Posted June 8, 201213 yr comment_44487 We have a pregnant female african american patient with an apparent anti-D in her plasma (no Rhogam received).Her gel ficin strongly is positive with all cells. DAT is negative and autocontrol is also negative.We sent the sample out of partial D typing and learned that she can make allo-anti-D.We've ruled out LW (cord cells only reacted w/D+ cells) so what is it in the gel ficin? What would you do next?
June 8, 201213 yr comment_44490 What are the 'full' D type results? Do you use ficin treated cells in your auto?
June 8, 201213 yr comment_44496 You say that she has anti-D, but that the Gel Ficin is reactive with all cells. Does this mean that you got a clean result of Anti-D without Gel? Why did you run a ficin panel? Was there unexplained reactivity that you were trying to account for?
June 8, 201213 yr comment_44499 I asume that you have found the anti D in a panel with untreated cells, and have excluded all other antibodies. I think that the reactions with ficin treated cells are coused by aspecific auto antibodies (if the patient cells are also reactive(after treatment with ficin)), the presence of this kind of autoantibodies is no problem. Just perform cross-match with RhD neg donor blood.Do you have (for my own interrest) further information on the type of RhD variant this patient has?Peter
June 9, 201213 yr Author comment_44514 What are the 'full' D type results? Do you use ficin treated cells in your auto?I can't remember since I don't have the case. No, we did not treat auto cells. Didn't think about it.
June 9, 201213 yr Author comment_44515 You say that she has anti-D, but that the Gel Ficin is reactive with all cells. Does this mean that you got a clean result of Anti-D without Gel? Why did you run a ficin panel? Was there unexplained reactivity that you were trying to account for?We ran a ficin to see if it's actually auto antibody w/D specificity, but then did not think about treating auto cells as well. Reactions were stronger with D+ cells and slight weaker w/other cells in gel ficin.
June 9, 201213 yr Author comment_44517 I asume that you have found the anti D in a panel with untreated cells, and have excluded all other antibodies. I think that the reactions with ficin treated cells are coused by aspecific auto antibodies (if the patient cells are also reactive(after treatment with ficin)), the presence of this kind of autoantibodies is no problem. Just perform cross-match with RhD neg donor blood.Do you have (for my own interrest) further information on the type of RhD variant this patient has?PeterWeak D type 4/4.3. Thought about doing an eluate anyways, even though DAT and AC were negative but then somehow got off track. Wouldn't WAA still react with cord D- cells? It was actually negative.
June 9, 201213 yr comment_44520 I'd do an auto against ficin treated patients cells. A positive results could be due due auto-anti-D but I think it would more likely represent an 'enzyme auto', as there's a reasonable chance the anti-D is 'allo'. Either interpretation would be 'OK' as both mean 'select' D- blood for xmatch, which is probably what you'd do anyway. A negative result would put you back in the 'what is it?' situation.
June 12, 201213 yr Author comment_44554 Is there a need to transfuse or is this case a HDFN worry?It was both. We gave her RH negative units while investigating though.
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