warm auto or antibodies against drug or 0.8% versus 3.0% panel cells

[salimsalim]

We have a strange case here:

- ABO/Rh B Negative( reverse group was week but 2+ when 2 more drops of patient plasma added)-immunodeficiency

-patient with known anti-E and known DAT 1+( 15 days before)

- screen with gel IAT( ortho 0.8%) hazy ( not positive not negative)

-panel cells with gel IAT ( panel a and panel B both ortho)- hazy to week positive and autocontrol positive

- DAT 3+

-antibody screen and panel cells with LISS IAT negative and 3 units compatible with LISS IAT.

-Elution done and was strongly positive with both panel A and panel B ( 0.8% ortho by Gel IAT) -showing multiple antibodies

-Last wash negative.

- Now the strange thing happened was when we were looking for more cells to exclude antibodies -we made 0.8% from 3.0 % immunocor cells( we added 50 ul of 3% cell into a tube add 0.5 ml saline and spin it down to get dry cell and then added 100 ul MTS diluent( panel cells) run Gel IAT with eluate and whole panel cell negative.

-Question arise:

1. we made 0.8% cells from 3.0% immunocor we used dry cell with MTS diluent to make it 0.8%- and it gives negative result.

2. why 0.8% cells( ortho are giving positive result. is there something in patient plasma which is agglutinating with preservative/antibiotics present in 0.8% cells?????

3. patient has drug induced antibodies

your timely help will be appreciated

thanks a lot in advance

[Malcolm Needs ☆]

I think that your suggestion that the patient has antibodies against an antibiotic/perservative in which the cells are suspended is probably the correct one.

Many of our hospitals use screening and panel cells that are suspended in DiaMed ID-CellStab, whereas we use them suspended in DiaMed ID-Diluent 2.

Every now and again, we get a sample in from a Hospital that has found an antibody reacting with all cells tested. When we test it, we get completely negative results, unless we use cells suspended in DiaMed ID-CellStab.

I have contact Imelda Bromilow of DiaMed in Switzerland about this, and she was also aware of such cases, and it is thought that it has something to do with an antibody the patient has made against an antibiotic in the liquid in which the red cells are suspended, but, as yet, she was not certain which one it was, or whether there are multiple specificities in different patients' plasma.

:)