KKidd Posted May 21, 2009 Share Posted May 21, 2009 We had a patient who typed O positive 5 days ago. He has a warm auto agglutinin and possible Anti-Kpa. One unit of O neg (K neg, C neg, Kpa neg) RBC were transfused 2 days ago. Today we obtained mixed field reactions with ANti-A and Anti-B (murine monoclonal). It did not go away with a warm wash of the cells and identical results were observed with a second specimen. Other than the one unit transfusion, the only notable addition to the treatment was Rituxan. Does anyone have any ideas?Sorry about the length of the post! Link to comment Share on other sites More sharing options...
L106 Posted May 21, 2009 Share Posted May 21, 2009 Questions:What is the patient's diagnosis?Did you run a patient autocontrol?Did you perform a Direct Antiglobulin Test? (If so, what were the results?)Are you fortunate enough to have access to ABO antisera from another manufacturer (so you could repeat the test)?(I've got lots of questions, but no answer at this point!!) Link to comment Share on other sites More sharing options...
Malcolm Needs ☆ Posted May 22, 2009 Share Posted May 22, 2009 I'm just wondering if he had a mixed-typed cold and warm auto-immune developing. They are very rare (well, quite rare) but they do exist.Did you try warm-washing the red cells prior to re-running the tests? Link to comment Share on other sites More sharing options...
Yanxia Posted May 23, 2009 Share Posted May 23, 2009 I agree with L106 about the autocontrol. And what about the reverse group result? Rituxan is a kind of antibody preparation, maybe it can interfere the ABO group testing . Link to comment Share on other sites More sharing options...
KKidd Posted May 26, 2009 Author Share Posted May 26, 2009 Thanks for the input. The autocontol was negative on the patient and a pre-warmed sample gave the same mixed field result. The reverse group gave 3+ results with both cells. My patient was transferred to another hospital the same day as these results and the receiving hospital wanted to put him on a truck and ship him back since they also got the mixed field results!Aaah, the joys of Blood Banking!!! THey haven't diminished after 30 years!:sarcastic Link to comment Share on other sites More sharing options...
galvania Posted May 26, 2009 Share Posted May 26, 2009 What technique are you using to do your forward typing? On how many specimens did the patient originally type as OPos? Roughly what percentage of the cells are grouping as 'positive' in the mixed field? Link to comment Share on other sites More sharing options...
Yanxia Posted May 27, 2009 Share Posted May 27, 2009 Maybe you can change the reagent anti-A and anti-B or try to incubate Rituxan and other known O type cells in 37 degree C for 30 minutes, and then type it with the same reagent anti-A and anti-B, to see if the reagent have something reacted with the rituxan on the red cells. Link to comment Share on other sites More sharing options...
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