Anh Dinh1, Kent Eliason2, Walter Sunny Dzik2. 1. Harvard Joint Fellowship Program in Transfusion Medicine, Boston, Massachusetts. 2. Department of Pathology and Laboratory Medicine, Massachusetts General Hospital, Boston, Massachusetts.
Abstract
BACKGROUND: Current national standards for pretransfusion testing do not address the frequency or optimal time interval to repeat antibody identification testing for patients in whom antibodies have been previously detected. STUDY DESIGN AND METHODS: A retrospective review was performed of patients with existing red blood cell (RBC) antibodies who subsequently developed new antibody specificities. Data were drawn from a single institution where the antibody investigation was repeated if the screen suggested a new antibody or if 14 days had elapsed since the previous investigation. Clinically insignificant or drug-dependent antibodies were excluded. Among cases in which new antibodies were detected within 30 days of a previous sample that already demonstrated existing antibodies, the median and lower 95% confidence intervals for the number of days between the detection of the existing and new antibodies were determined. RESULTS: Over a 9-year period, among 2114 patients with more than 1 antibody, 699 (33%) had serially detected antibodies from separate samples. Among 152 patients whose subsequent antibody was detected within 30 days of the existing antibodies, the median time interval to detection of the new antibody was 13 days. The lower 95% confidence interval was 1 day. By Day 3, 18% of the new antibodies had already appeared. CONCLUSION: In patients who form multiple antibodies, the serial emergence of clinically significant antibodies is common. In some patients, detection of a new specificity occurs in a sample drawn shortly after the sample that demonstrated the first antibody. These results have implications for the frequency of pretransfusion testing.
BACKGROUND: Current national standards for pretransfusion testing do not address the frequency or optimal time interval to repeat antibody identification testing for patients in whom antibodies have been previously detected. STUDY DESIGN AND METHODS: A retrospective review was performed of patients with existing red blood cell (RBC) antibodies who subsequently developed new antibody specificities. Data were drawn from a single institution where the antibody investigation was repeated if the screen suggested a new antibody or if 14 days had elapsed since the previous investigation. Clinically insignificant or drug-dependent antibodies were excluded. Among cases in which new antibodies were detected within 30 days of a previous sample that already demonstrated existing antibodies, the median and lower 95% confidence intervals for the number of days between the detection of the existing and new antibodies were determined. RESULTS: Over a 9-year period, among 2114 patients with more than 1 antibody, 699 (33%) had serially detected antibodies from separate samples. Among 152 patients whose subsequent antibody was detected within 30 days of the existing antibodies, the median time interval to detection of the new antibody was 13 days. The lower 95% confidence interval was 1 day. By Day 3, 18% of the new antibodies had already appeared. CONCLUSION: In patients who form multiple antibodies, the serial emergence of clinically significant antibodies is common. In some patients, detection of a new specificity occurs in a sample drawn shortly after the sample that demonstrated the first antibody. These results have implications for the frequency of pretransfusion testing.