Inconclusive workup

[klsmith]

Hi All,

I am looking for any help that I can get on an inconclusive work up that we had in our blood bank the other day. A patient came in through the emergency dept. and a type and screen was ordered. Screening cell #2 on the absn was 1+ positive. We set up an ortho panel A, and only cell #9 was 1+ positive. We then set up panel C, ficin treated and untreated, and cell #3 was 2+ positive, cells #6 & 9 were ever so slightly positive. The ficin didnt seem to have any effect on it. According to our records, the patient was transfused in 2008, and was pregnant a few years prior to that. On the panels, we were able to rule everything out homozygously, and are now at a loss on where to go with it. Any suggestions or ideas would be appreciated!

[Yanxia]

What is the method? AHG?

[Malcolm Needs ☆]

I also have a question.

In terms of treating the patient, does the exact specificity matter if it is that weak and reacts with so few cell samples?

Surely, cross-match compatible blood would do?

:confused::confused:

[hsdunnmt]

just as an fyi, I had a bad lot of ortho screening cells that caused false positives in screening cell 2. I know that doesn't explain the panel A for your patient. Just an observation I guess

[Eagle Eye]

Cell 9 on panel A & cell 6 on panel C are Bg+. (If you are using VRA 146, & VRC 144).

1) I would give crossmatch compatible by gel.

2) More conservative approch would be: (since only one homozygous rule out for E)

I would try to run few more E+ cells as cell2(surgiscreen), panel C cell 3 & cell 6 are positive and all three are E+. So out of five E+ cells three are reacting, you can type pt's cell for E antigen and if patient is E-, give E- ,crossmatch compatible by gel. (off course panel C treated did not react as expected(in case if this is E, it should enhance reaction)

[JOANBALONE]

I would not be worried about putting a name to this antibody if you have ruled out everything according to your SOP. This happens quite frequently especially with some lots of screening/panel cells. Do you have a antibody identification code such as "All clinically significant antibodies ruled out"? I would give AHG compatible units though.

JB

[Beth Eades]

I had the exact same thing last night. My initial screen and panel was in gel. I switched to LISS and PeG by tube with the same results although PeG gave significantly stronger reactions. I did a full phenotype to see what I was working with (neg for E, K, Fya, Fyb, Jka and s) and antibodies to all common red cell antigens were ruled out using a selected cell panel. Only one cell was noted as positive for Bga, the other positives were untyped. I ran another selected cell panel with only Bga pos cells and they were all positive. I recommended crossmatch compatible blood for the patient.

[Yanxia]

Bga is sensitive to ficin, but klsmith's describe not like this.

[DOGLOVER]

We would call it inconclusvie antibody and issued crossmatch compatible (by gel or PEG) units. We seem to get these on a fairly frequent basis.

[David Saikin]

There are many comments on the vagaries of 1-2+ rxs with Ortho's screening cell number 2. I have seen the same phenomenon and have been able to r/o all clinically significant abs. We comment that it probably the "anomalous reactions" associated with Ortho's methodology. Ortho has tried to "fix" this by recommending various things: keep the screening cells in the dark, keep them at 4C . . . I have found 90% of these to be sensitive to ficin, but some are not. My feelings is that they are some type of HTLA (aka LOUD). Give gel xm compatible and don't worry.

[jojo808]

For future transfusions, if your screen is negative do you still give AHG compatible units? If yes, do you do this for all future transfusions?

[Dansket]

According to our SOP, patient whose current antibody screen is negative and a history of clinically insignificant antibody qualifes for electronic crossmatch.

Edited October 12, 2015 by Dansket

[David Saikin]

For future transfusions, if your screen is negative do you still give AHG compatible units? If yes, do you do this for all future transfusions?

I would not - have not had any recurrent pts of this type. 

[goodchild]

Are we an outlier?

 

If a patient has a history of an antibody of undetermined specificity, even if the current screen is negative we'll continue to go the route of IAT XM blood, as a safety precaution.

[Malcolm Needs ☆]

I would do the same as you goodchild.

[David Saikin]

I would do the same as you goodchild.

Me too!

[AMcCord]

Me too!

 

Me three! I've seen a few of these patients show up with a 'real' antibody with specificity on a later visit (Echo). Maybe what we were seeing was some kind of immune response that just hadn't arrived at the finished product (antibody) yet??? Anyway, I figure better safe than sorry.

[mcgouc]

When using manual gel, before getting the ECHO, we kept doing the IGG crossmatches if the gel screens were negative later. Now, if we have an ECHO inconclusive, gel negative who has negative screens on the ECHO later, we switch to electronic crossmatches. When the ECHO is reacting with multiple screen & panel cells with inconclusive interpretations & the gel screens are negative, the ECHO crossmatches are invariably compatible & the DAT is negative.