Arno

In which buffer do you resuspend your DTT treated cells? May be these patients do have antibodies against one or several components of this buffer (antibodies against preservatives used in RBC buffer are not so uncommon).

Hi Rich, I am not a clinician but as far as I know IVIG can be given to obstetrical patient in diff. conditions (autoimmune disorders, recurrent pregnancy loss, ...). I thought about IVIG when I saw the DAT becoming positive plus additional reactions coming up over the time. Anti-A and Anti-B are indeed the most prevalent antibodies in plasma derived products but other specificities of low titre can be present sometimes such as anti-D, anti-K and a bunch of antibodies of undetermined specificity reacting with several to not say all RBCs. Just a thought that can be doublechecked with the clinician..? Hereunder is a very great (not recent though) paper to be read and re-read again: Problems Associated With Passively Transfused Blood Group Alloantibodies George Garratty, PhD, FRCPath American Journal of Clinical Pathology, Volume 109, Issue 6, 1 June 1998, Pages 769–777, https://doi.org/10.1093/ajcp/109.6.769

Is she given plasma derived product (not talking here about anti-D prophylaxis)? Thinking more here about IVIG?

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The reaction with the A2 cell would show there is an anti-A (+an anti-A1) so I presume it would rather speak for a B(A). I would expect for a AweakB having an anti-A1 only (?).

Could it be a B(A) phenomenon with elevated level of B transferase and decreased activity of the anti-A (and anti-A1)?

I believe newborn and maternal red blood cells do not have exactly the same density. So, on 2 different sampling even from the same tube of packed cells, you may have diff. proportions of maternal vs newborn red blood cells. It is the same in case of transfusion, as transfused cells are heavier, depending on the way RBCs are sampled (bottom/middle/top of packed cells) you may have diff. results/pictures (DP, no DP...).

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If the reverse cells are ficin treated, it might be the anti-c giving this mf result.

https://www.ncbi.nlm.nih.gov/pubmed/30779172 Interesting method developed in Brazil if you get access to the drug.

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To my knowledge no (?). I believe it is more likely due to his disease leading to this hematopoiesis stress and may have evolved over the time (?).