Anti-D Epidemic

[Brenda K Hutson]

The Title alone makes you want to look at it!

Thanks!

Brenda

I have attached part of my lecture on the blood groups that I've been doing for a few years. (I've added my voiceovers in quotes.) It may not help Brenda with her autoanti-Ds but might brighten up your day for a moment. Most BB lectures are pretty dry, I try to have a little fun with my students.

[Malcolm Needs ☆]

I have attached part of my lecture on the blood groups that I've been doing for a few years. (I've added my voiceovers in quotes.) It may not help Brenda with her autoanti-Ds but might brighten up your day for a moment. Most BB lectures are pretty dry, I try to have a little fun with my students.

Phil, your lecture is quite brilliant!

[Kathy]

We have had a few of them lately too with the same reagent manufacturer. I'd like to know what you find out.

[ANORRIS]

I recently had a known Rh positive who received 2 units of Rh pos blood one month prior suddenly show an auto Anti-D and a Ant-JKb.......ran numerous panels with same result.

What is going on???

[Rh-fan]

I recently had a known Rh positive who received 2 units of Rh pos blood one month prior suddenly show an auto Anti-D and a Ant-JKb.......ran numerous panels with same result.

What is going on???

Was the autocontrole positive or negative?

Negative RhD variant.

Positive it can be a variant or an auto anti D, repeat the auto contole 3 months after the last transfusion.

Peter

[Brenda K Hutson]

Well, the mystery only deepens. The 2nd and 3rd patient specimens we sent (both pregnant women; Rh POS; Appeared to be Auto Anti-D), were Negative at the Reference Lab! They said they could not even duplicate our GEL results! This is very confusing to me; these were not weak reactions (2-3+).

Any other thoughts??

Thanks,

Brenda

[ANORRIS]

was the autocontrole positive or negative?

Negative rhd variant.

Positive it can be a variant or an auto anti d, repeat the auto contole 3 months after the last transfusion.

Peter

negative auto control. This "auto" d did not show prior to previous transfusion 3 months earlier.

[Malcolm Needs ☆]

Do they use the same gel technique as you Brenda?

We sometimes find that we cannot confirm reactions detected by Ortho BioVue in our Hospital Laboratories when we test using our first line Bio-Rad gel.

[Brenda K Hutson]

I am guessing they are all manual. And while we would have performed the initial Antibody Screen on the ProVue, the Antibody ID Panel would have been manual.

Brenda

Do they use the same gel technique as you Brenda?

We sometimes find that we cannot confirm reactions detected by Ortho BioVue in our Hospital Laboratories when we test using our first line Bio-Rad gel.

[Malcolm Needs ☆]

Thanks for that Brenda, but what I really meant was not is one lab performing the tests manually and one automatically, but rather are both laboratories using the same gel manufacturer?

Sorry, I wasn't very clear in my other email.

[Brenda K Hutson]

Aaaaaaaaaahhhhh, well truthfully, I have only heard of Ortho GEL use so I would have to confirm that with them. That being said, I think they only keep GEL Cards because so many of their clients use it and they want to be able to compare "apples to apples;" so I am guessing they would use the GEL technology used by most; with is Ortho.

Did I get the right answer this time?

Thanks,

Brenda

Thanks for that Brenda, but what I really meant was not is one lab performing the tests manually and one automatically, but rather are both laboratories using the same gel manufacturer?

Sorry, I wasn't very clear in my other email.

[Malcolm Needs ☆]

Thanks Brenda - yes you did, but it does help when I actually ask the question correctly, I know!!!!!!!!!!!!!!!!!!!!!!!!!

.........and I even got that wrong, I've just realised; it was a "post", not an "email" - I'll get there one day!!!!!!!!!

[apfelblosm]

As a side note, Malcolm, Ortho is the only one with a patent at this time for Gel, so there are no other manufacturers in the US that are able to sell Gel, but that is changing soon. Additionally, I was wondering, Brenda, if you had thought of anti-G. I don't know what your patient's phenotypes are like, but being pregnant is a good possibility, though two in a row would be strange. Perhaps one is and the other is something else. I have had a lot of "gel crap" in my day at the reference lab and especially with the pregnant patients. They tend to make things that only show up in Gel and no other methods. Good Luck! Jen

[Mabel Adams]

Did you send the same exact specimen that you had tested or draw a new one to send to the reference lab? Any way the original sample could have got contaminated with reagent anti-D or another patient's anti-D?

[Malcolm Needs ☆]

Additionally, I was wondering, Brenda, if you had thought of anti-G. I don't know what your patient's phenotypes are like, but being pregnant is a good possibility, though two in a row would be strange.

The only thing that would make me doubt an anti-G is the fact that there has been no mention of an anti-C, and, usually, anti-G reacts more strongly with R1R1 and r'r red cells than it does with R2R2.

[Brenda K Hutson]

We have had 3 such patients; 2 of which are pregnant (and had a positive DAT). I would have expected to also see an Anti-C with a G. I have seen a fair number of G's, but none alone.

The Reference Lab cannot even duplicate our GEL results though; and I have NO idea what that is about. Given the perfect Anti-D pattern, I can't say it is a problem with a GEL Lot#. Also, these 3 patients spanned 2 different Antibody Screen Lot numbers; so that makes that possibility unlikely also.

