Case Studies

I have concluded the test patient has an anti C antibody. However the only hiccup is the R1wR1 cell is negative in gel and would essentially rule out C in the homozygous cell. Currently the policy is that R1wR1 cell is not used to rule out C due to the weakened expression of C. Just wanted feed back from others.

A blood sample from an antenatal clinic (9 weeks gestation) showed 3+ reactions in the antibody screen. Antibody identification show 2+ reactivity in IAT and 4+ reactivity in enzyme techniques, with a negative autocontrol. The patient's phenotype is C+c+E+e+K-. The sample was sent to a reference lab, which reported non-specific reactions in IAT and enzyme , with no antibodies detected by LISS . DAT: Negative Any explanation for this results why strong reaction in screening and antibody identification but no alloantbodies

Hi We Received URGENT request for 1 unit of blood transfusion for 1 year old child who had previous transfusion at abroad due Thalassemia Major. This was patient 1st visit in the UK therefore Rh and K phenotype was not known . As per guidelines Rh and K phenotype performed. Rh phenotype results obtained as below C mf E 4+ c+4 e4+ K mf. (Probably R2r) Because patients was previously transfused at other country sample was sent for genotype which will take 2 weeks to get results back. Due to clinical condition, patient, required urgent transfusion therfore with Haematology consultation 1 unit of blood C-K- blood issued by IAT xmatch. Meanw…

Looking for a "paper" Case Study antibody ID exercise for our staff to use as a competency exercise. We are a large academic medical center and transfusion service and we perform essentially ALL of our own testing......except molecular testing. Our staff needs to know how to ID antibodies, know next steps to take, what needs to be R/O, and how to do it...... I can make up "simple" ABID exercises......but seem to be having a mind block when it comes to figuring our how to create something that may have more "steps" for conclusive ABID. This would be given to all staff - on paper most likely - to work through and turn in for management to assess. Can anyone help? …

Does anyone know of a book I could buy to help me practice case studies and get a more in depth understanding of Transfusion situations?

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Interesting case 3 units were crossmatch electronically. After 1st unit patient developed chills,rigor and Temperature, therefore transfusion was stopped and requested for transfusion investigation requested. upon investigation it was found pre and post transfusion Antibody screen and identification Panel was also performed and negative on both sample. DAT was negative on pre transfusion sample and positive in post transfusion sample. Ig G 1+ C3d negative. However crossmatch was performed by IAT and found to be positive 3+ reaction. Pre and post Samples were sent to RCI for investigation. Patien Billirubin and LDH went up significantly. Case was discussed…

We had a mother who had a C - Section yesterday and a Cord Blood Workup was performed on it. The Mom is Type O Rh Positive (negative antibody screen) and the newborn typed as O Rh Positive as well but had a positive DAT. We are unsure as why this occurred. The testing was repeated on a heel stick and the same results were achieved. Any help anyone could give as why this could happen would be greatly appreciated. Thanks

For those of who works in transfusion service laboratory and would like to learn more reference cases, I can post some mock-up cases here. If you would like me to do it, please hit the "heart" button on this post. If enough folks want to practice case studies on reference lab cases, I can post mock-up cases here weekly or so..

Hi Patient has Anti Jkb antibody therefore x match 4 units with Jkb negative blood but while performing xmatch it was found all the units were positive BUT Auto is negative. What are the possible reasons for this?

Hello, to all Blood Bankers here. i have a question regarding about our new protocol regarding Antibody Screening. my question is our supervisor made a new SOP about Antibody Screen and Crossmatch. In our new policy she removed the immediate spin and 37 degrees reading using Tube method . The enhancement medium we are using is ML2B LISS by BIORAD. kindly enlighten me ? Is this possible? Thank you in advance

Lets do a muck case study just for fun. Here we go. Background- 31 year old Hispanic Male was admitted to hospital with GI bleed. Patient blood type is O Pos, C+E-c-e+K-S-s+Fy(a-b+)Jk(a+b-). Antibody screen showed all 3 cells positive (2+) and autocontrol was negative All 18 cells tested in antibody panel showed positive (2+) reaction, including C+E-c-e+K-S-s+Fy(a-b+)Jk(a+b-) cells. Ficin-treated panel cells were all negative and DTT-treated panel cells were all positive. What would you do next? ** I am trying to tease some brains from transfusion services. If reference lab folks are reading this, please do not give away the answer**

"A donor unit obtained from a central blood bank was labeled as Group O, D-negative. When the hospital transfusion service confirmed the donor's type, the result was group O, D-positive. Investigation of the label issued at the blood bank verified the unit's correct labeling. How can you explain the discrepancy in the D type of this donor unit?" The person who wrote this question said it is a "critical thinking" question and there is only one correct answer.

