The Laboratory Scientist’s lament: “Oh, no! There’s an isolated reaction that we can’t explain on this guy’s antibody detection tests, and they need blood right away!” This episode will help blood bankers and clinicians understand what these reactions represent, and what they might or might not become.

Dr. Brenda Grossman

Dr. Brenda Grossman

Blood bankers everywhere can describe the frustration of trying to screen a patient for unexpected antibodies, and having just one weird reaction that they can’t explain! These seem to arise at the most inconvenient times, when a patient desperately needs blood and chaos reigns. What is a conscientious blood banker to do? Ignore the one reaction that doesn’t fit any pattern, and focus on the antibodies you see that ARE present? Or, perhaps more commonly, are we tempted to pretend that one tiny little weakly positive reaction just wasn’t there, when you’ve got dozens of other cells that do NOT react? And, what do we tell the clinicians?

Data, Please!

Dr. Brenda Grossman has been there, and she feels your pain! Brenda was trying to explain these isolated reactions to one of her residents a few years back, and it dawned on her that solid data on these “antibodies of undetermined specificity” (as she came to describe them) was pretty much nonexistent. So, she and that resident (and later colleague), Dr. Chang Liu, put together a study describing the frequency of these irritating “stray” reactions in a large cohort of patients at their hospital in St. Louis. What they found may surprise you (put it this way: The most common antibody they identified in their study was not anti-D, anti-E, or anti-K, as you might guess!). Brenda also outlines some possible management strategies for patients impacted by antibodies of undetermined specificity.

About My Guest:

Brenda Grossman, MD, MPH is a professor in the Department of Pathology and Immunology and the Department of Medicine at Washington University in St. Louis, MO. She is board-certified in Internal Medicine, Hematology, and Blood Banking/Transfusion Medicine. She serves as Medical Director of Transfusion Medicine Services at Barnes-Jewish Hospital, and is the program director for both the Clinical Pathology Residency Program and Transfusion Medicine Fellowship at Washington University. Brenda served as associate editor for the 16th, 17th, and (current) 18th editions of the AABB Technical Manual. She has won numerous teaching awards, and has numerous publications in peer-reviewed journals including Transfusion, JAMA, Vox Sanguinis, and the Annals of Internal Medicine.

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DISCLAIMER: The opinions expressed on this episode are those of my guest and I alone, and do not reflect those of the organizations with which either of us is affiliated. Neither Dr. Grossman nor I have any relevant financial disclosures.

The images below are generously provided by Brenda Grossman.

Slide 1 - Natural history of AUS; note the small but significant number of new alloantibodies
Slide 2 - Why do antibodies of undetermined specificity occur? Here are the most common reasons.
Slide 3 - Some pros and cons of further workups on AUS cases

Music Credit

Music for this episode includes “Cuando te invade el temor” and “Reflejo,” both by Mar Virtual via the Free Music Archive. Click the image below for permissions and license details.
Creative Commons license and link

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