Incompatible cross match in enzyme phase

[drwajiha]

Dear fellow blood bankers, Hi!

I need your help and suggestions to solve a problem. I have a patient,G₂P_1, case of placenta praevia in need of blood.No history of previous blood transfusion. Blood group B Positive.

Cross match done using complete cross match gel cards ( DiaMed /BioRad). 50 units tried all incompatible in enzyme phase only. AHG phase is compatible. Antibody screening using Liss/Coomb's gel cards is giving a negative reaction. DCT is negative. Tried doing crossmatch using samples from her sisters and brother but same incompatible result in enzyme phase. blood group of her siblings are O negative and O positive.

I need urgent help/ suggestions to solve this problem.

Is there any interference? or rare antibody ? or anything I missed ?

Thanks

Edited March 23, 2014 by drwajiha

[Malcolm Needs ☆]

Well done for doing all that work, but you actually did more than you needed to do.

The point is that the blood you are going to transfuse to her, always assuming that she needs blood, is NOT going to be enzyme-treated and will NOT cause a transfusion reaction.

There has been a an awful lot of work done on "enzyme-only" antibodies and, as far as I know, only 3 EVER have proved to be clinically significant (and all 3 of those were specific, rather than non-specific [or pan-reactive]) and so I, for one, would not worry one iota about this lady's "enzyme only" antibody.

Don't worry about it and just transfuse blood that you find compatible by IAT cross-match.

There is NOTHING that you have missed. It may be a rare antibody (in that it is actually an anti-Rh17 or anti-Rh18) but you are never going to be able to prove that, unless you have access to incredibly rare red cells (and what is that going to prove?), so stop worrying and give the lady IAT cross-match compatible blood and sleep with a clear conscience.

[drwajiha]

Well done for doing all that work, but you actually did more than you needed to do.

The point is that the blood you are going to transfuse to her, always assuming that she needs blood, is NOT going to be enzyme-treated and will NOT cause a transfusion reaction.

There has been a an awful lot of work done on "enzyme-only" antibodies and, as far as I know, only 3 EVER have proved to be clinically significant (and all 3 of those were specific, rather than non-specific [or pan-reactive]) and so I, for one, would not worry one iota about this lady's "enzyme only" antibody.

Don't worry about it and just transfuse blood that you find compatible by IAT cross-match.

There is NOTHING that you have missed. It may be a rare antibody (in that it is actually an anti-Rh17 or anti-Rh18) but you are never going to be able to prove that, unless you have access to incredibly rare red cells (and what is that going to prove?), so stop worrying and give the lady IAT cross-match compatible blood and sleep with a clear conscience.

Thank you Malcolm Needs, You do not know how much you have relieved me mentally.

I work in a setting where every small thing has medico legal issues. I would be much obliged if you could forward some links to these articles to have as ready reference to show that in such circumstances what course of action I have taken in not unscientific

Thank you again, drwajiha

[Eagle Eye]

Why would you crossmatch with enzyme??? Never did and will never do it....

 

We do not do enzyme unless it is absolutely necessary....[ I know Malcolm will not agree and other Ref. lab also will not agree. I believe in ref. lab they run enzyme panel on every specimen?)

There are more serious issues we can and should worry about.

[Malcolm Needs ☆]

No Eagle Eye - I totally agree. We would NEVER cross-match using enzyme-treated red cells.

Yes, we do run a panel of enzyme-treated red cells, but, to be frank, the only thing that we are really looking for there is either an Rh antibody or an enzyme auto-antibody. In other words, our enzyme panels are pretty basic.

[Abdulhameed Al-Attas]

Dear fellow blood bankers, Hi!

I need your help and suggestions to solve a problem. I have a patient,G₂P_1, case of placenta praevia in need of blood.No history of previous blood transfusion. Blood group B Positive.

Cross match done using complete cross match gel cards ( DiaMed /BioRad). 50 units tried all incompatible in enzyme phase only.

