antibody to a high frequency antigen????

[sandoq]

Hi everyone,

I need your help in figuring this one out:cries:. patient is Hispanic; Autocontrol: negative

DAT= negative

All screen cells(3 cell panel) and antibody panel positive: all tests ran in PeG at 37C

immediate spin= 2+

coomb's phase= 3-4+ all cells;

DTT treated cells= same reactions(resistant)

Enzyme(Papain)= enhanced reactions(resistant)

I tested with Lub-, I-, Vel-, Jk(a-b-), P- cells but all same reactions= 2+ immediate spin (RT), and 3+ AHG phase;

Also tried testing patients cells with anti-Ge2, -Ge3, -Dib, -Wrb antisera =all tested positive for the antigen.

Any suggestions?? Let me know what to do next?

Thanks

Edited January 15, 2012 by sandoq
add info

[Malcolm Needs ☆]

The first thing I would suggest is a full cell phenotype.

Also, I would try DTT treating the plasma, to see if the antibody by immediate spin is IgM. If it is, this may go on to make the other tests negative.

What is the ABO group?

[Yanxia]

Thanks for sandoq's intersting question and Malcolm's reply.

What an intesting case. I am not familia with this kind of question, but I know a hign frequency antigen H, what about the ABO group?( the same question as Malcolm's)

[chill]

Hi everyone,

I need your help in figuring this one out:cries:. patient is Hispanic; Autocontrol: negative

DAT= negative

All screen cells(3 cell panel) and antibody panel positive: all tests ran in PeG at 37C

immediate spin= 2+

coomb's phase= 3-4+ all cells;

DTT treated cells= same reactions(resistant)

Enzyme(Papain)= enhanced reactions(resistant)

I tested with Lub-, I-, Vel-, Jk(a-b-), P- cells but all same reactions= 2+ immediate spin (RT), and 3+ AHG phase;

Also tried testing patients cells with anti-Ge2, -Ge3, -Dib, -Wrb antisera =all tested positive for the antigen.

Any suggestions?? Let me know what to do next?

Thanks

We recently (yesterday) had a similar scenario, but without DTT treated cells and Enzyme treatment. Our reference lab came up with anti-U. Hope to heaven this person never needs a transfusion! Odds of finding compatible unit around 1 in 1000.

[chill]

We recently (yesterday) had a similar scenario, but without DTT treated cells and Enzyme treatment. Our reference lab came up with anti-U. Hope to heaven this person never needs a transfusion! Odds of finding compatible unit around 1 in 1000. Our patient is African-American. As I understand it, all Caucasions would be U antigen positive, and those of African descent have a 0.1% chance of being U antigen negative.

[cbaldwin]

Hi everyone,

I need your help in figuring this one out:cries:. patient is Hispanic; Autocontrol: negative

DAT= negative

All screen cells(3 cell panel) and antibody panel positive: all tests ran in PeG at 37C

immediate spin= 2+

coomb's phase= 3-4+ all cells;

DTT treated cells= same reactions(resistant)

Enzyme(Papain)= enhanced reactions(resistant)

I tested with Lub-, I-, Vel-, Jk(a-b-), P- cells but all same reactions= 2+ immediate spin (RT), and 3+ AHG phase;

Also tried testing patients cells with anti-Ge2, -Ge3, -Dib, -Wrb antisera =all tested positive for the antigen.

I hope you let us know what this antibody turns out to be!

In the meantime, please, would somebody educate me as to why the Lub-, I-, Vel-, Jk(a-b-), P- cells were chosen for testing, and why the anti-Ge2, -Ge3, -Dib, -Wrb antisera was chosen? I am a BB newbie and am learning. And please, get technical!

Thank you!

[sandoq]

Hi guys,

Thanks for all the responses.

Patient is type: B Rh+

I tested the cells with anti-H : +

We found out that the patient had a history of multiple abortions!!!!! which lead us to suspect anti-PP1Pk (p), fortunately our lab had a few cells that were PP1Pk - and they tested negative for the patient. Conclusion= anti-PP1Pk.

[Malcolm Needs ☆]

Hi guys,

Thanks for all the responses.

Patient is type: B Rh+

I tested the cells with anti-H : +

We found out that the patient had a history of multiple abortions!!!!! which lead us to suspect anti-PP1Pk (p), fortunately our lab had a few cells that were PP1Pk - and they tested negative for the patient. Conclusion= anti-PP1Pk.

WOW!!!!!!!!!!!!! Not many of them to the pound (as we say in the UK)!!!!!!!!!!!!

How many have you seen before? How many more do you expect to see during your career?

[Malcolm Needs ☆]

Hi everyone,

I need your help in figuring this one out:cries:. patient is Hispanic; Autocontrol: negative

DAT= negative

All screen cells(3 cell panel) and antibody panel positive: all tests ran in PeG at 37C

immediate spin= 2+

coomb's phase= 3-4+ all cells;

DTT treated cells= same reactions(resistant)

Enzyme(Papain)= enhanced reactions(resistant)

I tested with Lub-, I-, Vel-, Jk(a-b-), P- cells but all same reactions= 2+ immediate spin (RT), and 3+ AHG phase;

Also tried testing patients cells with anti-Ge2, -Ge3, -Dib, -Wrb antisera =all tested positive for the antigen.

Any suggestions?? Let me know what to do next?

Thanks

??????????

If the plasma was reacting with P- red cells, how can it be anti-P, P1, Pk, because the only P- cells (apart from pp) are P1+, Pk+ (Pk1) or just Pk+ (Pk2)?

