bj5826023 Posted June 8, 2012 Share Posted June 8, 2012 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? Link to comment Share on other sites More sharing options...
John Eggington Posted June 8, 2012 Share Posted June 8, 2012 What are the 'full' D type results? Do you use ficin treated cells in your auto? Link to comment Share on other sites More sharing options...
JEMarti Posted June 8, 2012 Share Posted June 8, 2012 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? Link to comment Share on other sites More sharing options...
Rh-fan Posted June 8, 2012 Share Posted June 8, 2012 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 Link to comment Share on other sites More sharing options...
bj5826023 Posted June 9, 2012 Author Share Posted June 9, 2012 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. Link to comment Share on other sites More sharing options...
bj5826023 Posted June 9, 2012 Author Share Posted June 9, 2012 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. Link to comment Share on other sites More sharing options...
bj5826023 Posted June 9, 2012 Author Share Posted June 9, 2012 The report we got was weak D type 4/4.3 Link to comment Share on other sites More sharing options...
bj5826023 Posted June 9, 2012 Author Share Posted June 9, 2012 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. Link to comment Share on other sites More sharing options...
John Eggington Posted June 9, 2012 Share Posted June 9, 2012 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. Link to comment Share on other sites More sharing options...
Mabel Adams Posted June 10, 2012 Share Posted June 10, 2012 Is there a need to transfuse or is this case a HDFN worry? Link to comment Share on other sites More sharing options...
bj5826023 Posted June 12, 2012 Author Share Posted June 12, 2012 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. Link to comment Share on other sites More sharing options...
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