Unidentified Antibody, Little Help Please

[radwan1411 2]

Hey guys.. 

I just had this case today in blood bank, and i couldn't id the Antibody in this patient serum. All i know is this : 

- the patient is A pos , the cassette control is +positive

- AC pos 4+ 

- gives in Untreated id panel 4+ in some cells and w+ in others as shown in the picture, and when we used the Ficin Treated panel all cells from 1 to 11 all 4+. 

- at first i thought about Anti-D but this patient is already Rh pos. And i reached a dead end. 

 

- BTW he gives w+ incompatibility with all A pos units. 

 

Just ignore the blue highlight, one of the staff but im not convinced its one of those. 

 

Edited April 20 by radwan1411

[jayinsat 139]

What is the patient's transfusion history? Did you perform a DAT or elution? These tests need to be done next.

My initial thoughts are you may have a warm autoantibody and, if the patient has not been recently transfused, try a W.A.R.M. adsorption. What enhancement medium are you using? Try to run the screen using a different enhancement (ie LISS vs PEG). 

 

[galvania 763]

and what is wrong with this patient?  what drugs is (s)he on?

[radwan1411 2]

- Patient has Transfusion history type to type units he received. 

- DAT 4+ 

- we use LISS and the only medium available. 

Physician diagnosis : Hemolytic Anaemia.

[Malcolm Needs ★ 4,689]

I think your physician's diagnosis is probably correct, as it very much looks like a "warm" auto-antibody, but you will need to ensure that there are no underlying clinically significant atypical alloantibodies.

[Arno 41]

First of all, if the cassette Ctl is positive, the blood type result is invalid (esp. the D antigen typing) . Looks like a (warm) AIHA and several rounds of adsorption (allo with enzyme treated cells or auto, depends on date of previous transfusion, how much RBCs are available and possibility to "clean them up" using ZZAP for instance) may bring some clarity here to check if there is an underlying antibody.

 

 

[exlimey 333]

Agree with previous - looks like a warm autoantibody and it's important to see what, if anything is underneath. Adsorptions will be necessary. Interestingly, if I can read the results correctly, the antibody is showing a marked preference for D+ cells. It may have LW specificity, although 4+ is unusually strong for anti-LW.

I'm curious as to why there is "w+ incompatibility with all A pos units". I would have expected those to be 4+ reactive, also.

There may be several issues going on here.

[Malcolm Needs ★ 4,689]

40 minutes ago, exlimey said:

Agree with previous - looks like a warm autoantibody and it's important to see what, if anything is underneath. Adsorptions will be necessary. Interestingly, if I can read the results correctly, the antibody is showing a marked preference for D+ cells. It may have LW specificity, although 4+ is unusually strong for anti-LW.

I'm curious as to why there is "w+ incompatibility with all A pos units". I would have expected those to be 4+ reactive, also.

There may be several issues going on here.

Maybe it is a mixed cold and warm AIHA - rare, but they exist (I co-wrote a paper on a case), in which case the "cold" could be an auto-anti-H, or even just the normal auto-anti-H commonly found in group A plasma.  That would explain the weak reactions with group A red cells.

[exlimey 333]

3 hours ago, Malcolm Needs said:

Maybe it is a mixed cold and warm AIHA - rare, but they exist (I co-wrote a paper on a case), in which case the "cold" could be an auto-anti-H, or even just the normal auto-anti-H commonly found in group A plasma.  That would explain the weak reactions with group A red cells.

It's tough to see on the scanned panel sheets, but the D- group O panel cells are w+ reactive, equivalent reactivity to the crossmatched group A cells.

[Ally 6]

Agree with previous replies, when you have screen, panel and AC all 4+ the first thing to think about WAA. I suggest to do Adsorption in order to rule out alloantibodies. Also you might have warm autoantibody demonstrating D specificity in this case transfusion of antigen negative rbc is Not required BUT antigen negative blood may increase cell survival.

Did you do DAT? 

[radwan1411 2]

DAT :  4+ 

BTW: Patient was transferred to another facility, after performing 70+ (A,O) units all Incompatible 1+ and more, even same phenotype also as well Incompatible.