[Rh-fan]

I hope you let us know what this antibody turns out to be!

In the meantime, please, would somebody educate me as to why the Lub-, I-, Vel-, Jk(a-b-), P- cells were chosen for testing, and why the anti-Ge2, -Ge3, -Dib, -Wrb antisera was chosen? I am a BB newbie and am learning. And please, get technical!

Thank you!

It is not only the ponit of chosing but also what do have to chose from. I think that this are the HFA antigens that they can test, but also the once you expect the first to find. Although rare they are a little more commen than other antibodies to HFA. Mostly you can not buy these reagents so you mostly use cells and sera from patients you already have found.

Peter

[Brenda K Hutson]

Along the lines of Malcolm's response, just a little education for anyone that doesn't already know this (though perhaps this has been presented here before??).

When all cells are positive (with negative autocontrol), it could be a High; or it could be Multiples. A way to distinguish is to perform a Complete Phenotype; then run a Phenotypically similar cell (it is ok if something on the cell you test is negative for something the patient is posiitive for, as you are not concerned about them making that; but it must be negative for what the patient is negative for). If the cell reaction turns out Negative, you are dealing with multiples; if Positive, a High Incidence. That actually occurred with a CAP Survey a few years ago; some of you may remember; anti-U. The Tech. ran a couple of panels (all positive) before consulting me. I told her to do what I stated above. When she did, she typed the patient as S-s-; then I knew!

When I was a Reference Lab Supervisor, I was helping on the bench one day when 2 specimens came in that "appeared" to be High Incidence Antibodies from the work-ups at the Hospitals. I was going to tell my Tech. how to approach it, but she said NO; you do it your way and I will do it mine (which was first to run panels to see if she got any negative reactions, then to just start pulling frozen High Neg cells and test); let's see who finishes first. Well, lucky me; my patient ended up being Jk(a-b-) so I didn't even have to find the phenotypically matched cell (not that I could assume it was Jk3; but I knew there was a good chance and pulled frozen Jk3- cells to confirm and rule-out). She spent the day on her

work-up, which ended up being anti-Vel.

Brenda Hutson, MT(ASCP)SBB

[Eagle Eye]

Yes we have seen this particularly with gel---you may get all cell same strength and have multiple.

[Yanxia]

Along the lines of Malcolm's response, just a little education for anyone that doesn't already know this (though perhaps this has been presented here before??).

When all cells are positive (with negative autocontrol), it could be a High; or it could be Multiples. A way to distinguish is to perform a Complete Phenotype; then run a Phenotypically similar cell (it is ok if something on the cell you test is negative for something the patient is posiitive for, as you are not concerned about them making that; but it must be negative for what the patient is negative for). If the cell reaction turns out Negative, you are dealing with multiples; if Positive, a High Incidence. That actually occurred with a CAP Survey a few years ago; some of you may remember; anti-U. The Tech. ran a couple of panels (all positive) before consulting me. I told her to do what I stated above. When she did, she typed the patient as S-s-; then I knew!

When I was a Reference Lab Supervisor, I was helping on the bench one day when 2 specimens came in that "appeared" to be High Incidence Antibodies from the work-ups at the Hospitals. I was going to tell my Tech. how to approach it, but she said NO; you do it your way and I will do it mine (which was first to run panels to see if she got any negative reactions, then to just start pulling frozen High Neg cells and test); let's see who finishes first. Well, lucky me; my patient ended up being Jk(a-b-) so I didn't even have to find the phenotypically matched cell (not that I could assume it was Jk3; but I knew there was a good chance and pulled frozen Jk3- cells to confirm and rule-out). She spent the day on her

work-up, which ended up being anti-Vel.

Brenda Hutson, MT(ASCP)SBB

Brenda Hutson, thanks for your post.

I am very interesting in it, but because my English is not so good, I don't know if I understand it rightly.

Do you mean if all cells are positive, then we phenotype the patient first, second use the phenotype similar cells to do the screen, if it is neg, the antibody is multiple, if the screen is pos, the antibody is to HFA.

finally we use rare cells to test the patients plasma to see what antibody is in ?

[Brenda K Hutson]

1. If all cells positive (becomes more complicated if positive autocontrol; so just referring to panel cells here), perform complete phenotype on patient (if not transfused in past 3 months; or do retic separation if they have)

2. Find a Panel Cell that matches the phenotype of the patient (at least whatever antigens the patient lacks, that cell must also lack; it is ok if the cell is negative for something the patient is positive for) and Test that cell

3. If the cell is non-reactive, you are likely dealing with multiples. Now you just have to start splitting out the possibilities and running combinations that lack the antigens the patient lacks; until you are fortunate enough to get a negative reaction.

4. If phenotypically matched Panel cell is positive, you are likely dealing with a High Incidence. If you were fortunate like me and got a double-negative; i.e. Fy(a-b-), Jk(a-b-), S-s-, etc., you can head in that direction first. If you don't get that and/or that does not pan out, you can run some High Incidence Negative (frozen) cells.

If there is a flaw in my protocol, hopefully Malcolm will point it out before I lead everyone astray!

Brenda Hutson, MT(ASCP)SBB

Brenda Hutson, thanks for your post.

I am very interesting in it, but because my English is not so good, I don't know if I understand it rightly.

Do you mean if all cells are positive, then we phenotype the patient first, second use the phenotype similar cells to do the screen, if it is neg, the antibody is multiple, if the screen is pos, the antibody is to HFA.

finally we use rare cells to test the patients plasma to see what antibody is in ?

[Malcolm Needs ☆]

No moaning from me Brenda.

I think that is excellent advice.