How do I provide rare red cells to patients?

Abstract

Background The demand for rare blood is expected to increase in Canada as its population continues to expand through immigration from diverse regions of the world. Material and methods This paper outlines a national approach to providing rare red cells for patients through the Rare Blood Program of Canadian Blood Services (CBS). Data detailing the rare red cell requests and inventory managed by CBS' Rare Blood Program is provided. Results The provision of rare red cells involves multiple considerations such as multidisciplinary communication, serologic/molecular confirmation, donor recruitment, inventory optimization and logistical factors. Conclusion The description of CBS' Rare Blood Program will inform others that seek to create, optimize, or expand programs that facilitate the provision of rare blood. New technologies such as next‐generation sequencing may also affect how rare donors are identified and recruited in the future.

The need for rare blood programs is real

“…The authors reviewed the current and future Canadian rare blood requirements and the functioning of the rare donor program. The article “How do I provide rare red cells to patients?” in this issue of Transfusion summarizes the findings 1 …”

“…The expiry date for frozen RBCs is commonly required to be 10 years, with some rare unit types stored for up to 30 years, but some are so rare that they are stored longer 10 . Laureano et al comment that “units can remain in frozen storage up to 30 years” 1 . RBC units collected from rare donors as autologous units are generally stored for the life of the donor.…”

“…The “How do I" article highlights the importance of an accurate and detailed antibody investigation 1 . Correct antibody identification prior to, or simultaneous with (if urgent need) requesting rare blood shipments and the determination of allo‐ versus autoantibody specificity is essential not only for safe transfusion but also to ensure the best use of rare resources.…”

“…Laureano and colleagues, 1 in Table 1, provide example requests for rare blood received by the CBS. The number of requests were determined along with the number of international requests and number of units imported.…”

“…The United Stated uses MMAs more often; from 1995 to 2017, 402 samples were referred to the National Laboratory for Blood Group Serology (NRLBGS) in Philadelphia for MMA 30 . Relating to the cases presented by Laureano et al, 1 of 11 anti‐Di b referred to NRLBGS, only 3 were negative in the MMA, and, with anti‐Kp b , 4 of 6 cases yielded negative MMAs. The ARDP uses the MMA to predict clinical significance of alloantibodies and thus, antibody identification is critical to selection of red cells for testing.…”