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:
- Perform antibody screen and identification (if indicated) for all prospective organ donors and recipients.
- 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:
- Technical Manual, Current Edition, Bethesda, MD, USA
- Standards for Blood Banks and Transfusion Services Current Edition, AABB, Bethesda, MD, USA
