Dr. Pepper Posted October 16, 2014 Share Posted October 16, 2014 Fun couple of days: Patient #1: weak anti-E 10 days ago, transfused with 1 unit E- RBC. Today she has anti-M reacting 3+ at IS, 37o and AHG (tube/LISS). Found out there's a history of anti-M at another hospital. I've never seen a secondary antibody response with anti-M before. Anyone else? Patient #2: Typed this one as O+ years ago. Yesterday he reacted variably w+ to 2+ with monoclonal (Immucor) anti-A, anti-B and monoclonal control. By variably I mean you could set the tests up again and get different reactivity from the last time you tried it. The cells were negative with patient-source anti-A and anti-B. The patient had a negative ab screen, negative auto control. Washed cells typed normally. If you let the red cell suspension sit for a half hour the cells would then type as a normal O. Make up a fresh suspension and you got the spurious agglutination to one degree or another. The agglutination did not look like rouleaux under the scope. We got our valid typing with washed cells, but I'm baffled as to the cause of the spurious reactivity. Any ideas? Phil goodchild 1 Link to comment Share on other sites More sharing options...
goodchild Posted October 16, 2014 Share Posted October 16, 2014 (edited) I've seen #1 before. Was the patient's autocontrol / DAT positive? The patient I can remember off the top of my head had a long history of anti-M and occasional transfusions. Two years after initially encountering the patient they became very ill and had numerous admissions over a three month time period where they were transfused 1-2 IAT-compatible RBCs each week. The patient's gel-method antibody IDs consistently demonstrated an anti-M that only reacted against panel cells of homozygous expression (1+). After probably the 12th RBC unit the patient's antibody ID reactivity changed, now reacting with w-2+ with all M-positive cells, a positive autocontrol, positive IgG DAT, and anti-M identified in the eluate. We switched to M-negative units after that. The patient developed additional antibodies later on but I don't remember which ones. Edited October 16, 2014 by goodchild Link to comment Share on other sites More sharing options...
goodchild Posted October 16, 2014 Share Posted October 16, 2014 I had to look it up after thinking about it and the patient developed consistent additional reactivity that we could never pin down with a specificity. Link to comment Share on other sites More sharing options...
Yanxia Posted October 17, 2014 Share Posted October 17, 2014 (edited) I just seen #2, he is a kidney disease patient, his doctor deny use any special medicine to him, and we see this very often ,most of them arekidney patients and hematonosis.If I centrifuge the specimen, then the reaction is not been interfered. I thought it is because the albumen, after wash or some time, it will part from the red cells ,then we will get the right typing.As to antibodies screen and its autocontrol, after wash the albumen is not here, so we get neg result. Edited October 17, 2014 by shily Link to comment Share on other sites More sharing options...
jojo808 Posted October 18, 2014 Share Posted October 18, 2014 Patient #2 Happened to us twice. Both were bone marrow transplants. Link to comment Share on other sites More sharing options...
Bb_in_the_rain Posted November 18, 2014 Share Posted November 18, 2014 (edited) I am just typing my thoughts outloud (not that I have seen anything like that during my very short career) Patient #2 Happened to us twice. Both were bone marrow transplants.Maybe soluable A or B substances from non O recipient's serum adsorbed onto O BM donor cells after engraftment? Fun couple of days: Patient #1: weak anti-E 10 days ago, transfused with 1 unit E- RBC. Today she has anti-M reacting 3+ at IS, 37o and AHG (tube/LISS). Found out there's a history of anti-M at another hospital. I've never seen a secondary antibody response with anti-M before. Anyone else? Patient #2: Typed this one as O+ years ago. Yesterday he reacted variably w+ to 2+ with monoclonal (Immucor) anti-A, anti-B and monoclonal control. By variably I mean you could set the tests up again and get different reactivity from the last time you tried it. The cells were negative with patient-source anti-A and anti-B. The patient had a negative ab screen, negative auto control. Washed cells typed normally. If you let the red cell suspension sit for a half hour the cells would then type as a normal O. Make up a fresh suspension and you got the spurious agglutination to one degree or another. The agglutination did not look like rouleaux under the scope. We got our valid typing with washed cells, but I'm baffled as to the cause of the spurious reactivity. Any ideas? PhilCase #2 can some chemicals or antibiotics in monoclonal reagent cause positive reaction? that does not explain the reaction only with unwashed cells. Maybe something is coating on patient's cells? Perhaps this patient has too much protein floating around in its plasma and they got onto the cells? Edited November 18, 2014 by dothandar Link to comment Share on other sites More sharing options...
Auntie-D Posted November 19, 2014 Share Posted November 19, 2014 I am just typing my thoughts outloud (not that I have seen anything like that during my very short career) Maybe soluable A or B substances from non O recipient's serum adsorbed onto O BM donor cells after engraftment? Case #2 can some chemicals or antibiotics in monoclonal reagent cause positive reaction? that does not explain the reaction only with unwashed cells. Maybe something is coating on patient's cells? Perhaps this patient has too much protein floating around in its plasma and they got onto the cells? Nitrofurnatoin is notorious for this... Link to comment Share on other sites More sharing options...
Dr. Pepper Posted November 20, 2014 Author Share Posted November 20, 2014 Auntie, so nitrofurnatoin, in the patient's bloodstream after taking a dose to treat a UTI, coats the cells in such a fashion to react with something in the reagent antisera, but will wash off with saline washes or dissociate over time in a saline suspension left at room temp??? Link to comment Share on other sites More sharing options...
Auntie-D Posted November 20, 2014 Share Posted November 20, 2014 Auntie, so nitrofurnatoin, in the patient's bloodstream after taking a dose to treat a UTI, coats the cells in such a fashion to react with something in the reagent antisera, but will wash off with saline washes or dissociate over time in a saline suspension left at room temp??? It can do, yes. Link to comment Share on other sites More sharing options...
Dr. Pepper Posted November 20, 2014 Author Share Posted November 20, 2014 I just went back and looked in the patient's record. Thanks for the info, Auntie, but in this case that might not be it. The patient was getting bloodwork prior to a total knee replacement. No mention of the drug. Good thing to know, though. Phil Link to comment Share on other sites More sharing options...
Auntie-D Posted November 20, 2014 Share Posted November 20, 2014 (edited) I just went back and looked in the patient's record. Thanks for the info, Auntie, but in this case that might not be it. The patient was getting bloodwork prior to a total knee replacement. No mention of the drug. Good thing to know, though. Phil Just had a bit of a google and it seems high-dose Penacillin and Alpha-methyldopa can also cause a positive DCT and quinine in doses used for malarial prophylaxis can cause false positive reverse groups due to IgM production. Edited November 20, 2014 by Auntie-D Link to comment Share on other sites More sharing options...
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