A Sickle patient with weaker auto control

[Rh-fan]

We have a Sickle patient with antibodies reactive with all panel cells but is weaker with the patient cells.

There has been multiple transfusions. After washing with 3% saline (to remove the donorcells) we performd a DAT and this was also positive indicating auto antibodies.

Has anyone seen such a weaker reaction with the patient cells in Sickle patients?

Peter

[Malcolm Needs ☆]

I haven't, but I was just wondering Peter, if you had re-tested the auto with the washed red cells?

[Rh-fan]

Yes and it was also positive.

[Malcolm Needs ☆]

Then I just wonder if there is an alloantibody present that is (almost) being masked by the auto-antibody?

[Rh-fan]

That is what I am afraid of. After transfusion the antibodies become stronger.

The antibody has Rh17 (like) specificity (non reactive with RhNull and -D- cells), but this is also common in AIHA.

We are now doing sequencing for RHCE to see if this patient is lacking a high frequent Rh antigen.

[Malcolm Needs ☆]

I'd be very interested in the results that you obtain. Would you mind posting them here?

[Rh-fan]

I'd be very interested in the results that you obtain. Would you mind posting them here?

No problem, I hope the end of this day to have more info.

[Nisar]

We have a Sickle patient with antibodies reactive with all panel cells but is weaker with the patient cells.

There has been multiple transfusions. After washing with 3% saline (to remove the donorcells) we performd a DAT and this was also positive indicating auto antibodies.

Has anyone seen such a weaker reaction with the patient cells in Sickle patients?

Peter

dear what method you used for DAT ?

[Yanxia]

We have a Sickle patient with antibodies reactive with all panel cells but is weaker with the patient cells.

There has been multiple transfusions. After washing with 3% saline (to remove the donorcells) we performd a DAT and this was also positive indicating auto antibodies.

Has anyone seen such a weaker reaction with the patient cells in Sickle patients?

Peter

It is an interestiong case.

I don't know if it can help you, just in case , I remember I have read a paper says sickle patient's cell size is abnormal, so if use gel to test it, it will cause false pos result.

[Rh-fan]

For DAT we use gel and tube, both are positive.

[Nisar]

we have just like the same case,we identfied underlying all0 antib0dies after multiple transfusi0n.First anti C and then JKa.

[Liz]

I'd be very interested in the results that you obtain. Would you mind posting them here?

Peter: No problem, I hope the end of this day to have more info.

Hello Peter, did you get the results? and if so, I would love to know what they are.

Thank you

Liz

[Rh-fan]

Malcolm/Liz and the others,

The DNA took a bit more time then I aspected, but I have the total of results.

She has 2 RHD allels, one normal and the other is a r's allel (expressing no RhD but a variant of C and VS). In the RHCE we now see only an ces (c, e and VS) allel and a normal ce.

The antibody was non reactive with Rh null and also not reactive with -D- so I was affraid of an anti Hr0-like antibody, but with the normal RHce allels there will not be an allo anti Hr0-like.

SO for now we have to stick with auto antibodies. But still strnage that the auto control is weaker.

Peter

[Malcolm Needs ☆]

Very interesting case. Thanks for that Peter.

[Liz]

thank you Peter.