I had a case of sickle cell anemia patient 20 years old female with recurrent blood transfusion last transfusion since 2 months, group A+, Ab screen positive with all three cells by IAT only with AHG not in immediate spine or 37c and positive with all cells in panel only with AHG step, also autocontrol positive and DAT positive.

I suggest that warm autoantibody but I can’t identify it, so I don’t know how can I select the allogenic cell for alloadsorption or how can I remove this warm autoantibody without disturb the possible alloantibody which is more important than that warm autoatibody?

Thanks for help

The answer is, you can't, but the chances are that the antibody is not clinically significant.

The only thing you could try is alloadsorption with non-enzyme-treated red cells, and see where you get with that.

You can select different cells for the absorption (lets say 3) that are different in antigen typing. On these three cells every antigen must be negative at one cell (minimal). In that way every allo antibody will be left over after the absorption with one of the cells.

The (only) problem is that antibodies against a high frequent antigen will be removed by all 3 cells. Specialy in youe case there is a great change that you patient is Fya-b- so maybe it is smart to get a Fya-b- donor as one of the absorption cells. That last option we only perform when we see unaspected red cells destruction.

Peter

Yes, that's sort of what I meant (but, looking back on my post, I could have put it a LOT better!).

I understood, from the original post, that the antibody was not reacting with enzyme-treated red cells, which would rule out an anti-Fy3, so why include an Fy(a-b-)?

I do not see that the antibody is non reactive with enzyme but in the netherlands it is quite common to perform a enzym test only in direct agglutination. Then sometime anti Kell HFA antibodies are non reactive so you are not able to rule out any antibodies. The problem is that you have to be sure wich enzyme technic is used, IAT or direct agglutination.

The answer is, you can't, but the chances are that the antibody is not clinically significant.

.

I didn't react this sample with enzyme treated cells, but If I treat that sample with enzymed panel and result give me negative is this prove that Ab nonclinicaly significant?

it gives you no information on the clinical significans but it can help you with determining the specificity

it gives you no information on the clinical significans but it can help you with determining the specificity

Agreed.

The answer is, you can't, but the chances are that the antibody is not clinically significant.

The only thing you could try is alloadsorption with non-enzyme-treated red cells, and see where you get with that.

One friend told me he heard about commercial Kit can remove warm autoantibody from the mixture leaving the plasma free from autoantibody so can test for possible alloantibody, Is it true and if true how that kit works?

I must admit, I've never heard of it (and I certainly wouldn't trust it), unless you are talking about WARM, in which case I have heard of it, and I still don't trust it!

I can't pass this one up.....

WARM reagent is used most frequently in an auto-adsorption procedure (and since msdesoki's patient has been recently transfused she is not a candidate for an autoadsorption.)

But Malcolm....I'd like to hear what you have to say about the WARM reagent, and why don't you trust it? (Thanks!)

Donna

I can't pass this one up.....

WARM reagent is used most frequently in an auto-adsorption procedure (and since msdesoki's patient has been recently transfused she is not a candidate for an autoadsorption.)

But Malcolm....I'd like to hear what you have to say about the WARM reagent, and why don't you trust it? (Thanks!)

Donna

Oh Good Lord Donna - you are absolutely and utterly correct. I can't believe I posted that!!!!!!!! Mia Culpa, mia culpa.

Bang goes any chance of an invite to lecture at the AABB.

I'll tell you why I don't trust WARM tomorrow (if I can show my face on PLT).

No, you misunderstood, Malcolm........ I meant that I could pass up asking you to share your thoughts/opinions about WARM.

(I'll check on your response tomorrow.)

I can't pass this one up.....

WARM reagent is used most frequently in an auto-adsorption procedure (and since msdesoki's patient has been recently transfused she is not a candidate for an autoadsorption.)

What is W.A.R.M reagent you talked about it, it is first time I heard about it, if possible send me link to it's package insert or send it me by email msdesoki@yahoo.com

thanks for help.

What is W.A.R.M reagent you talked about it, it is first time I heard about it, if possible send me link to it's package insert or send it me by email msdesoki@yahoo.com

thanks for help.

I can't do this, as we do not use it. Please could someone else help?

No, you misunderstood, Malcolm........ I meant that I could pass up asking you to share your thoughts/opinions about WARM.

(I'll check on your response tomorrow.)

I may have misunderstood you Donna, but I was still WRONG!

The reason I wouldn't use W.A.R.M. is because, unlike REsT, where we know what antibodies are removed (including anti-, and most of those removed (except anti- are not going to be clinically significant (because they are "cold"), with W.A.R.M., the whole reason for using it is to remove the auto-antibody to see what is underneath it, but we do not know for sure what else may be removed (as it has not been tested against every clinically significant antibody ever detected), and, as it is removing "warm" antibodies, there is a higher chance that it is removing an underlying "warm" clinically significant antibody.

Just my opinion.

W.A.R.M. is a lyophilized mix of DTT and cysteine-activated papain in a phosphate buffer. It's sold by Immucor.

Is WARM not a comercial name for ZZAP. Which can be used to clean the patients cells form attached IgG antibodies so you can use then for an auto absorption. It is not to remove antibodies from a serum but to clean the cells so these can be used to remove antibodies from the serum. I see no hard in using this (in case of an un-transfused patient).

Peter

I know ZZAP but i didn't know other name WARM

Is WARM not a comercial name for ZZAP. Which can be used to clean the patients cells form attached IgG antibodies so you can use then for an auto absorption. It is not to remove antibodies from a serum but to clean the cells so these can be used to remove antibodies from the serum. I see no hard in using this (in case of an un-transfused patient).

Peter

Quite correct Peter.

I have had a complete brain block over this thread and realise that I have been talking complete tosh.

Sorry about that everyone.

:surrender:surrender:surrender:surrender:surrender:slap::slap::slap:

Anyone can help me to solve this problem by send me isert of WARM reagent...!!!!

my email is msdesoki@yahoo.com

Thanks my friends

I must admit, I've never heard of it (and I certainly wouldn't trust it), unless you are talking about WARM, in which case I have heard of it, and I still don't trust it!

If it is indeed WARM, don't waste your money or time, in my humble opinion it doesnt work appropriately.

[ATTACH]567[/ATTACH]I will try to attach it here:

Edited November 8, 201113 yr by aakupaku
like to add attachement

many thanks for aakupaku

If it is indeed WARM, don't waste your money or time, in my humble opinion it doesnt work appropriately.

It is awfully time consuming, but what happened to make you say that it doesnt work?