Brenda

As a side note, Malcolm, Ortho is the only one with a patent at this time for Gel, so there are no other manufacturers in the US that are able to sell Gel, but that is changing soon. Additionally, I was wondering, Brenda, if you had thought of anti-G. I don't know what your patient's phenotypes are like, but being pregnant is a good possibility, though two in a row would be strange. Perhaps one is and the other is something else. I have had a lot of "gel crap" in my day at the reference lab and especially with the pregnant patients. They tend to make things that only show up in Gel and no other methods. Good Luck! Jen

[Brenda K Hutson]

We sent a different specimen. So I asked for them back. I only know that 1 of them which we tested, was also Negative by us. Not sure I am going to be able to solve this one.....

Brenda

Did you send the same exact specimen that you had tested or draw a new one to send to the reference lab? Any way the original sample could have got contaminated with reagent anti-D or another patient's anti-D?

[Brenda K Hutson]

Ah, did not read your reply until I replied with the same! :tongue: Good, now I don't feel like I am just "hanging out there" in left field.

Brenda

The only thing that would make me doubt an anti-G is the fact that there has been no mention of an anti-C, and, usually, anti-G reacts more strongly with R1R1 and r'r red cells than it does with R2R2.

[Brenda K Hutson]

Just wanted to update all of you on where this is at.....

1. So as mentioned, the Reference Lab obtained Negative GEL Antibody Screens on all 3 patients

(1st patient had a cold agglutinin though)

2. We asked for the specimens back from the Reference Lab (since they were drawn a different

day than those we Tested) and the Antibody Screens on them were Negative

3. I had a Tech. pull "our" original 3 specimens and repeat the Antibody Screens....still Positive!

There must be a common link but I just cannot figure out what that is! It is making me

crazy (er).

Thanks to all of you for your attempts to figure this out also!

Brenda

[Malcolm Needs ☆]

I know that you don't want to hear/think this Brenda, but I suppose the samples with the positive screens, or the ones with the negative screens were taken from the correct patients?

Have you any reagents to type other than Rh and K, just to see if the respective samples (patient A and patient A, patient B and patient B, patient C and patient C) all match?

I know it's a horrible thought, but it could be that there is a "rogue" phlebotomist around.

[Dr. Pepper]

Brenda, we had a mystery many years ago. In those days one tech did the typings, another did the screens etc. The first tech does 3 typings, all D-. Tech 2 does the screens, all are positive 2+. We dove into the panels, all showed anti-D with a positive auto control. Huh? The short answer is, tech #1 had added a drop of anti-D to each of the tubes she had aliquotted the serum into instead of the tubes intended for the D typings! All 3 were really D+ with a negative ab screen. Your gel cards are pre-loaded, right? No chance of reagent anti-D getting into any of those plasmas?

[Brenda K Hutson]

Well, the thought did occur to me. However, that would mean:

1. The same phlebotomist happened to draw all 3 patients

2. The phlebotomist misdrew/mislabeled specimens on 3 different patients, drawn on different

days, at different times

3. And the reality is, regardless of whether they were drawn on the correct patient, the blood

types for all 3 specimens still typed as Rh Positive; and the Antibody Screens still showed

what they did....

So, I can't figure out how that could be the issue??

Brenda

I know that you don't want to hear/think this Brenda, but I suppose the samples with the positive screens, or the ones with the negative screens were taken from the correct patients?

Have you any reagents to type other than Rh and K, just to see if the respective samples (patient A and patient A, patient B and patient B, patient C and patient C) all match?

I know it's a horrible thought, but it could be that there is a "rogue" phlebotomist around.

[Brenda K Hutson]

Correct, the GEL Cards are pre-loaded. In addition, if a patient does not have a historical blood type, a manual tube type must also be performed (in addition to the ProVue).

Brenda

Brenda, we had a mystery many years ago. In those days one tech did the typings, another did the screens etc. The first tech does 3 typings, all D-. Tech 2 does the screens, all are positive 2+. We dove into the panels, all showed anti-D with a positive auto control. Huh? The short answer is, tech #1 had added a drop of anti-D to each of the tubes she had aliquotted the serum into instead of the tubes intended for the D typings! All 3 were really D+ with a negative ab screen. Your gel cards are pre-loaded, right? No chance of reagent anti-D getting into any of those plasmas?

[Malcolm Needs ☆]

Well, the thought did occur to me. However, that would mean:

1. The same phlebotomist happened to draw all 3 patients

2. The phlebotomist misdrew/mislabeled specimens on 3 different patients, drawn on different

days, at different times

3. And the reality is, regardless of whether they were drawn on the correct patient, the blood

types for all 3 specimens still typed as Rh Positive; and the Antibody Screens still showed

what they did....

So, I can't figure out how that could be the issue??

Brenda

Hmmmmmmm. Thinking cap back on then!

[Mabel Adams]

Did all 3 patients require manual typing? I am thinking of any source of contaminating anti-D. Did someone spill a bottle in the box of tubes used to aliquot plasma samples? Spill it on the pipets used to take sample from the tube for the manual reverse type which contaminated the sample before it was put on the machine? Put or spill anti-D in some spot in the machine that would contaminate the probe for these samples' antibody screens?