immune mediated hemolysis

[EGYPT]

Hi every body

I hope you are all feel good

I had a case of childe 10 years old SCD Hb 5 g/dl AB Rh + who had been transfused with 5 units of PRBCs 2 units A+ 10 days ago, followed by 1 unit AB+ 8 days ago, followed by 2 units A+ 5 days ago. Now he is Screening Cells neg. Autocontrol pos MF at RT and 3+ at AHG pase

DAT 3+ poly, IGg neg, C3d 3+

What is the possible Differntial Diagnosis and Manegemnt of this case

Thanks

[John Eggington]

Have you considered the action of passively acquired anti-B, from one of the group A units?

How much plasma is usually left on your PRBCs? Are they tested for the presence of 'high titre' ABO haemolysins? Patients with a 'small' red cell volume (e.g., children) are more susceptable to the action of residual ABO antibodies than patients with a 'large' red cell volume (e.g., adults), even if units were labelled as 'HT-'.

[Yanxia]

I will do antibody screening test use enzyme treated B and O cells, begin with room temperature and then at AHG phase to see if there is free anti-B in the patient's serum.

And then I will do the elution test with hot elution method like the method to do HDFN test.

The O cell here is as a neg control, if it is pos then we will think about abnormal antibodies apart from anti-B. Then we will do hot elution method , and the elution fluid will react with panel cells.

What is the meaning of SCD? Maybe the MF DAT is because antoantibodies?:p

BTW:

Because the DAT is C3d pos only and the RT autocontrol pos, I think the antibody maybe IgM or cold reactive IgG, so I think befroe the elution the washing step use cold salin is better, to avoid the disociation of the antibodies from the cells. And the elution reacted with the B and O cells step I will add the react in 4 degree C step.

Edited March 7, 2011 by shily
Add somthing more

[John Eggington]

I think that SCD stands for 'Sickle Cell Disease', in this case.

[Malcolm Needs ☆]

It could be that the diagnosis of Sickle Cell Disease is a "red herring", given that the DAT is C3d positive only.

Has the child had any recent viral infection?

If os, it may be worthwhile undertaking an indirect Donnath-Landsteiner test.

[EGYPT]

Thanks for All