HX of WAA Case

[Bbank90 1]

Advice on how to proceed if possible.

We were given a teaching case as follows: Patient has HX of WAA, with every antibody except for C, and E according to HX.

DAT and Auto control negative, screen positive at IS and PEG-IAT. Not enough cells for autoadsorption-would you proceed with an alloadsorption or ? Thanks for any direction. 

[Malcolm Needs ★ 4,682]

Alloasorption.  In fact, having worked in Reference Laboratories for most of my life, it was VERY unusual for the patient either to have NOT have a transfusion within the previous three months - meaning that they were not a candidate for auto-adsorptions - or their haematocrit is so low that there are too few autologous red cells to perform an auto-adsorption in the first place (usually because they were sent to us because they needed a transfusion in the first place!).

[yan xia 193]

The DAT and Auto control negative, do we need to do auto-adsorption?

[Bbank90 1]

28 minutes ago, yan xia said:

The DAT and Auto control negative, do we need to do auto-adsorption?

Taking this case further...an alloadsorption was done, only one cell was positive when redoing the screen. C and E were then ruled out with a select cell. 
Crossmatch results were as follows: IS compatible, Peg- IAT incompatible, Peg-IAT with adsorbed plasma was compatible. In theory this faculty will only accept usage of PEG when crossmatching for them. Getting mixed messages regarding the approach taken. I’ve seen cases similar and not sure what should’ve been done differently? 

[yan xia 193]

That was new to me, is it because the auto-cells are antigen-depressed by the autoantibodies or some other reasons?

Edited March 11 by yan xia
typo

[e specificity 3]

if the DAT and auto control are both negative, what are you adsorbing out? An antibody to a high freq antigen? A cold? This would need additional work/perspective. A history of WAA doesn't mean it's a WAA forever.

Does the patient have a history of anti-C and anti-E or everything else? Everything but Rh antibodies seems unusual to me.

 

[David Saikin 1,353]

On ‎03‎/‎10‎/‎2020 at 8:49 PM, Bbank90 said:

Taking this case further...an alloadsorption was done, only one cell was positive when redoing the screen. C and E were then ruled out with a select cell. 
 

If you have done the alloabsorption, do you not elute and test the absorbed abs?  I find it hard to believe that a patient would be sensitized to all the ags except C and E.  (The most abs I've ever encountered were 10).