kmmoton Posted April 14, 2014 Share Posted April 14, 2014 The patient has a weakly reactive Jka that is of course enhanced with Ficin. The patient's auto control is weakly positive. The DAT is completely negative. The patient hasn't been transfused since 2012. The patient's antigen typing is 3+. Advice please!! Link to comment Share on other sites More sharing options...
galvania Posted April 15, 2014 Share Posted April 15, 2014 Possibilities:1. Auto anti-Jka (have been documented)2. The patient is a Jka variant with allo-anti-Jka3. Patient has a BM transplant4. The antibody is not a real anti-Jka. (There is a type of pseudo anti-Jka that is dependent on parabens for its activity. Depending on the method you are using to do your antibody screens, this might be probability no.1)5. Something else that I haven't thought of!To do:1. Check patient's records for eventual bone marrow or stem cell transplantation.2. If possible, repeat the antibody screen with cells and methods from different manufacturers3. Repeat antigen typing and if necessary molecular biology.In the meantime, and provided he is Jkb+, transfuse with Jka-b+ blood. Hope this helpsanna Sandy L, Eagle Eye, Yanxia and 2 others 5 Link to comment Share on other sites More sharing options...
Malcolm Needs ☆ Posted April 15, 2014 Share Posted April 15, 2014 I agree 100% with Anna. We actually see a few of these every year. The only thing that I would say is that variant Jk(a) antigens are few and far between, and usually result in considerable weakening of the Jk(a) antigen. In this case, your results point to a normal expression of the antigen. kmmoton and L106 2 Link to comment Share on other sites More sharing options...
Malcolm Needs ☆ Posted April 15, 2014 Share Posted April 15, 2014 The reason that Jk(a) variants tend to weaken the antigen expression is because of the way the amino acid residue that produces the antigen is very close to the red cell membrane and is"semi-hidden" by the third external loop (see the attached diagram).Kidd Molecule.ppt L106, Sandy L, mpmiola and 5 others 8 Link to comment Share on other sites More sharing options...
kmmoton Posted April 15, 2014 Author Share Posted April 15, 2014 (edited) My next question is would an elution be necessary to call this an auto Anti-Jka?? By the way, you guys are awesome with your answers! Edited April 15, 2014 by kmmoton Link to comment Share on other sites More sharing options...
Malcolm Needs ☆ Posted April 15, 2014 Share Posted April 15, 2014 Yes, is the simple answer kmmoton, but be careful. As you are no doubt aware, anti-Jka can be extremely labile, and will find any excuse not to play by the rules!!!!!!!!!!!!!!!!!!!! PammyDQ 1 Link to comment Share on other sites More sharing options...
Dr. Pepper Posted April 15, 2014 Share Posted April 15, 2014 We had a patient years ago with a clearcut anti-Jka + E in serum and eluate. Kind of looked like a delayed rxn at first, but he was 33 with no history of transfusion and the antigen typings were pretty strongly positive. I don't think steroids helped him much; after a week or two they took his spleen out. Link to comment Share on other sites More sharing options...
kteka Posted May 9, 2014 Share Posted May 9, 2014 The patient has a syngen graft (HSCT: Febr. 2011.). She has now an auto-anti-Jka with differential absorption. The DAT is 4+ (covered with IgG, C3d). The Jka antigen typing is 3+ (with monoclonal reagent), Jkb antigen negativ. The patient hasn't been transfused within 3 months.What would you advise if the patient need to be transfused? Link to comment Share on other sites More sharing options...
Malcolm Needs ☆ Posted May 9, 2014 Share Posted May 9, 2014 I would not hesitate to give Jk(a+b-) blood, but, given that the Jk( antigen is not particularly immunogenic, I would also not hesitate to give Jk(a+b+) or Jk(a-b+) blood. I think the clue is in the fact that your patient has an auto-anti-Jka, has (by now) 100% Jk(a+b-) red cells in his or her circulation, but has not required a transfusion for 3 months. In other words, Jk(a+b-) red cells seem to survive quite nicely in their circulation! Link to comment Share on other sites More sharing options...
galvania Posted May 10, 2014 Share Posted May 10, 2014 Sorry to be thick - what is a syngen graft? BankerGirl 1 Link to comment Share on other sites More sharing options...
kteka Posted May 10, 2014 Share Posted May 10, 2014 The donor is her identical twin. Link to comment Share on other sites More sharing options...
galvania Posted May 12, 2014 Share Posted May 12, 2014 Thank you. Anna Link to comment Share on other sites More sharing options...
jojo808 Posted May 22, 2014 Share Posted May 22, 2014 With a completely negative DAT would you find anything in an elution?? Link to comment Share on other sites More sharing options...
Malcolm Needs ☆ Posted May 22, 2014 Share Posted May 22, 2014 You could do, although this is not a given. Link to comment Share on other sites More sharing options...
jojo808 Posted May 22, 2014 Share Posted May 22, 2014 Thanks Malcolm Link to comment Share on other sites More sharing options...
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