mrmic

My initial answer would be no. Haven't seen this happen with a transfusion of 1 unit. Would have to recheck the whole process of the 1st sample (pre transfusion), starting from the collection (correct patient, correct collection site, correct person collecting, correct labeling, specimen handling, specimen testing, etc.etc)…. maybe there was an error along that path and not a immunohematological issue?

Anti-Fya and Anti-Fyb are not well known to cause significant HDFN. I have not seen one, at least. Was there any follow-up testing of the infant? What were the laboratory findings, i.e. bilirubin etc. ? It has been a few months now, have you had a chance to re-type the infant's red cells? Is there a chance that it really was a weak binding of Anti-Fya with Fya+ red cell antigens? If only a gel-card method of interpretation of a "weak positive" as being negative was used, I wouldn't necessarily be convinced that the infant is Fya-. Gel card methods do funny things sometimes.

"Does anybody know what time it is" Chicago, 1970. Does anybody know what titer it is? Simple question, answer not too simple. If you are following titers of a specific antibody for a specific reason (anti-D, pregnancy), it is important to establish the method you use is reproducible and that it correlates with what the physicians that are going to be using that information for. As has been pointed out with previous responses, the methods used for antibody enhancement may affect the endpoint results of the antibody titration. The physician is often attempting to make a decision for the care of the mother and her child, current or future. The laboratory should provide a interpretation of the results based on results they have laboratory data and based on histories of patients previously followed. Certainly, literature should be searched for information that has been shared regarding this subject, as the one previously mentioned, however, if your laboratory is involved in following titrations and clinical significance, it is probably important you established the data for your own laboratory.

I know this is a late response but re-reading some posts brings up old ponderings. I have always been interested in the non-immune stimulated antibody specificities (naturally occurring). When we have seen these in different patient populations, i.e. malignancies, pregnancies, and autoimmune anemias. There was some papers that put forth the term "mimicking" antibody specificities, we may occur from immune malignancies, drugs, herbs, etc., or due to a dilutional effect or specific enhancement methods. At the time we attempted to absorb and elute the antibody specificity in question with red cells that were negative for the antigen of the specificity in question. With some success but not 100%. Maybe the antibody was actually directed to some specific epitope that was part of or in common with the antigen in question? Is the ultimate test to transfuse the patient to determine if the red cell survival is affected by this apparent mis-match? I do not see a lot of red cell survival studies anymore. However, I will stop there. Only to say to Ms. Adams thank you for your non-immune stimulation of my old days immunohematology...…it is a naturally occurring problem I have reading BB posts......

I certainly agree with Mr. Blumberg and Mr. Needs as well as others, everyone brings up excellent points and explanations. My only comment I could put forth for consideration would be from a BB Pathologist I once worked with many years ago having observed similar cases. "Pregnancy is a disease".

I am interested if anyone has attempted to use one of the wireless temperature monitoring systems to monitor the coolers being used within the hospital? More hospital in the USA are looking at these systems for their refrigerator/freezer/room temperatures monitoring. That would seem to be an excellent monitoring and data documentation for the products outside BB's control.

It is all relative. Yes, antibodies' titers can rise and fall during pregancy whether or not the fetus is positive for the corresponding antigen(s). So titers may not be helpful in a subsequent pregnancy from a mother whom has shown to be an immune responder. But, it may be a one piece of the puzzle a physician can use to make decisions about the management of the pregnancy. It may be an opportunity for us to be part of the team, share our knowledge and experiences with the team, follow the immunohematology path, maybe learn something ourselves and share with our peers. I would be willing to follow the titers, it's Immunohematology, it's what we do, and maybe, just maybe, we might discover something relative. My soapbox for the day, just comments from my perspective as an old retired SBB.

WOW, don't see anti-JK3 too often! Have you already pursued family members and extended family members? Also, is there a ethnic group you may want to screen? We have had some success in the past in our area with Native Americans whom have had some members with a antibodies to a high antigens. Certainly would want that patient and or other family members start donating and freezing their donations for their and others' future. Technically, I agree with Mr. Needs approach with trying to resolve your immediate requirements. Good luck and best wishes for your patient's recovery.

