Can rare anti-A1 IgG cause HTR after one sensitization?

[Han Chau]

I had one lady whose blood group is AB pos was transfused with one unit of A pos and ended up with HTR.

Pre transfusion samples:

Group: AB (without any discrepancies in the forward and reverse group)

Ab screen: Neg

DAT: Neg

Crossmatch (IAT): Neg

Post transfusion samples

Pt: showed group AB with mixed field reaction with anti-B demonstrated

Ab screen: still Neg

DAT: Pos (POLY) and a score of 3 for IgG and of 0.5 for C3b/d

Crossmatch (IAT): Pos

I performed elution and it was pos for A1 cell and Neg for 11 cell panel.

An AB patient with an A subgroup and anti-A1 presented, it's usually naturally occurred IgM (if so, we will have discrepancies in reverse grouping with A1 cell which I don't have with this case). So, possibly it's IgG, and I don't know if anti-A1 IgG (which is clinically significant) can be produced just after the initial transfusion with A1 cell or it carries characteristics of allo-Abs in which an initial sensitization is necessary? On the other hand, anti-A1 Ab is usually not clinically significant. Therefore, the HTR may not be due to anti-A1.

Hence, there are 2 causes came up to my mind that the HTR was due to anti-A1 Ab (but it must be IgG to be considered) or the patient produce antibodies to a low incidence Ab which the donor's cells carry.

Can I have your opinion about this???? Thanks

Edited September 24, 2011 by Han Chau

[Malcolm Needs ☆]

I would be much more inclined to think in terms of the patient having an antibody directed against a low incidence antigen expressed on the donor's red cells than to think in terms of an IgG anti-A1.

I think that the anti-A that can be eluted from the post-transfusion patient red cells is coincidental.

[galvania]

What type of anti-A and anti-B reagents are you using?

[Han Chau]

Hi Anna,

I used anti-A and anti-B CSL reagent. Is that what you mean?

[galvania]

I wondered whether the anti-B was picking up an aquired B in a patient with a very weak reverse group

[Yanxia]

I performed elution and it was pos for A1 cell and Neg for 11 cell panel.

I am wonder the elution react with how many A1 cells, more than one A1 cells donor? If it react with more than one A1 DONOR cells, then I prefer it is anti-A1.

Pregnanc is a cause of sensitivity.

Edited October 2, 2011 by shily

[pharez]

Hi Malcolm, when I surveyed this forum, I noticed that everybody recognizes your immunohematology authority. May I ask if you have a workflow map or summary guide to make blood bank antibody identification easier? For example, what makes you think that an antibody could be warm, cold, 901 series or 700 series and so on and so forth. Any guide leading to the easy identification of these antibodies? What are the associated workups from beginning to end? My email: pharezi@yahoo.com

[phan,binh]

Hi Malcolm, when I surveyed this forum, I noticed that everybody recognizes your immunohematology authority. May I ask if you have a workflow map or summary guide to make blood bank antibody identification easier? For example, what makes you think that an antibody could be warm, cold, 901 series or 700 series and so on and so forth. Any guide leading to the easy identification of these antibodies? What are the associated workups from beginning to end? My email: pharezi@yahoo.com

i'd like to know about that too. thanks for the question

sbphan

[Eagle Eye]

Did you try to run some panel cells with low ffrequency antigens? Eg. Kpa+, Jsa+ etc.