Lindz82 Posted November 10, 2009 Share Posted November 10, 2009 I have a case study i would like some input in .... be forwarned I have no definitive answers and that is why I am here...Patient is a 95 year old female. Hospitalized for amputations. Original antibody ID (10-22-09) Found an Anti-K with PeG in tubes.Extra reactions at AHG in gel. Auto was + at AHG in gel. Eluate was -. Thought to be a drug interaction of some sort.... Last week we worked up patient again and found Plasma had reactions varying from w+ to 3+ in gel, only Anti-K in PeG. Ficin diminished extra reactions. Extra reaction were DTT resisitant. Reactivity was not inhibited using normal pooled plasma. Eluate is now + w+to 2+ some negative cells in both plasma and eluate. Performed a stromal alloadsorption using R1, R2, and r stroma and extra reactivity was not adsorbed out of plasma but was adsorbed out of eluate.I will try to provide more info if it is asked for. Thanks for any input. Link to comment Share on other sites More sharing options...
crummer Posted November 11, 2009 Share Posted November 11, 2009 ethnicity, transfusion history, considered JMH?crummer Link to comment Share on other sites More sharing options...
Malcolm Needs ☆ Posted November 11, 2009 Share Posted November 11, 2009 Also, what was the pathology behind the amputations?It could well be bacterial metabolites that are causing the serological problems. Link to comment Share on other sites More sharing options...
marquij@caribe.net Posted November 11, 2009 Share Posted November 11, 2009 Whatever specificities present in plasma are detroyed by ficin treatment of the rbcs. This may be the reason for unsuccesful stromal adsorptions. Maybe adsorptions with untreated red cells will help isolate/elute the specifity, identify underlying aby unless you have an low avidity aby in such case you will not be able to adsorb it out. Crossreactivity with bacterial antigens may be the reason of these hit and miss rxns. More info: diagnosis, tx history, etc might be helpful. Link to comment Share on other sites More sharing options...
Lindz82 Posted November 13, 2009 Author Share Posted November 13, 2009 She is caucasian. Has recieved multiple transfusions. The stroma we use for adsorption is not enzyme treated. I am unsure about other diagnostic information except that sepsis is probable. Could sepsis cause this kind of extra reactivity? Link to comment Share on other sites More sharing options...
Yanxia Posted November 13, 2009 Share Posted November 13, 2009 I can't understand the meaning of "extra reactions", help me please, thanks! Link to comment Share on other sites More sharing options...
Malcolm Needs ☆ Posted November 13, 2009 Share Posted November 13, 2009 She is caucasian. Has recieved multiple transfusions. The stroma we use for adsorption is not enzyme treated. I am unsure about other diagnostic information except that sepsis is probable. Could sepsis cause this kind of extra reactivity?Hi Lindz82,Not only could sepsis cause the extra reactivity, but in my opinion (and it is only an opinion) the sepsis has caused the extra reactions in this case. This was why I asked about the underlying pathology with regard to the amputations.Pathological bacteria, as opposed to the normal gut flora (in their normal place within the body), chuck out all kinds of junk (most of which is pretty nasty to the human body) and this junk gets into the blood stream and causes all sorts of problems for the serologist (to put it scientifically)!!!:o:o Link to comment Share on other sites More sharing options...
adiescast Posted November 13, 2009 Share Posted November 13, 2009 I can't understand the meaning of "extra reactions", help me please, thanks!If I understand correctly, the "extra reactions" are cells that reacted that are not explained by the known antibody. Hope that helps. Link to comment Share on other sites More sharing options...
Lindz82 Posted November 13, 2009 Author Share Posted November 13, 2009 Would bacterial "Junk" also cause to eluate to turn up positive? Link to comment Share on other sites More sharing options...
crummer Posted November 14, 2009 Share Posted November 14, 2009 Auto IAT weak positive - probable junk! (lovely serological word) eluate negative (depending on eluate procedure) you are probably dealing with something 'other than red cell antibodies'!!!!!!!!! Link to comment Share on other sites More sharing options...
