Physicians and RBC Antibodies

During my career, the role of the transfusion medicine physician in handling RBC antibodies has evolved.  Depending on your location, either a specific transfusion medicine physician or a hematologist covering the specialty handled this.  In the United States, most hematologists nowadays do not do this.

During my US residency training in pathology, most trainees did not have an interest in blood banking and often used the rotation to take vacations.  For their board certification in clinical pathology, they crammed for the examination and afterwards did not engage in it.

When I started my career in the United States, hospitals had a hospital blood bank/transfusion service and handled most of their antibody problems themselves.  In Chicago where I practiced, many blood banks had Specialist in Blood Banks SBB graduates or SBB students working, and of course, they had a dedicated blood bank supervisor.

Currently in the United States, the hospital blood banks may be staffed by generalists and there is no one with specific antibody experience.  SBB graduates are expensive and usually work in blood centers or academic hospitals.

If you have a regional blood center with a reference laboratory, you can send your antibody workups there and let the blood center select appropriately antigen-matched units.  The physician covering the blood bank does not have to get very involved.

In the Middle East in the systems that I have run, there have been no reference laboratories and often no regional blood center.  The hospital system or the free-standing blood bank is an independent entity and must rely on itself.  The physician responsible for the blood bank must review the antibody panels and make his own decision how to select RBC components.

In the Middle East, especially in the larger centers with academic hospitals, there is usually a transfusion medicine physician who reviews the antibody workups and makes the final decision of what RBC types to dispense.  He does not have a reference laboratory to rely on.  He is responsible for the choices and has no one to refer cases on a 24/7 basis.

In the Middle East, the transfusion medicine physician must be proactive.  He must also select antigen-matched, fully or partially, and understand the trade-offs in cases with multiple antibodies.  He must know how to deal with nonspecific antibodies and antibodies to high-incidence antigens, especially if he works in a region where the antibody panels are not optimized to the local population or there are many different ethnic groups in the local area.

Thus, training someone to practice in the Middle East requires spending considerable time in technical matters that might not be necessary if he/she practiced in the West.  He may not only have to serve as a physician but he may be the equivalent of the reference laboratory supervisor.  Until such time that reference laboratories are available, this model is essential for safe practice.  Training programs for the region must reflect this and in particular, teach about specific antibodies common to the region.  He must be technically oriented and he must take ultimate responsibility for the interpretation of the antibody workups and selection of the appropriately matched units.