Antibody with anti-s specificity in a little s positive patient

[Annadele]

Hi All! I'm looking for general ideas involving in a case from this weekend that none of our resident immuno gurus have reviewed yet.

A selected cell appears to give me p values for an anti-s. The plasma doesn't react with any of the heterozygous cells but reacts at + or 1+ with all of the S-s+ cells chosen. The patient has multiple other antibodies.

The patient has been antigen typed via Bioarray and is S-s+. They're white so Dantu (with a weaker s expression that could therefore possibly produce an anti-s isn't likely?). The Bioarray apparently would flag you if the patient is U-.

The patient's DAT is negative by AHG including a five minute incubation.

Let me know if any more information would be helpful!

[Malcolm Needs ☆]

I must admit that this one is foxing me.

Do you know, however, if the patient has a panreactive antibody with papain-treated red cells (including auto)?

The reason I ask is because, from time-to-time, we see an apparent anti-S reacting with papain-treated red cells in an S+ patient, that is, if you perform "exquisit" serology, actually an auto-anti-U that is mimicking an anti-S. I just wonder if this is the antithetical version????????????

I have no idea though!!!!!!!!!!!!!!!!!!!

[Annadele]

Thanks Malcolm!

We opted to go ahead and crossmatch them for a couple of units (they're supposed to be transfused on Monday) ....and both units were incompatible. First shift consulted with our analytical supervisor who advised us to do a cold screen and try prewarming if it's positive.

Annadele

I must admit that this one is foxing me.

Do you know, however, if the patient has a panreactive antibody with papain-treated red cells (including auto)?

The reason I ask is because, from time-to-time, we see an apparent anti-S reacting with papain-treated red cells in an S+ patient, that is, if you perform "exquisit" serology, actually an auto-anti-U that is mimicking an anti-S. I just wonder if this is the antithetical version????????????

I have no idea though!!!!!!!!!!!!!!!!!!!

[Annadele]

Hi All! I just wanted to let you know that the final conclusion was that the reactions might be due to a possible HTLA. The HTLA titer was rather low for an HTLA but no other explanation was found.

She got two least incompatible units - no reactions after transfusion that we know of.

Thanks Malcolm!

We opted to go ahead and crossmatch them for a couple of units (they're supposed to be transfused on Monday) ....and both units were incompatible. First shift consulted with our analytical supervisor who advised us to do a cold screen and try prewarming if it's positive.

Annadele