Malcolm Needs ☆ Posted November 14, 2009 Share Posted November 14, 2009 (edited) Would bacterial "Junk" also cause to eluate to turn up positive?It could well not cause a positive eluate, as it would not necessarily be tightly bound to the membrane. It could, therefore, be washed off during the initial washing process involved to get rid of the plasma, prior to making the elution.It could also be that non-specific complement uptake has partly caused the reaction, and that, of course, would not show up in the eluate, hence the patchy results.:confused::confused: Edited November 14, 2009 by Malcolm Needs Link to comment Share on other sites More sharing options...
Yanxia Posted November 17, 2009 Share Posted November 17, 2009 What about the anti-IgG DAT result? We do elute only when this result is postitive or suspect positive. Link to comment Share on other sites More sharing options...
Malcolm Needs ☆ Posted November 17, 2009 Share Posted November 17, 2009 What about the anti-IgG DAT result? We do elute only when this result is postitive or suspect positive.Oh yes Yanxia, I am not disputing for one moment that there is an element of IgG causing the positive DAT. All I was saying was that this IgG element may be very loosely bound to the red cells and (possibly) could be washed off during the (fairly vigorous) washing phase that takes place prior to the actual elution itself.I would dispute that elutions should only be done when the result is positive, however, ever since I read the study by Sachs UJU, Roder L, Santoso S, Bein G. Does a negative direct antiglobulin test exclude warm autoimmune haemolytic anaemia? A prospective study of 504 cases. Brit J Haemat 2006; 122: 655-656 and have also dealt with a fatal case of group A into group O acute haemolytic transfusion reaction where, apparently, no group A cells could be identified by normal serological techniques (having all been destroyed), the DAT was negative, but, that notwithstanding, anti-A could still be eluted from the patient's post-mortem sample.:shocked: Link to comment Share on other sites More sharing options...
Yanxia Posted November 23, 2009 Share Posted November 23, 2009 I have a case study i would like some input in .... be forwarned I have no definitive answers and that is why I am here...Patient is a 95 year old female. Hospitalized for amputations. Original antibody ID (10-22-09) Found an Anti-K with PeG in tubes.Extra reactions at AHG in gel. Auto was + at AHG in gel. Eluate was -. Thought to be a drug interaction of some sort.... Last week we worked up patient again and found Plasma had reactions varying from w+ to 3+ in gel, only Anti-K in PeG. Ficin diminished extra reactions. Extra reaction were DTT resisitant. Reactivity was not inhibited using normal pooled plasma. Eluate is now + w+to 2+ some negative cells in both plasma and eluate. Performed a stromal alloadsorption using R1, R2, and r stroma and extra reactivity was not adsorbed out of plasma but was adsorbed out of eluate.I will try to provide more info if it is asked for. Thanks for any input. I think the extra reaction in plasma is because complements active antibodies such like room temperature reactive antibodies 37degree C no reactive but can act complements when add cells to plasma. T he extra reaction in elution is Rh system autoantibodies. Link to comment Share on other sites More sharing options...
jcdayaz Posted November 24, 2009 Share Posted November 24, 2009 Oh yes Yanxia, I am not disputing for one moment that there is an element of IgG causing the positive DAT. All I was saying was that this IgG element may be very loosely bound to the red cells and (possibly) could be washed off during the (fairly vigorous) washing phase that takes place prior to the actual elution itself.I would dispute that elutions should only be done when the result is positive, however, ever since I read the study by Sachs UJU, Roder L, Santoso S, Bein G. Does a negative direct antiglobulin test exclude warm autoimmune haemolytic anaemia? A prospective study of 504 cases. Brit J Haemat 2006; 122: 655-656 and have also dealt with a fatal case of group A into group O acute haemolytic transfusion reaction where, apparently, no group A cells could be identified by normal serological techniques (having all been destroyed), the DAT was negative, but, that notwithstanding, anti-A could still be eluted from the patient's post-mortem sample.:shocked:Malcolm,How could a donor unit of blood not present as A? I know there are multiple subgroups of A that will react at different strengths.....but to have one that doesn't react at all is quite scary!! Link to comment Share on other sites More sharing options...
