Follow-up after transfusion: delayed antibody screen, chronically transfused patient
BioMG follows French guidelines. Adapt it to the guidelines and the tests available where you practise.
After a red cell transfusion: delayed antibody screen
Between 1 and 3 months after the transfusion
- Irregular red cell antibody screen (RAI), result to be sent to the prescriber of the transfusion and to the haemovigilance correspondent
Also consider
- Positive RAI, woman of childbearing potential? See also the page “Positive red cell antibody screen (red cell alloimmunisation) in a pregnant woman”.
Do not order
- Routine post-transfusion HIV and HCV serology and transaminases: these checks were abolished by the 2006 circular, for lack of usefulness (risk of transmission now very low); only the post-transfusion antibody screen (RAI) was maintained [8].
Regularly transfused patient (sickle cell disease, thalassaemia, myelodysplasia)
Laboratory tests, at the frequency set by the haematologist
- Serum ferritin (sickle cell disease: every 6 months)
- RAI
- FBCif neededTo judge the anaemia and the need for the next transfusion (indication set by the specialist); no cited source sets a frequency.
- ASTif neededGermany (DGHO, 2025) measures them every month in thalassaemia [9], the American NHLBI once or twice a year in sickle cell disease [10]; the French PNDS monthly with an oral chelator, quarterly with deferoxamine [11].
- ALTif neededGermany (DGHO, 2025) measures them every month in thalassaemia [9], the American NHLBI once or twice a year in sickle cell disease [10]; the French PNDS monthly with an oral chelator, quarterly with deferoxamine [11].
- GGTif neededGermany (DGHO, 2025) measures them every month in thalassaemia [9], the American NHLBI once or twice a year in sickle cell disease [10]; the French PNDS monthly with an oral chelator, quarterly with deferoxamine [11].
- Alkaline phosphataseif neededGermany (DGHO, 2025) measures them every month in thalassaemia [9], the American NHLBI once or twice a year in sickle cell disease [10]; the French PNDS monthly with an oral chelator, quarterly with deferoxamine [11].
- Bilirubinif neededGermany (DGHO, 2025) measures them every month in thalassaemia [9], the American NHLBI once or twice a year in sickle cell disease [10]; the French PNDS monthly with an oral chelator, quarterly with deferoxamine [11].
- TSHif neededGermany (DGHO, 2025) monitors the thyroid every year and calcium metabolism quarterly from age 10 [9]. The French PNDS provides for annual screening for endocrine complications of iron overload [11].
- Serum calciumif neededGermany (DGHO, 2025) monitors the thyroid every year and calcium metabolism quarterly from age 10 [9]. The French PNDS provides for annual screening for endocrine complications of iron overload [11].
- HIV serologyif neededGermany (DGHO, 2025, thalassaemia) and the United States (NHLBI, 2014, sickle cell disease) request them every year [9,10]. The French PNDS on thalassaemia no longer considers them routine, leaves them to the prescriber’s initiative and proposes a first measurement before transfusing, then a check every 2 to 3 years [11].
- Hepatitis B serologyif neededGermany (DGHO, 2025, thalassaemia) and the United States (NHLBI, 2014, sickle cell disease) request them every year [9,10]. The French PNDS on thalassaemia no longer considers them routine, leaves them to the prescriber’s initiative and proposes a first measurement before transfusing, then a check every 2 to 3 years [11].
- Hepatitis C serologyif neededGermany (DGHO, 2025, thalassaemia) and the United States (NHLBI, 2014, sickle cell disease) request them every year [9,10]. The French PNDS on thalassaemia no longer considers them routine, leaves them to the prescriber’s initiative and proposes a first measurement before transfusing, then a check every 2 to 3 years [11].
Also consider
- Sickle cell disease? See also the page “Sickle cell disease”.
Sources (13)
- Agence nationale de sécurité du médicament et des produits de santé. 21e rapport national d'hémovigilance, activité 2023. Janvier 2025 (version corrigée du 30/01/2025).
- Haute Autorité de santé, ANSM. Transfusion de globules rouges homologues : produits, indications, alternatives. Recommandation de bonne pratique, novembre 2014 (texte des recommandations).
- Ministère de la Santé. Instruction n° DGS/PP4/DGOS/PF2/2021/230 du 16 novembre 2021 relative à la réalisation de l'acte transfusionnel, fiche 4 « La transfusion du produit sanguin labile, la surveillance et la traçabilité de la transfusion ».
- Bundesärztekammer (Allemagne). Richtlinie zur Gewinnung von Blut und Blutbestandteilen und zur Anwendung von Blutprodukten (Richtlinie Hämotherapie), Gesamtnovelle 2023. Bundesanzeiger, BAnz AT 26.10.2023 B5.
- Nederlandse Internisten Vereniging, NVA, NVKC (Pays-Bas). Richtlijn Bloedtransfusiebeleid, module « Antistofscreening/-identificatie », évalué le 15/10/2020.
- National Institute for Health and Care Excellence. Blood transfusion (NG24), 2015, révision du 26 février 2026 : recommandation 1.14.4 (Patient information).
- Tormey CA. Challenges in Blood Group Alloantibody Detection. Pearls of Laboratory Medicine, Clinical Chemistry (American Association for Clinical Chemistry), 19 avril 2016.
- Ministère de la Santé et des Solidarités. Circulaire DGS/DHOS n° 2006-11 du 11 janvier 2006 abrogeant la circulaire DGS/DH n° 609 du 1er octobre 1996 relative aux analyses et tests pratiqués sur des receveurs de produits sanguins labiles (NOR : SANP0630013C).
- Cario H, Alashkar F, Andres O, Hoferer A, Meisel R, Schmugge Liner M, Sillaber C, Wörmann B. Beta-Thalassämie. Leitlinie Onkopedia (DGHO, OeGHO, SGH-SSH, SGMO), Stand Juli 2025.
- National Heart, Lung, and Blood Institute (États-Unis). Evidence-Based Management of Sickle Cell Disease: Expert Panel Report, 2014.
- Filière de santé maladies rares MCGRE. Protocole national de diagnostic et de soins (PNDS) : syndromes thalassémiques majeurs et intermédiaires. Haute Autorité de santé, juillet 2021.
- Sickle Cell Society (Royaume-Uni). Standards for the Clinical Care of Adults with Sickle Cell Disease in the UK. 2e édition, 2018.
- Nederlandse Internisten Vereniging, NVA, NVKC (Pays-Bas). Richtlijn Bloedtransfusiebeleid, module « IJzerstapeling bij hemato-oncologische patiënten », évalué le 15/10/2020.