redstaff2003 Posted December 17, 2008 Share Posted December 17, 2008 a 71 year old male diagnosed with community acquired pneumonia. blood group was O Rh positive. a broad spectum crossmatch was made but without antibody screening. no previous history of transfusion all 5 units that was crossmatch were all incompatible. what could have cause this incompatibility? what other possible pre transfusion work up could have been done?....have anyone of you experienced this situation???like to hear some insights from you guys... Link to comment Share on other sites More sharing options...
OPUS104 Posted December 17, 2008 Share Posted December 17, 2008 Are you saying no Ab screen performed? If so ...many possibilities ranging from warm auto to naturally occuring antibodies..more info please. Link to comment Share on other sites More sharing options...
Eagle Eye Posted December 18, 2008 Share Posted December 18, 2008 did you run all phases? (Immediate spin, 37, AHG/or Gel). Patient's blood group may be Oh Bombay. Link to comment Share on other sites More sharing options...
rescyth Posted December 18, 2008 Share Posted December 18, 2008 (edited) Well if you have limited resources to do an AB screen, there are other ways to know if he may have an AB...try testing his red cells by doing DAT, if it is sensitized then that should give you some info on the probable cause. By the way, what's the causative agent for the pneumonia?-just my 2 cents Edited December 18, 2008 by rescyth Link to comment Share on other sites More sharing options...
Yanxia Posted December 18, 2008 Share Posted December 18, 2008 I have encountered some pneumonia infants have cold antibodies. Link to comment Share on other sites More sharing options...
rescyth Posted December 18, 2008 Share Posted December 18, 2008 If the etiologic agent for his Pneumonia is Mycoplasma Pneumoniae, then he would have a high titer of anti-I that could interfere with his ABO typing and will give him incompatible Xmatch... but we won't know that unless he tells us that he had discrepancies with his blood typing and did a prewarm technique to resolve it . So, for now...it's better i think to rule it out unless we get better info...-just my 2 cents Link to comment Share on other sites More sharing options...
redstaff2003 Posted December 18, 2008 Author Share Posted December 18, 2008 yes they did all phases immediate spin, 37degrees and AHG but no gel...unfortunately no antibody screen was during that time due to some problems with purchasing of supplies but anyway the i try to get the what have cause his pneumonia...i get some more details to resolve this discripancy Link to comment Share on other sites More sharing options...
David Saikin Posted December 18, 2008 Share Posted December 18, 2008 Sounds like an anti-I from the pneumonia. Try xming ABO identical cord cells - should be compatible if anti-I. Prewarm is next step. Link to comment Share on other sites More sharing options...
KKidd Posted December 18, 2008 Share Posted December 18, 2008 I wonder what the crossmatches would have looked like with anti-IgG instead of broad spectrum anti-human. That could provide some more info. Link to comment Share on other sites More sharing options...
redstaff2003 Posted December 19, 2008 Author Share Posted December 19, 2008 (edited) broad spectrum immediate spin result was compatible but both the 37 deg and AHG phase result was incompatible if anti I is suspected will the IS phase result be the same with the 37 and AHG?...just curiousone more thing no discripancy was observed on forward and reverse ABO typing Edited December 19, 2008 by redstaff2003 addition of point to clarify Link to comment Share on other sites More sharing options...
rcdjr Posted December 19, 2008 Share Posted December 19, 2008 immediate spin compatable but 37 and AHG incompatable? It's not sounding like an anti-I. No chance of running an AB screen? Did you run a DAT or do a prewarm? I hate doing a prewarm blind but if you can't do a screen..... Link to comment Share on other sites More sharing options...
rescyth Posted December 21, 2008 Share Posted December 21, 2008 what's your DAT say? use monospecific IgG heavy chain for your AHG if you have one and if it is positive run a negative control (px red cell + saline)... and since we are just shooting darts, run AUTO control if it's positive so it is a warm auto that's interferring with your XM.-just my 2 cents Link to comment Share on other sites More sharing options...
redstaff2003 Posted December 23, 2008 Author Share Posted December 23, 2008 immediate spin compatable but 37 and AHG incompatable? It's not sounding like an anti-I. No chance of running an AB screen? Did you run a DAT or do a prewarm? I hate doing a prewarm blind but if you can't do a screen.....the result for the immediate spin was compatible but for the 37 degrees and AHG was incompatible...unfortunately that no further testing was made patient was discharge early last week Link to comment Share on other sites More sharing options...
redstaff2003 Posted December 23, 2008 Author Share Posted December 23, 2008 well thank you for your insights and contribution to this thread Link to comment Share on other sites More sharing options...
Yanxia Posted December 24, 2008 Share Posted December 24, 2008 (edited) We have encountered a patient just like this one. He is 56 years old, have not been transfused, liver disease. ABO type is B . Antibodies screening is positive with all three screening cells, aoto-control is pos ,too and is stronger than screening cells. It is on my night duty, we have no time to identify the antibodies , the patient is dead. His IS screening is neg ,polybrene and AHG is pos.I have a question, if he have not dead and need transfusion urgently, what will I do in the short time. To screen a least incompatible cell is safe or not?He has no the symptome of auto-hemolysis, I am not sure the antibodies is auto or allo. Edited December 24, 2008 by shily add something Link to comment Share on other sites More sharing options...
marilynm Posted December 24, 2008 Share Posted December 24, 2008 do you have anti-IgG? What was the DAT on the patient's RBCs and did you do an autologous control along with your crossmatches? If the DAT and autocontrol are positive at 37C and AHG, then the patient probably has a warm reactive autoantibody. If anti-I or anti-H, then the IS should have been positive and stronger then 37C and AHG. Marilynm Link to comment Share on other sites More sharing options...
Yanxia Posted December 25, 2008 Share Posted December 25, 2008 (edited) Marilynm,we have not do the anti-IgG DAT,but the autocontrol in polybrene is pos, and autocontrol is neg in IS, so I think it is because the IgG autoantibodies.I don't think it is anti-H or anti-I, it looks like a kind of warm auto, but I don't know the specificity of it. My director want me to select a least incompatible cells to transfuse, I dare not to do this, if it is auto anti-D, the result maybe dangerous. What do you think? Edited December 25, 2008 by shily spelling error Link to comment Share on other sites More sharing options...
Yanxia Posted December 25, 2008 Share Posted December 25, 2008 (edited) I do the autocontrol along with crossmatch.The physician don't think this patient have auto-hemolysis, so he refuse to use incretion to lighten the maybe hemolysis during transfusion. He is afraid of minus effect on the illness, I understand him, and I have not the power to order him how to treat the patient. Edited December 25, 2008 by shily Link to comment Share on other sites More sharing options...
rescyth Posted December 25, 2008 Share Posted December 25, 2008 First, you have to do an autoabsorption to remove the autoAB which may mask other clinically significant alloAB but since the patient has never been transfused, i assumed he has none. Then do Xmatch on the absorbed serum. Link to comment Share on other sites More sharing options...
marilynm Posted December 26, 2008 Share Posted December 26, 2008 Shilly, I thought your patient died? If your patient had not been transfused, then he should not have any alloantibodies underneath the autoantibody, and you could probably get by without doing an autoadsorption. I do not know why you think the autoantibody has anti-D specificity as all three of your screening were positive, but even if it had this specificity it is autoantibody and you would just crossmatc random units. Sometimes you have to transfuse these patients if their hematocrit gets too low, but it is best to give them only 1 or 2 units to see how they do rather then a lot.Marilynm Link to comment Share on other sites More sharing options...
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