I would be interested in the patient's history; male/female/ pregnancy/infections/drugs/drug use/medications/herb etc. use/transplants. Also, specimen information; standard clot tube/clot activator? / edta or other anticoagulant, time from collection to testing/ storage time? etc. Have new specimens been collected and retested by same and different methods or lot #s. I apologize in advance if this is asking for basic "given" items that were all ready looked at but before I would investigate unusual laboratory findings I am always interested in history first before finding out there were other contributing factors. laboratory question; are you able to remove the cells from the cell-typing gel-tube and elute anti-A from the cells. Will be watching to see your final decision on this case! Thanks for presenting it.

Sooooooo.........is is 1 positive reactive cell out of 3 selected cells ok? What next? Do you keep testing "homozygous or heterozygous" selected antigen positive cells til you get 3 negative? It's not just rulling out, it's looking for what's in. It is a good thing to have a Immunohematology Reference Lab partner to assist with multiple antibodies or antibodies to antigens of high frequency. Your blood supplier should have this service for you... Probability calculations do not always go hand to hand with antigen expression. 🐀 mic

😁 Something I remember!! Back in the "Reference" lab days when we could innovate on our feet without reimbursement issues, and probably some safety issues too. Malcolm, if I may address you informally, if not pardon me,. we did the same process as you described except, we found an old incubator we could adjust the temp and put our serofuge inside to centrifuge, running the plug wire up through the hole of the incubator that normally would have a black rubber stopper holding a glass thermometer! Good story, thanks for the memory. 🐀 mic

Still old school........why..........because I'm old.............. Is RBC genotyping our future? But first.............. Has research revealed if the extent of RBC antigen polymorphism higher than previously known by the number of antigen specificities? Are there serologically indistinguishable variants or subtypes identified, and if these variants are different from the wild type only by a very few amino acid substitutions, can these be functionally distinct and relevant in genotype matching for transfusion and hematopoietic stem cell transplantation? Which are clinically significant for transfusion purposes or hematopoietic stem cell transplantation or GVHD? These are similar issues that the HLA transplantation field has been discussing. Are blood bankers (Immunohematology field) today also discussing similar issues at regional and national meetings? I may be off track and need to get back involved with meeting to get "re-educated" and how far we have progressed over the last 20 years.

Gel testing is just a "miniature" tube system using a "controlled" % cell suspension and a Low ionic environment. Although the tube test can be similar, unless you are using the same %, concentrations and ratio, you might find it difficult to compare in-vitro results. Although the sensitivity may be slightly increased for some antigen-antibody reactivity, maybe those we don't want to see, it also has similar problems as other low-ionic methods with the Kell system. I agree with Ms. Adams comments. It is important that the OB/GYNs know how you are performing the titrations and if the method(s) correlates with clinical outcomes. This has been established with the tube method, maybe the tile as well, but I am not aware of references for the "gel" method. I believe, as long as the OB/GYN is aware that the "trigger" titer number for clinical intervention may be different for the gel method, however, the monitoring during pregnancy looking for a significant change in titer may be consistent with both methods. I also agree that use of other clinical data (Doppler etc.) is becoming a better standard of practice than amniocentesis and it is less risky for the mother and child. Although in suspected severe cases of HDN, amniocentesis may still be warranted. Better have your validations and IQCP ready...

Just a thought, Has the donor center been contacted to review the Donor's history? Meds,(prescrip or herbal), donor not feeling well in the past, or afterwards of the donation? Could they test the donor's plasma/serum against other antigens of low frequency? They should have extra or could call the donor in. Patient may be reacting to something specific with the donor's donation. Patient has allergies to something the donor is taking (meds or etc). Could be a cytotoxin from some bacterial exposure the donor has had. Once we had a case with a snake handler, donor had or has had Salmonella but felt fine at the time of donation, and the toxins were present in the platelets' plasma..... similar reaction. (no positive DAT though). I agree with previous response from Mr. Needs, that DAT and eluate specificity could be co-incidental, especially since he has been multi-transfused and may not be related to the immediate "transfusion reaction". Interesting case! Thanks for sharing....