifying information

4. react at 37ºС or in the antihuman globulin (AHG) phase
Detection and Identification of unexpected Antibodies to Red Cell Antigens
Clinically significant alloantibodies
react at 37ºС or in the antihuman globulin (AHG) phase
are usually IgG antibodies
cause a transfusion reaction
decrease survival of RBCs

5. Detection and Identification of unexpected Antibodies to Red Cell Antigens جستجو و شناسائي آنتي باديهاي غيرمنتظره عليه آنتي ژنهاي گلبول قرمز خون
Antibody Screen
Definition : Testing the patient’s serum/ plasma with group ‘’O” reagent red cells in an effort to detect atypical antibodies
Small percentage of general population has detectable RBC antibodies
Percent
Thalassemia/Sickle cell patients %
Heart surgery patients %
Renal disease patients 7%
Incubation at 37ºС
Use of an antiglobulin test
IBTO (AABB) requirement states that method used to detect clinically significant antibodies must include

6. Groups that an antibody screen test is required
Detection and Identification of unexpected Antibodies to Red Cell Antigens جستجو و شناسائي آنتي باديهاي غيرمنتظره عليه آنتي ژنهاي گلبول قرمز خون
Groups that an antibody screen test is required
As part of pre transfusion testing on the recipient
Thalassemia & Sickle cell
2. Routine prenatal testing for obstetric patients
evaluate HDN
candidacy for RhIG
3. Donors of allogenic blood and blood products stem/ progenitor cells

7. Methods Tube technique - Gel technique Solid phase technique
Automation
Methods
Tube technique Gel technique
Solid phase technique

9. More is no better in Blood Transfusion

10. Providing blood for Thalassemia patient with Anti-M & Anti-Jkb and more
A blood sample from a female patient with Hg 2.5 g/dl was received by IRL .Patient was suffering from serious multiple blood transfusion reactions including severe confusion and mild syncope.
Name
M.D
Age
26 years old
City
Isfahan
Diagnosis
Splenomegaly-anemia /candidate for splenectomy

11. Providing blood for Thalassemia patient
ABO O
Rh(D)
Positive
Antibody Screen test
Auto control test
Positive(weak+)
Antibody ID
Anti-M and Anti-Jkb
DAT
PS1
PS2
Anti-IgG
Anti-C3d
Control
0 / 2+
W+/3+ 4+
w+/w+
0/w+ W+ C c E e K k
Fya
Fyb
Jka
Jkb M N S s
Patient phenotype
Dec 2014 4+
Mf(3+)
Mf(2+)
Nov 2015 3+

12. Patient’s Chronological Medical History
Medical decisions
Outcome
Reason
Number of RBCs transfused
Important dates
Blood transfusion stopped
Transfusion reaction reported ?
2 RBCs
9 yrs old
2 more rbcs infused patient suffered severe AHT reaction including confusion and mild syncope
Hg  4.5 g/dl
and  2.5 in few days
Hg  to 2.5g/dl after one week
Gallstone removed post endoscopy
4 WRBCs
25 yrs old
Oct 2014
Resting at home with Hg 3.7 g/dl
contacted blood center in Isfahan IRL in Tehran
splenectomy
requested
2 more
Nov 2014
splenectomy was performed successfully on Dec
Hg 5.9 g/dl
transported to Isfahan
blood center M-
Jkb- C- K-
3RBCs were prepared
Dec
No Transfusion since then Hg 7.5g/dl
No transfusion reaction
One unit was prepared RBC
M- , Jkb- ,C- K-
Dental surgery
1 RBC
Oct
C 32% M 22% Jkb 28% Fya 17% s 11%
= %
Only one unit RBC has been found patient needs C-, K-, M- , JKb- ,
Fya- , s-
anti-M not reacting this time anti-Jkb reconfirmed anti-s also was identified
Plastic surgery
Requested
5 RBCs
Nov

13. + Should Transfusion of thalassemia patients be matched using phenotype –matched RBC donor units?
Disease
What Antigens
Name of Laboratory
61 sickle patients 1830 LRBC
C, E , K neg HTR dropped 90% reduction of alloimmunization from 3% to 0.5
Transfusion 2001
Sickle cell anemia
K, C, E, S, Fya or Fybneg
40 patient Ag matched No alloantibody
46 patients No Ag matched 16 developed antibodies
Transfusion 1994
Sickle cell patients
12year study 351 patient received 8939 LRBC
29.1 % developed at least 1 or more antibodies
C , c, E, e and K Ag neg prevent all antibodies in 53.3 patients
C , c, E , e, K ,S , Fya and Jkb prevent all antibodies in 70.8 patients
Transfusion 2002

14. + Should Transfusion of thalassemia patients be matched using phenotype –matched RBC donor units?
Disease
What Antigens
Name of organization
thalassemia
K neg
Canada Ontario Hospital
sickle cell anemia
D, C, c, E, e, K neg
U.S.A Ohio Blood Bank
K neg for female under 45 years
no antigen negative RBCs for patient with no antibody
Australian Blood Bank
LRBCs avoid providing stored RBC
drived cytokines
sickle , thalassemia GI bleed ,AML
but not for ALL or CLL
D , C, c E, e , K , phenotyping
Fya , Fyb , Jka or Jkb is waste of time
New York Blood Bank
Vox 1983
Sickle & thalassemia
Full phenotype tested at diagnosis
give C, c ,D, E, e , K Ag neg
R◦ should receive R◦ & rr on emergency
no matching for Duffy , Kidd, M, N,S
British Committee
For Standardization
Hematology 1996 Transfusion Medicine

15. Very Rare Blood Type in Iranian Rare Donor Data Base 2009-2015
Oh Bombay
Kpb-
Lu (a- b- )
Fy (a-b-)
Jk(a-b-)
RzRz
RzR1
RzR2
r'' r''
r' r'
D - -
k-(Cellano)
Rh null
K null
P null
(Allo-Anti-P)
P1 pK
In(b-)
Total number of donors identified 26 1 8 19 2 3 9 13 12

16. Alternative for Incompatible Transfusion Events
Countries
Cristalloid
Colloid
Small volume transfusion
Corticosteroids
IVIG
Radiation therapy
Eculizumab (Soliris ,complement inhibitor)
Volum expander Albumin –Dextran
Autologous RBCs
Erytropoetin
Plasma Exchange
Blood substitute (research phase)
Brazil
China
Finland
France
Germany
Italy
Iran
Japan
Singapore
Sweden
Switzerland
The Netherlands UK US

17. چرخه سازگـاری و خون سـالم = آزمایشگـاه رفرانس ایمونوهمـاتولوژی
ImmunohematologyReference Laboratory = Compatibility Wheel and Safe Blood
and if any one saved a life, it would be as if he saved the life of the whole people
32 maedeh