Malcolm Needs ☆ Posted November 24, 2009 Share Posted November 24, 2009 (edited) Malcolm,How could a donor unit of blood not present as A? I know there are multiple subgroups of A that will react at different strengths.....but to have one that doesn't react at all is quite scary!!No, sorry, that isn't what I meant.What I meant was that the group A blood that had been transfused to the unfortunate patient appeared to have been totally cleared from his circulation (as, indeed, had most of his own red cells, as innocent bystanders to the complement cascade), as we could not detect any group A cells in the post-mortem blood sample, but, although the DAT of the post-mortem blood sample was negative, we could still elute anti-A from the few red cells that were left.The original unit that was transfused in error was most certainly a group A, and reacted normally with anti-A.Sorry for any confusion.Having said that, Apae reacts a bit like the scary phenomenon that you describe (but is most unlkely to cause an acute transfusion reaction i a group O patient. Edited November 24, 2009 by Malcolm Needs Link to comment Share on other sites More sharing options...
jcdayaz Posted November 24, 2009 Share Posted November 24, 2009 No, sorry, that isn't what I meant.What I meant was that the group A blood that had been transfused to the unfortunate patient appeared to have been totally cleared from his circulation (as, indeed, had most of his own red cells, as innocent bystanders to the complement cascade), as we could not detect any group A cells in the post-mortem blood sample, but, although the DAT of the post-mortem blood sample was negative, we could still elute anti-A from the few red cells that were left.The original unit that was transfused in error was most certainly a group A, and reacted normally with anti-A.Sorry for any confusion.Having said that, Apae reacts a bit like the scary phenomenon that you describe (but is most unlkely to cause an acute transfusion reaction i a group O patient.Thanks for the clarification! It makes perfect sense now!On a side note...did you ever determine how/why the A unit was transfused to an O patient?... Link to comment Share on other sites More sharing options...
Malcolm Needs ☆ Posted November 24, 2009 Share Posted November 24, 2009 Thanks for the clarification! It makes perfect sense now!On a side note...did you ever determine how/why the A unit was transfused to an O patient?...Yes (in fact, it was more than one unit - it was a few years ago, so some of the details are a bit hazy, but it may have been as many as three).The patient was under general anaesthetic, and so, of course, only the overt symptoms were seen (generalised bleeding, temperature, etc) by which time it was too late. Of course, the patient could not tell them that he felt unwell.It was a laboratory error. We never did get to the bottom of what he either did or didn't do (which probably saved him from, not only being struck off [as he was], but a jail sentence, because we suspect he was as high as a kite on-call - but could prove nothing).:eek::eek: Link to comment Share on other sites More sharing options...
jcdayaz Posted November 25, 2009 Share Posted November 25, 2009 Yes (in fact, it was more than one unit - it was a few years ago, so some of the details are a bit hazy, but it may have been as many as three).The patient was under general anaesthetic, and so, of course, only the overt symptoms were seen (generalised bleeding, temperature, etc) by which time it was too late. Of course, the patient could not tell them that he felt unwell.It was a laboratory error. We never did get to the bottom of what he either did or didn't do (which probably saved him from, not only being struck off [as he was], but a jail sentence, because we suspect he was as high as a kite on-call - but could prove nothing).:eek::eek:Uggh. Sounds like the right course of action to have fired him. Seriously? High on call? How scary is that!!! Link to comment Share on other sites More sharing options...
Malcolm Needs ☆ Posted November 25, 2009 Share Posted November 25, 2009 Uggh. Sounds like the right course of action to have fired him. Seriously? High on call? How scary is that!!!Well, as I say, we couldn't prove anything, but............... Link to comment Share on other sites More sharing options...
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