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Hi: patient is positive for all panel cells and autocontrol.DAT pos for IgG only. Recently transfused and requires units, how to proceed next

Thank you

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This is nasty.

Do you know the underlying pathology?

Is there a pre-transfusion sample still available from the patient?

What is the ethnicity of the patient?

What is the ABO group of the patient?

Surely you gave give us a few more details than you have given?

Previous results?

Anything could help.

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Hello Malcolm,. O pos 30 yrs old.

She has never been pregnant. New DX of uterine cancer, required 4 units after surgery 3 weeks ago in another hospital, no records available. Dr put off transfusion for today but wants blood ready ASAP. Panel done in gel 2+ all cells except one R2R2 that was negative. Auto is 3+. DAT is 3+ IgG. Thanks

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I take it that there was more than one example of R2R2 used, as you say "one R2R2 that was negative", which is a pity, otherwise I would have been thinking in terms of an anti-e (or, possibly, anti-hrB, depending upon the lady's ethnicity.  It still could be, but perhaps there is another specificity there too.

The real problem here is the transfusion three weeks ago.  This could lead to alloimmunisation, but, according to Petz and Garratty (and I certainly wouldn't argue with them!), it could easily be exacerbating a low-grade, almost undetectable auto-antibody, and anti-e is a very common specificity found as an auto-antibody, although often as a mimicking specificity.

This, together with the lady's underlying pathology, suggests to me that it is an auto-anti-e, BUT I HAVE TO STRESS THAT THIS IS A GUESS.  In a case like this,a sample really should be sent to a Reference Laboratory.

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On ‎3‎/‎12‎/‎2019 at 4:09 AM, Malcolm Needs said:

  In a case like this,a sample really should be sent to a Reference Laboratory.

That is definitely what we do here.  We do not have what we would need for an autoabsorption, and our ARC Reference Lab folks serve us well.

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