DAT Negative Hemolytic Anemia

[margaretcox]

Hey Margaret and Malcolm,

Are the posibilities you present here capable of causing the clearence of three units of PC's within a few days with no appearent outward symptoms (only a slight fever), and no appearent serologic evidence to support an immune response ( I did not see a result of an auto control mentioned). I think that this case is very interesting. The patient had "coca-cola" urine prior to the initial ER visit and upon subsequent admission. The pre-transfusion Hgb=7.9, and after three units of PC's the hgb was only 9.2 with no appearent bleeding. With a normal, yet depleted, system the hemoglobin should have reached approx 11.9 (1gram per unit). It seems that the patient is clearing the red cells at a very rapid pace; approx. one third the total circulating volume for this patient; and this is occuring with only a slight temp noted two days later and curiously the patients hemoglobin resides there after at 7.2; the approx starting hgb. Given these facts is it not posible that we are seeing an overall upset in the isotonisty of the whole blood such that only a volume of rbc's producing a hgb of approx 7 g/dl can be supported. I think that it is very interesting that the initial hgb=7.9, post tranfusion hgb= 9.2, and after clearence the hgb is back to 7.2. It appears that this concentration of rbc's is the equilibrium piont or product there of. I guess what I am trying to ask is if an immune response can destroy approx. one third the circulating rbc's with no appearent symtoms and go undetected by conventional serologic procedures or is it equally possible that we are seeing an isotonic upset of the circulating whole blood with currently an unknown origin????? It seems that the suspition of PNH is more probable than an immune response in this case.

Our patient did indeed appear to have chewed up (2) units of donor cells. She did report "not feeling well". PNH testing was done but was negative. We never did find the presumptive anti-Jka by tube methods.

[Malcolm Needs ☆]

Our patient did indeed appear to have chewed up (2) units of donor cells. She did report "not feeling well". PNH testing was done but was negative. We never did find the presumptive anti-Jka by tube methods.

How long atfer the transfusion were you looking for the anti-Jka (or any other specificity come to that)?

:confused::confused:

[margaretcox]

How long atfer the transfusion were you looking for the anti-Jka (or any other specificity come to that)?

:confused::confused:

Malcolm: we did the workup the day after she received. Because "everything" was negative, other thoughts (like PNH) were pursued. As I mentioned, a ref lab did find a few cells to react by solid phase. We continued to transfuse her and I kept thinking the anti-Jka might become detectable at a later point, but it did not. The episode is kept compartmentalized in a part of my brain labeled "is it time to adopt a more sensitive method than tube"

[rravkin@aol.com]

Our patient did indeed appear to have chewed up (2) units of donor cells. She did report "not feeling well". PNH testing was done but was negative. We never did find the presumptive anti-Jka by tube methods.

Greetings Margaret,

From the info given in the initial thread it seems that a total of three units of PC's were cleared. Also, what other testing is being done for this patient and are there any other diagnostic theories??:)

[Malcolm Needs ☆]

Malcolm: we did the workup the day after she received. Because "everything" was negative, other thoughts (like PNH) were pursued. As I mentioned, a ref lab did find a few cells to react by solid phase. We continued to transfuse her and I kept thinking the anti-Jka might become detectable at a later point, but it did not. The episode is kept compartmentalized in a part of my brain labeled "is it time to adopt a more sensitive method than tube"

Sorry. Questions; always questions!

Did you try doing a tube IAT using enzyme-treated red cells. This method is particularly good at detecting anti-Jka, much more so, actually, than most CAT.

Sorry to be a nuisance. Sometimes I'm llike a dog with a bone. My staff hate it when I'm in one of those moods!!!!!!!!!!!!

:redface::confused::redface:

[margaretcox]

Greetings Margaret,

From the info given in the initial thread it seems that a total of three units of PC's were cleared. Also, what other testing is being done for this patient and are there any other diagnostic theories??:)

Hi RR: The initial patient "belonged" to bbbirder, and it sounds like they also did not detect a new allo-antibody. Being a new(er) BB'er (compared to some eminences grises reporting here), it astounded me to experience that case where the (presumed) antibody came, destroyed, and disappeared. I wondered if bbbirder's case might be similar.

[margaretcox]

Sorry. Questions; always questions!

Did you try doing a tube IAT using enzyme-treated red cells. This method is particularly good at detecting anti-Jka, much more so, actually, than most CAT.

We don't stock enzymes/treated cells. One of the ref labs we sent to did include a ficin panel - still did not find anything. We did get some homoz Jka cells to react (so weakly) using PEG.

[L106]

Sorry. Questions; always questions!

Did you try doing a tube IAT using enzyme-treated red cells. This method is particularly good at detecting anti-Jka, much more so, actually, than most CAT.

Sorry to be a nuisance. Sometimes I'm llike a dog with a bone. My staff hate it when I'm in one of those moods!!!!!!!!!!!!

:redface::confused::redface:

Inquiring minds want to know...........

[Malcolm Needs ☆]

What a charitable person you are!!!!!!!!!!!

:D:D:D:D

[Yanxia]

We don't stock enzymes/treated cells. One of the ref labs we sent to did include a ficin panel - still did not find anything. We did get some homoz Jka cells to react (so weakly) using PEG.

dosage effect?

[antigen132]

hi can anyone help me out with a blood bank problem. i am looking at a TENCELL ab screen. immediate spin all negative, Alb37 all negative, IAT all 2+ except donor R0. cell R0 has additional antigen U- and another R0 has U var. dows anyone know what antibody gives these results in a screen? all responds are appreciated!

[Malcolm Needs ☆]

hi can anyone help me out with a blood bank problem. i am looking at a TENCELL ab screen. immediate spin all negative, Alb37 all negative, IAT all 2+ except donor R0. cell R0 has additional antigen U- and another R0 has U var. dows anyone know what antibody gives these results in a screen? all responds are appreciated!

Obviously, I can't see the panel myself, but I wouldn't mind betting that both these cells are Fy(a-b-).

If all of the other cells are Fy(a+b-), Fy(a+b+) or Fy(a-b+), and the patient is also Fy(a-b-), there is a fair chance that the antibody could be anti-Fy3.

:confused::confused: