Cold auto with Anti-A1 specificity? plasma and in Eluate

[GilTphoto]

Had an interesting case today.

A 41 y/o male was admitted with an 8.3 Hgb. Diagnosis: weakness, R/O Guillain Barr Syndrome.

Patient has never been transfused.

Patient typed as A pos and appeared to have an Anti-A1. (1+ A1 cell at I.S.)

Did Anti-A1 Lectin to check for subgroup, but got 4+, so patient IS an A1 and not a subgroup.

Next did a short cold panel at both I.S. and 15 min RT

Cell___________IS_____ RT

SC I (O cell)___ 0______ w+

SC II(O cell) ___0______ w+

O cord________ 1+_____ 1+

Auto Control ___3+_____ 3+

A1 cell ________1+_____ 3+

A2 cell ________w+____ w+

Patient's antibody screen was negative at 37 and IAT.

Patient's DAT was w+ with both Poly and IgG (C3 neg)

Performed Elution by 2 methods:

Gamma Elu-Kit - neg with all O cells

Lui Freeze/Thaw - neg with O cells, 2+ A1 cells, neg A2 cells, w+ B cells

I have never heard of an autoanti-A1, but that is what this looks like to me.

Does this sound right? Is there anything else I could do?

He already got 2 A pos units last night, but I think for future transfusions should get A2 and not type O, because of giving him more anti-A in the residual plasma.

Edited August 11, 2011 by GilTphoto

[Malcolm Needs ☆]

I have come across an auto-anti-A1 before (although, in the case I saw, it was probably an auto-anti-A that was so weak that it mimicked an anti-A1), but, as far as I am aware, it is a VERY rare phenomenon.

Just as a matter of interest, it may be worthwhile testing the patient's red cells against a couple of random plasma/serum samples from random group A samples, just to check that the patient's red cells are not polyagglutinable. If the lectin anti-A1 you are using is Dolichos biflorus, as I suspect it probably is, this will also detect Cad polyagglutination, as well as A1 (and, come to that, the A antigen, if the lectin is not sufficiently diluted at source).

Cad polyagglutination is, of course, also extremely rare, but it could just conceivably by that your patient has an alloanti-A1, is actually A2, but is also Cad polyagglutinable.

BELIEVE ME WHEN I SAY, THIS IS REALLY LOOKING FOR ZEBRAS, WHEN I SHOULD BE LOOKING FOR HORSES!!!!!!!

:devilish::eyepoppin:eyepoppin:eyepoppin:no::no:

[Liz]

O cells are fine for transfusion especially if you remove as much plasma as you can and add ADSOL.

Yes one can encounter Anti-A1 in an A1 patient, it may also be non specific or specific to an antigen not mentioned on the antigram ..it is weakly reacting with the B cells.

So, it may be another auto that is present on the A1 reagent cells.

I would give 0 RBCs.

Your patient has an autoimmune disorder, possibly Guillame Barre', and these auto-immune disorders are associated with auto abs to the RBCS. Once treatment is started, IVIG -/+ Plasma pheresis, +/- Rituximab, +/- Steroids, you will see a great improvement and your tests will be straightforward.

Nice case. Keep us informed.

[Yanxia]

I think it looks like anti-A1 and anti-i.

[John Eggington]

If this patient has already been given IVIG, it could be that you're detecting a 'passively acquired' antibody (e.g., anti-A and/or anti-A1)

[majolica]

Very Interesting...

Thanks