Is the drugs play role in this reaction?

[Desoki]

Today I had a strange case, need you scientific explanation:

That case was for pregnant female 30 years old age A+ve, since two months she got two transfusions last one since one week, also she didn’t suffer from any thing other than anemia, only medications she took was Zantac and Palsil, her antibody screen was before today negative and all unites were compatible, and these transfusions done smoothly.

Yesterday her doctor asked for one unit PRBCs, the technician did antibody screen and cross match by gel cards, results were negative but the patient has severe reaction after transfused with that unit, the reaction interpreted by blood bank observer as febrile nonhemolytic transfusion reaction.

Today her doctor again asking one PRBC unit, but when we start working for this patient, her antibody screen became positive by gel card in AHG phase with three screening cell grade 3, autocontrol and DAT negative, we did panel with extended six cells the result was all cells positive but with different grades, we also did enzyme panel to save our time, the result was only two cells positive and interpreted as alloanti E.

Also I wanted to repeat our work with manual tube methods, unfortunately the result of antibody screen with three cells were negative macroscopically but few mixed field under microscope and positive after adding check cells, also we did manual crossmatch, the result was negative of one unit macroscopically and microscopically and also strong positive with check cells so we released this unit, the second unit was negative macroscopically but very few mixed field under microscope and positive after adding check cells but we didn’t issue this unit.

My question is why there is strong reaction with card nearly negative with tube?

Also, is her drugs played a roll in this scene?

[David Saikin]

I have found that 2+ or weaker reactions in gel cards give negtive results when tested in tubes (LISS or PeG). I do not think that her medications are involved in the reactions you are seeing.

[Deny Morlino]

I have had the same experience with strength of reaction that David describes.

[Barbarakym]

Gel is more sensitive than tube. I agree with the above assessment (below 2+ will be negative on tube). What company makes your screening cells? Ortho had a problem 2 or 3 years ago when they went to gel (0.8%) cells where they were missing weak Anti-E. The cells also can degrade if left out more than 1 shift at a time without going back in the refrigerator, though I have had that be mixed contamination or slightly lysed cells and not necessarily missed antibody. Still be sure your 0.8% cells are stored properly (validated for no more than 8 hours at RT in Ortho studies), that you have lots which have been fixed for the weak Anti E problem (write Ortho)... how they had us solve that was to incubate the cards 40 minutes instead of 15 until they figured it out.

It sound like to me that she had a weak E that was not showing even on gel and the first unit spiked her. Still not strong enough to show on gel when you gave the next unit and she had a reaction but it looked ok. Now you are getting junk (as well as the E). The junk CAN be from patient issues (protein high, plts high, colds (did you do IS with your tube method), rouloux, junky plasma (some drugs do this, some disease states do this).

Good luck, but it sounds like you did all the right stuff. Why is she still getting blood? Usually moms have problem during delivery but afterwords clear up. Maybe something else going on?

Kym