Where to go from here?

[Melanie]

Sample sent on 67 year old male multiply transfused in october of 2003 in renal failure following a transplant who needs dialysis and transfusion ASAP. Patient has a history of Anti-E, K, Jka.

A panel of cells was run that was negative for E, K, Jka and about 75% reacted from micro to 3+ using Liss and peg enhancement techniques. The auto control was 1+ in both, but the DAT was only micro using Polyspecific and IgG coombs. It was negative with Anti-C3b,C3d. Eluate did not react with any cells using both saline and peg enhancement techniques.

Patient was fully phenotyped and found to be R1r, M-N+, S-s+, K-,

Fy(a-b+), Jk(a-b+), Le(a-b+)

The antibody that was reacting 3+ appeared to be Anti-S and was able to ruleout Fya, Lea and M. I xmatched 8 units that were E, S, K, Jka negative and 50% reacted with Liss and 80% in peg from micro to 1+.

I then ran a cold panel and titered one of the incompatible units. The antibody titered out to 128 and there was also a non-specific cold auto-agglutinin at 18'C and 4'C that reacted 2-4+.

I have two compatible units and all common allo-antibodies ruled out....what next? any suggestions are welcome..... Thanks

[David Saikin]

Is your titer a cold titer? If not, do you know what the titered ab specificity is? My impression was that there is a cold in there, which you seem to have demonstrated. Did prewarming remove any of those microscopic reactions? Was the patient recently exposed to anything like HES?

Now that iit is a week plus since your post, a new specimen might provide clearer information.

Good luck . . . post up your final results . . . I'm certain they will be of interest to all of us.

[mfleach]

Did you try an HTLA screen or titer? :?: Sound to me like you might have something like a Rga or a Cha.

[luhubert]

You may have to go with just the practical. You were able to find 2 compatible units. You may have to antigen type and then crossmatch and know that you will only get a certain percentage of the antigen negative units to be compatible.

Considering his positive DAT, you will only be able to judge those 1+ 's as incompatible, anything microscopic must be discounted due to the DAT. Did you see anything at 37? This may be developing like the S and you might get a better idea from its IgM reactions. I'm sure it's more important to find compatible units than to identify the culprit.

[John C. Staley]

Well, it's been over a month. What happened :?: Don't leave us hanging. I didn't have anything to add that would have helped. We would have transfused the compatible units and sent sample off to the reference lab.

[Melanie]

ok....i finally figured out how to get back to this site. Patient received the two compatible units with a positive outcome. The additional antibody was determined to be an HTLA. It was detroyed in ficin, and still reacted with DTT treated cells, but because it did not react with most cells tested, we could not determine which one it was and left it as "unidentified"