Jump to content

Unidentified Antibody, Little Help Please


radwan1411

Recommended Posts

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. 

 

result.jpg

result.jpg

Edited by radwan1411
Link to comment
Share on other sites

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). 

 

Link to comment
Share on other sites

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.

 

 

Link to comment
Share on other sites

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.

Link to comment
Share on other sites

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.

Link to comment
Share on other sites

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.

Link to comment
Share on other sites

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? 

Link to comment
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now
  • Recently Browsing   0 members

    • No registered users viewing this page.
  • Advertisement

×
×
  • Create New...

Important Information

We have placed cookies on your device to help make this website better. You can adjust your cookie settings, otherwise we'll assume you're okay to continue.