I am curious to know because to x-match 50 units through second stage enzyme is really time consuming and is NOT required as Eagle Eye, has stated above.

Drwajiha,could you please explain how you enzyme X-match?

Edited March 24, 2014 by Abdulhameed Al-Attas

[galvania]

Dear Drwajiha

When you say you are using the complete crossmatch cards, are you using the ones where you have to add Diluent 1 to the A-B-D wells?  In other words, the one with human reagents?  If that IS the case, then please can you write me a private e-mail.  We need to discuss this.

anna

[drwajiha]

Why would you crossmatch with enzyme??? Never did and will never do it....

 

We do not do enzyme unless it is absolutely necessary....[ I know Malcolm will not agree and other Ref. lab also will not agree. I believe in ref. lab they run enzyme panel on every specimen?)

There are more serious issues we can and should worry about.

I have explained earlier that at our facility we are using complete crossmatch gel card (by DiaMed / BioRad).

This card has two phases of crossmatch:

- AHG

- Enzyme phase.

I am getting positive result in enzyme phase only. NOT that I am doing crossmatch using only enzyme phase.

 

In reply to the other queries  and comments by Malcolm Needs and Abdul Hameed  i would like to say that at our facility we do serological crossmatch and my explanation given above might answer your queries that how and why so many units were tried .

If antibody screening was positive and Antibody Identification was conclusive, there would have been no problem. 

I brought up this problem in front of you because all of you are knowledgeable.

May be people are using these cards for a long time and they could give me information about any interferences encoutered or any similar experiences or advise me  to check my working or about my course of action to be taken now. 

Again thanking you all for your time and interest in this thread.

[Malcolm Needs ☆]

I will forward the links as requested drwajiha as soon as I can, but I am on compassionate leave at the moment because my Mother-in-Law died on Thursday and my Sister-in-law died on Friday, so I am at home and do not not have access to all of my collection of reprints at present, which are at work.

[galvania]

Malcolm - please accept my condolences.  That is really tough

Anna

[drwajiha]

I will forward the links as requested drwajiha as soon as I can, but I am on compassionate leave at the moment because my Mother-in-Law died on Thursday and my Sister-in-law died on Friday, so I am at home and do not not have access to all of my collection of reprints at present, which are at work.

Dear Malclm, Sorry to hear about the tradegy. But knowing this has made me to respect you more. Inspite of your problems you spent time to answer my thread and give me advice. It is truly very nice of you. 

Best regards, drwajiha

[AMcCord]

So sorry Malcolm. My sympathy to you and your family.

[aafrin]

I will forward the links as requested drwajiha as soon as I can, but I am on compassionate leave at the moment because my Mother-in-Law died on Thursday and my Sister-in-law died on Friday, so I am at home and do not not have access to all of my collection of reprints at present, which are at work.

Malcolm, Please accept my condolences,,,what a tragedy.

If I may ask what happened? accident or???

[Malcolm Needs ☆]

Thanks AMcCord and aafrin. No, not an accident. My Mother-in-Law, although 91, died suddenly of congestive cardiac failure and ischemic heart disease, complicated by diabetes, whereas my Sister-in-Law died after a short illness with Ca lung and SLE. It was very ironic in some ways, as they shared a birthday and also died within 24 hours of each other. AS you can imagine, my wife has been hit particularly hard with the news.

[Eagle Eye]

Malcolm Please accept my condolences.

God may give strength to you and your family to go though this tough time...

[Abdulhameed Al-Attas]

We are very saddened to hear to your loss and would like to express our sincere condolences to you and family.

Remember that we ( in PathLab Talk ) love and care about you.Our thoughts and prayers are with you and family.

[Dr. Pepper]

Malcolm, I am very sorry to hear of your loss. My condolences to you and yours, and know that you are in the thoughts and prayers of everyone in your Pathlab Talk family.

 

Phil