Principle:

Donor lymphocytes in an organ transplant may make antibodies and cause a clinically significant hemolytic anemia, i.e. a graft vs. host hemolytic anemia GVHHA.  Optimal handling in these cases should include antibody screening/identification for all potential donors and recipients.  The transfusion medicine physician should review the results for possible issues of antibody/antigen incompatibilities to proactively select matched blood components and avoid GVHHA.

In the Medinfo blood bank computer system, we can make custom rules to ensure release of only antigen-matched units as needed.

Policy:

1. Perform antibody screen and identification (if indicated) for all prospective organ donors and recipients.
2. If the organ donor has clinically significant antibodies, check if the recipient has the corresponding antigens.  If so, select RBC units negative for the donor antibody specificities. 

Example:  Donor has anti-Kell (K1) and patient is K1-positive.  Use only K1-negative RBCs post-transplant.

• Send the case to the transfusion medicine physician to review.  He will contact the clinicians as indicated.
• Create a rule in Medinfo forcing the antigen matching.

References:

1. Technical Manual, Current Edition, Bethesda, MD, USA
2. Standards for Blood Banks and Transfusion Services Current Edition, AABB, Bethesda, MD, USA