Antibody Problem, Mysterious

[Hankct9]

We have a patient who came in recently and required a unit of PRBCs.   The patient is an A1 positive with a history of anti-K and LuA dating back to 1999. 

 

Today his/her AB screen was negative using gel(no hemolysis was seen).

2 units of A pos red cells were crossmatched using gel, per our protocol. 

To our surprise, both columns were completely hemolyzed.
 

An AB panal was then done, which was negative, as was the poly and mono DAT.

 

The patient was then gel crossmathed with O cells, which were negative with no hemolysis.

 

Ultimatly the patient received one unit of o cells without incident.

 

We can't figure out what's going on.  Does anyone have an idea?

Thanks in advance for any help.

 

Hank  

[R1R2]

^{What was the immediate spin crossmatch reaction with A cells?}  

[Hankct9]

The Immediate spin crossmactches were negative.

[R1R2]

Did you inspect the A units?  Can you run them in gel without patient plasma or with a different patient's plasma and see what happens?

[Hankct9]

Thanks R1R2,  It seems like the MTS diluent may have been bad.  I repeated the gel XMs with freshly opened diluent and the XMs were negative with no hemolysis.  I then repeated with the old MTS diluent

and there was some hemolysis. 

The problem may just be with the diluent.  Maybe I should have done complete testing before posting my

problem..........oh well.

 

Thanks again for your help.

[Brenda K Hutson]

We had a case like this recently. Turned out the patient had received IVIgG and there was a passive transfer of

Anti-A (which we also eluted).

Brenda Hutson

[Malcolm Needs ☆]

Pain in the neck sometimes is IVIG.

[Brenda K Hutson]

Had a couple of other thoughts last night.....has the patient received a lot of ABO Incompatible Platelets in a short period of time?

One other thought....though may not apply; depending on how many units you tried to crossmatch. Was thinking of a cold reactive antibody that was present on the A1 cells but negative on your group O cells (though the chances of it just happenning to be present on the A1 cells and group A units you crossmatched; but not on the group O units you crossmatched; is probably a stretch). But was thinking of something like Anti-Lea??

That is all "my brain can think of" at this point.

Brenda Hutson

[John C. Staley]

Pain in the neck sometimes is IVIG.

Malcolm, I'm impressed.  You appear to be channeling your inner Yoda! 

 

It can be frustrating to do a lot of workup to discover the problem is reagent related.

[dbrown]

Interesting side note to Ortho Gel, I have been picking up a lot of anti-Ms in Orthos reagents lately. If I suspect a fuzzy reaction, I will perform an antibody ID panel with room temp incubation for 30 minutes in the IgG gel card. Amazing how many times this helps explain an unexplainable test result.

Although, this does not appear to be the case here...because of the diluent.

Deanna

[Mabel Adams]

If it hadn't been the diluent, I was thinking of anti Le bH.  But do you use serum in your gel testing?  You really can't get hemolysis as a positive reaction if you are using EDTA plasma as a specimen.

[Abdulhameed Al-Attas]

_{What about serum specimen with AHG monospecific IgG, Can I still have hemolysis as a positive reaction; because I use serum (source of complement)?}

_{Or something else is needed along with the serum?}

[Dansket]

_{What about serum specimen with AHG monospecific IgG, Can I still have hemolysis as a positive reaction; because I use serum (source of complement)?}

_{Or something else is needed along with the serum?}

Anti-Complement in your antiglobulin reagent.

[tupton]

Contaminated diluent should have been discovered when running QC