Help make sense of possibilities and if this is something to be of concern or not or if it could be a false positive: first pregnancy due in August - no previous miscarriages no blood transfusions etc. 2011 college class - did a lab and blood type was A+ (could have easily messed this up) feb 2020 pregnancy appt tested A- and negative for antibodies (13 weeks pregnant) June 2020 pregnancy appt tested A- but positive for “Passive anti D” antibodies (29 weeks pregnant) NOTE: doctors are super concerned and sending for ultrasound. Lab just assumed the result was expected because RHOGAM was given the same day BUT rho…

Hello all, doing some CPD on a theoretical patient case study with anti-In(b). Does anyone have a good reference (literature/journal) for the way this antibody behaves and potentially contributes to tx reaction / HDFN? Also the reason the antibody behaves in the way it does? Thanks in advance

Hey guys.. I just had this case today in blood bank, and i couldn't id the Antibody in this patient serum. All i know is this : - the patient is A pos , the cassette control is +positive - AC pos 4+ - gives in Untreated id panel 4+ in some cells and w+ in others as shown in the picture, and when we used the Ficin Treated panel all cells from 1 to 11 all 4+. - at first i thought about Anti-D but this patient is already Rh pos. And i reached a dead end. - BTW he gives w+ incompatibility with all A pos units. Just ignore the blue highlight, one of the staff but im not convinced its one of those.

Interesting study but I could use another brain. Last evening: Pt presents w a broken wrist. Looks like an A+ (R1R1) except the reverse A1 cells are mf (gel). Antibody screen all mf except auto. A2 cells and M= cells: all mf. Cold autoabsorption: results the same. Strict prewarmed using tubes/PeG/anti-IgG: all are 1+ except auto (neg). PeG Autoabsorption: all cells negative. I want to assume a cold etiology due to the reverse grouping discrepancy. Patient was discharged before additional samples could be obtained. No medication history and no PCP documented. Any thoughts out there please? I have about 4 drops of plasma remain…

A pregnant lady in her first prenancy develop Anti-Inb at that time her titre was 8. As far as I know anti-Inb doesn't cause HDFN but it can cause HTR. In her first prenancy we kept ready 2 unit of ABO ,D Rh and K matched compatible blood. No blood required in first prenancy. But now in her second pregnancy her titre gone upto 64 at 28 weeks . If blood required , does she need to have Inb negative blood ?

Hi we had patient who has known anti E antibody. He has been transfused with 2 units E- K- by IAT xmatch. 2 weeks iater we received sample for G/S and request for 1 unit of blood due to low Hb. However clinician haven't suspected any transfusions reaction. Performed antibody screen and found to be positive with Anti-E and Jka with DAT positive in IgG 1+ and C3d 2+. Would this be a transfusion reaction? Or patient had developed new antibody due to recent transfusions? What is reason for DAT to be positive in C3d as well? I think IgG antibody causes extracascular haemolysis . Is it due to antibody develop recently that might be IgM in nature ? Thanks in …

Can someone explain interpretation #2 and give examples of cold antibodies that can cause these Ab screen results? Here's a example of an antibody screen: Cell IS 37C AHG SC 1 2+ neg 1+ SC 2 3+ 1+ 2+ Auto neg neg neg Possible interpretations according to textbook: 1. multiple antibodies, warm & cold 2. potent cold antibody binding complement in AHG

Here's the antibody screen: Cell IS 37C AHG SC 1 neg neg 1+ SC 2 neg neg 1+ Auto neg neg neg The possible interpretations are: 1. single warm antibody, antigen present on both cells 2. antibody to high prevalence antigen 3. complement binding by a cold antibody not detected at IS Can someone explain interpretation #3?

We had a patient, 30-year-old female, B pos, who showed up last week with an anti-C along with a few equivocals. When it was time to repeat the T&S (and antibody ID) a few days later, we went ahead and set up a panel along with the screening cells, since we already knew there was an atypical antibody that would show up. To our surprise, the screen was negative (Ortho manual gel). The panel reacted as expected, pretty good 1+ reactions for the C, with a few equivocals. The second specimen's screen was with a different lot of screening cells. We also tested with the original specimen's lot number of screen cells, and 3% tube screening cells -- those reacted …

Our Reference Lab has informed us that a patient's sample we sent to them has anti-Dib (Diego b), anti-Fya, and anti-Jka! The patient is pregnant and due the end of July. All 3 antibodies are capable of causing HDFN, although usually mild from what I have read. My concern is if we have to transfuse the mother. The prospect of getting blood is problematic. Most likely the units would be frozen and our local supplier would have them shipped in already thawed and deglycerolized, plus the time of flying them here is a challenge with flight schedules to our area. From my reading the Diego antibodies are more commonly associated with HDFN than transfusion reactions, and anti-Di…

African American women transfused with two week ago with 2 units RBC, hemoglobin dropping and is sympatric. Patient has a positive screen now, anti-D like identified. Patient is group O, Rh positive. Is there a rare antibody that we did not identified?

Lab supervisor has bad attitude and so aggressive with his staff, the staff sent email to the lab director explaining the situation with their supervisor. Which of the following answers would be the best action from the lab director: A/ Lab director should request for meeting with staff. B/ Lab director should request meeting with supervisor. 3/ lab director should request meeting with staff and supervisor together. Your Feedback, Opinion and answer will be highly appreciated.