exlimey

Reading between the lines, I believe you're saying that C+D- (r'r) panel cells are nonreactive, thereby excluding the presence of anti-C, If that's the case, and since said cells should carry the G antigen, it is very unlikely you're dealing with anti-G. Anti-LW may mimic an anti-D pattern by demonstrating reactivity only with D+ cells.
It's also very remotely possible that one of the donors carries a rare form of D-antigen that is not readily detected by typical commercial reagents. However, those are very rare and their ability to stimulate an immune response is not well understood.

Reading between the lines, I believe you're saying that C+D- (r'r) panel cells are nonreactive, thereby excluding the presence of anti-C, If that's the case, and since said cells should carry the G antigen, it is very unlikely you're dealing with anti-G. Anti-LW may mimic an anti-D pattern by demonstrating reactivity only with D+ cells.
It's also very remotely possible that one of the donors carries a rare form of D-antigen that is not readily detected by typical commercial reagents. However, those are very rare and their ability to stimulate an immune response is not well understood.

Reading between the lines, I believe you're saying that C+D- (r'r) panel cells are nonreactive, thereby excluding the presence of anti-C, If that's the case, and since said cells should carry the G antigen, it is very unlikely you're dealing with anti-G. Anti-LW may mimic an anti-D pattern by demonstrating reactivity only with D+ cells.
It's also very remotely possible that one of the donors carries a rare form of D-antigen that is not readily detected by typical commercial reagents. However, those are very rare and their ability to stimulate an immune response is not well understood.

This morning we tested with DTT treated screening cells - reactivity was still there.  If it had been an Lw - it should have been negative.....
 

Suggests to me that this really is an anti-D then.  I'll keep thinking (or trying to think at my age!).

I agree ENTIRELY with the answer given by exlimey.

Anti-G usually (not always, but usually) reacts more strongly with the C antigen than the D antigen, so that R1R1 and r'r red cells would give stronger reactions than would R2R2, whereas both anti-D and anti-LW would react more strongly with R2R2 red cells than R1R1 and r'r red cells.

I agree that one of the units could express an unusual D type (I was caught out once in a pregnancy case when the dad had the unusual D type of RHD(L214F)-CE(7)-D - which I thought was rather unfair of him!).

Have you tried rr cord bloods against the patient's plasma/serum sample?  The LW antigen is expressed much more strongly on cord red cells than adult red cells.

Reading between the lines, I believe you're saying that C+D- (r'r) panel cells are nonreactive, thereby excluding the presence of anti-C, If that's the case, and since said cells should carry the G antigen, it is very unlikely you're dealing with anti-G. Anti-LW may mimic an anti-D pattern by demonstrating reactivity only with D+ cells.
It's also very remotely possible that one of the donors carries a rare form of D-antigen that is not readily detected by typical commercial reagents. However, those are very rare and their ability to stimulate an immune response is not well understood.

Reading between the lines, I believe you're saying that C+D- (r'r) panel cells are nonreactive, thereby excluding the presence of anti-C, If that's the case, and since said cells should carry the G antigen, it is very unlikely you're dealing with anti-G. Anti-LW may mimic an anti-D pattern by demonstrating reactivity only with D+ cells.
It's also very remotely possible that one of the donors carries a rare form of D-antigen that is not readily detected by typical commercial reagents. However, those are very rare and their ability to stimulate an immune response is not well understood.

I realize this is "fighting city hall" but is there a more useless requirement than having everyone review and sign off on procedures that haven't changed one iota?  In our laboratory, this is many hundreds of procedures (including the one on how to write a a procedure :). Bureaucratic make work of no value whatever.  An unfortunate example of the administrative/legal mindset versus the scientific/clinical mindset in our society.  Probably an early small sign of the coming end of our civilization when non-productive work receives such priority. Seriously.

In this case, the Safety goons may be your very best friends. If the space you describe is really that bad, you could use the safety angle as leverage. Alternatively, modern instrumentation (including the Ortho Vision) often has very specific installation requirements (space/clearance/ventilation, etc)....that may ammunition, too.

For the immediate time frame, with the mother in mind, consider the baby as D+ and provide RhIG.   On the other hand, with concerns for the baby, D= is how I would treat the baby. 

Until there is a definitive answer, it MUST be D Negative, even though the chances are that, at that stage of life, the baby's immune system would not produce an anti-D if D Positive blood was transfused, BUT it could well be that the baby's immune system could be sensitised to the D antigen.  ALWAYS ERR ON THE SAFE SIDE.

CAP simply requires adequate space, but workload and staff safety are both considerations as a part of that requirement. I agree with pushing the safety angle, as well as instrumentation requirements. 

Just another thought (and I'm sure you also considered this), we see a positive DAT which doesn't seem to make sense a few times a year that is resolved by washing the cells an additional 3-6 times or by obtaining a capillary specimen on baby.

If the baby is not anemic and has no evidence for hemolysis, I'd just leave it at that.  There are variant plasma antigens that can elicit antibodies and these can be hard to identify using red cell serologic techniques. If the eluate is negative against panel red cells, this is high probability.  Perhaps mom is sensitized to a paternal immunoglobulin variant and these immune complexes are adhering to red cells.  There are no standardized tests for such anti-plasma protein antigens, to my knowledge.  Not very satisfying, but the clinical findings are the most important issues here, not the serologic issues.

Contrary to the manufacturer's instructions ? That's really living on the edge. ☺

I use to work for a blood bank that QC'd expired panel cells when it is in use. We used the expired panels as selected cells, for rule outs/ins. 

Do you think it too passive aggressive to ask if you are required to QC ALL the low and high incident antigens on the panel especially those that you have no antisera for (or the cells to QC that antisera)? You could also ask them if and how you should QC the antigen variants on each panel!

Agreed. Anything less than a full phenotype is useless. We don't even do that for Screening Cells, which are arguably a lot more important.

If you have any, you could try D Negative Cord or Neonatal red cells, which express the LW antigen comparatively strongly (certainly compared with adult D Negative red cells).

Careful, now. You're bordering on "spatial discrimination".

How about a "Del" ? Fits the description perfectly.
One the other hand, "twice in the last few days" is worrying. While not impossible, it's highly unlikely that a facility would encounter more than one of these anomalies (zebras) in such a short period. I assume Malcolm's question regarding the Last Wash is an allusion to some laboratory artifact - bad technique, bad reagents, etc.

While the Ogata-Matuhasi phenomenon has been recognised since the early 1960's, it is, that notwithstanding, a very rare phenomenon to actually come across in practice.
With all due respect to you Bet'naSBB, if you "see this quite a bit", I would be a bit worried as to why.

How about a "Del" ? Fits the description perfectly.
One the other hand, "twice in the last few days" is worrying. While not impossible, it's highly unlikely that a facility would encounter more than one of these anomalies (zebras) in such a short period. I assume Malcolm's question regarding the Last Wash is an allusion to some laboratory artifact - bad technique, bad reagents, etc.

Have you considered that your patient could be a particularly low-grade weak D, a partial D of some kind (such as an RoHar), which would explain the anti-D in the eluate as a result of the RhoGam, or that what you are detecting in the eluate is not an anti-D, but is an anti-LW?
I also assume that the last wash is totally negative?  Sorry to ask this.