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Bb_in_the_rain last won the day on May 31

Bb_in_the_rain had the most liked content!

About Bb_in_the_rain

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    Junior Member
  • Birthday 07/23/1982

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  • Gender
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    I am obsessed with actions going on red cell surface
  • Location
    Seattle, WA
  • Occupation
    IRL tech

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  1. Has anybody look in maternal breast milk for IgG antibody in cases of prolonged HDFN? I just come across this article and found it to be very interesting. Leonard et al, "Identification of Red Cell Antibody in Maternal Breast Milk Implicated in Prolonged Hemolytic Disease of Fetus and Newborn"
  2. Please let me know if you would like me to do more "mock-up cases" with RHCE variants. I can look for some good ones. I think it is fun to interact with case studies here. (I mean it is quite fun to pick Malcolm's brain and learn from him... cough cough).
  3. No I did not do that. Great idea!! If I can find my eluate, I should...
  4. Haha. I copied that info right out the demographic sheet and typed "not pregnant or transfused" not thinking much about his gender. opps! I am surprised by this positive eluate as well. I was just "shooting in the dark" and performed the eluate blindly when I saw these reactions with e+ cells (since I saw way too much warm autoantibodies with relative anti-e specificity). Further serology results are- this antibody is weakly reactive w+ with 1 of 3 hrB- cells tested (all of them are C-e+) it is weakly reactive with 1 of 2 hrS- cells tested (both of them are C-e+) Genomic sequencing results in RHD gene (sequenced 1-10 exons) the following heterozygote changes were observed- c.410C>T, c.455A>C, c602C>G, c667T>G and 819G>A - predicted to be RHD*DIIIa or RHD*DAR3.01 A normal D gene was also observed. So the prediction was a normal D gene in Trans position to RHD*DIIIa heterozygote. Since RHD gene was associated with altered RHCE gene, RHCE sequencing was reflexed (sequenced 1-10 exons and some intronic flanking regions) variants - c.48G>C, c.676G>C, c733C>G, c.1006G>T - predicted to be RHCE*ceVS.03 in trans with RHCE*cE (because serologic phenotype is D+C-E+c+e+) So when I looked up RHCE*ceVS.03, I found it to be associated to V-VS+hrB-. So your suspicion is right on the spot! It is most likely anti-hrB!! At this point anti-C was not excluded but the transfusion recommendation was R2R2 blood, so we are ok here. In terms of eluate, it most likely is warm auto antibody with relative anti-D specificity due to the presence of normal D gene in hetrozygote expression. I am still puzzled by a negative auto-control. However since the antibody was eluated out of his untransfused red cells, so I can accept that it is most likely an autoantibody. Please let me know what your thoughts are and any further results that you may need. Hope this is a good case study!
  5. Ok It has been a while since this case was posted, I think we have given enough time for transfusion services folks to participate. Lets hear from the reference folks! I am so excited to see what your thoughts are!
  6. Very well done! I would suspect something along this line as well. You are very very close!! Lets hear from reference lab folks to see what their thoughts are. I will share more information on this patient's work up later.
  7. Correction: Eluate is reactive with DTT-treated cells.
  8. Will sure do! This look so good because it is not a real-life case that I just worked on. (cough cough)
  9. Sorry I missed this one. U antigen is ficin-resistant, therefore this cannot be anti-U
  10. Ok Lets try the first one here. Background - A 31 year old African American male, Bpos, C-E+c+e+K-S-s+Fya+Fyb-Jka+Jkb+. This patient was not previously transfused or pregnant. Plasma reactions tested with 18 cells antibody panel and the reactions are....... 3+ reactions with C+e+ cells, 1+ reaction with C-e+ cells, negative with e- cells AutoControl was negative. Reactivity in DTT-treated cells were similar to that of untreated cells. The reactivity with ficin-treated cells were enhanced, C+e+cells 4+, C-e+cells 3+, negative with e- cells Eluate reacted 1+ with D- cells, 3+ with D+ cells. non-reactive with DTT-treated cells cord cells yielded similar reactivity as that of the adult. Panagglutination 4+ was observed with ficin-treated cells. What are the possible antibodies that the patient can have? If genomic testing is warranted, I will be back next week to tell you what genomic testing the results are. Lets give a chance for the transfusion service folks to work on it before reference lab folks share their wisdom regarding this case.
  11. I have heard a couple of different clones coming from Seattle Hospitals (Hu5F9-G4 and ALX148). Watch out for the clone numbers when you work on patients on anti-CD47. It might make a big difference whether or not you can use Immucor anti-IgG to rule out your underlying alloantibodies.
  12. I am sorry I apologize for failing to realize that there may be more than one blood group recombinant proteins available for use in immunohematology. We may be talking about different recombinant proteins. The protein that I was thinking about is soluable CR1 recombinant protein (Mould JM, et al, Neutralization of Knops system antibodies using soluable complement receptor 1), which may be different from that of recombinant glycophorin protein by Schawalder A et al. Therefore, when I made up the result that "rRBG-treated plasma was positive", I meant to exclude antibodies to Knops and Ch/Rg blood group proteins. I also failed to mention that the suspect would be anti-EnaFS (but not Anti EnaFR or anti-EnaTS, which I almost have forgotten about since I have not seen those before). In this case, I suppose we can throw in anti-Pr to the mix of possibilities (if the patient's cell is glycophroin-deficient, with autocontrol negative, long shot??). Thank you very much for an opportunity for further learning. Awesome as always!!!
  13. 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..
  14. Rh negative is more prevalent in Europe than US that European Blood Centers can afford to permanently defer donors with anti-D without hurting Rh neg supply?
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