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A patient came to the ICU with Hb at 52. It was quickly concluded that he had some sort of hemolytic anemia. He also had an immunodeficiency since birth with low levels of both IgG and IgA, and was wholly uncapable of producing IgM. The doctor requested a monospecific DAT and a screen, and ordered 2 bags of blood. All my lab tests came out as 3+ straight over, including the ctl well, so I proceeded with an antibody identification. Unsurprisingly, the patient's plasma gave 3+ reactions against all panel cells as well as his own rbc's, both with IAT/LISS (gel) and PEG. Autoadsorption x2 gave no other outcome, not even the slightest reduction of reactions. I cross-matched blood (again, 3+ reactions) which the patient received without any reported transfusion reactions. When I had the results from the cold ab panel on NaCl gel cards it clearly showed an anti-e at all temperatures (4, 20 and 37°C). Since the panel is used to identify IgM antibodies I assume that this is an autoantibody of IgM-type, and not a regular IgG anti-e, possibly caused by the IVIg the patient has received? I have no clue. The hospital where I work isn't very large and we don't do any advanced ab identifications ourselves, neither do we encounter these kinds of results and patients regularly. Is there anybody who has some ideas and would like to enlighten me? Would you have done any further investigation regarding ab detection?