Case Study

[jmm8427]

We have a troublesome patient that came in again, history of warm auto a few years ago, cold autoantibody and an antibody of undetermined (reacts majority of cells).  

 

What do you think: majority of cells reacting in gel (about 1-2 were negative; strength of reactions 1-2+) with positive autocontrol, No reactivity with PeG except autocontrol is 1+, 1-2+ reactions at room temp and 3-4+ reactions at 4C.  A cold auto-I was identified based on the 4C/RT reactivity and cord testing.  Ficin testing panel was negative (including autocontrol), DTT panel was reactive still.  Neutralization testing was performed but cells were still reactive.  A cold autoadsorption didn't work.  A RESt adsorption was performed but still had partial reactivity.  The plasma reactivity was able to be adsorbed out this time with allogeneic cells.  The DAT was positive, no transfusion in last 3 months.  The eluate was non-reactive.  EGA treated cells were negative when tested with the plasma/PeG,

 

Do you think the reactivity is due to autoantibody or is it an alloantibody?    We don't think the warm auto is back but we weren't quite sure to make of all the gel reactivity and weren't quite sure what to do next, if anything.  Thoughts?

 

Thanks for the help!  

 

 

[Dansket]

Have you crossmatched any random units using your routine crossmatch method?

[Malcolm Needs ☆]

As the antibody appears not to react with enzyme-treated red cells, I am just wondering if you have an auto-anti-Pr, rather than an auto-anti-I, the reactions of which should be enhanced by the use of enzyme treated red cells.

[jmm8427]

Thank you both!  No, we didn't crossmatch any units but I will see what that does.  And I didn't think of Pr! Out of the lab today but I'll give it a second look, thank you!

[Yanxia]

jimm8427,you say this patient's DAT is pos, is it IgG,C3or IgM?

1.From your post, DTT treat not work ,I think there is IgG antibodies in plasma.

2.The differ between gel and PeG , I prefer think it is sensitivity ,because gel reaction is 1+-2+, not strong, maybe this antibody is gel sensitive.

3.You say you have proved anti-I in plasma, so the room and 4C reaction  can be proven.

4.I can't understand the  cold autoadsorption and  neutralization testing didn't work, maybe your meaning is the reaction is weaken but still exist.

5.The plasma reactivity was able to be adsorbed out with allogeneic cells,so it is allo antibodies.

Infer from the above, I think there is IgG alloantibodies in the plasma, because Ficin testing panel was neg,especially the auto is neg, the antigens is ficin sensitive.

As for the elution is neg, I think it depends on the DAT specificity.

Just personal thought .

[Yanxia]

I searched about the ficin sensitive high frequency antigens, there are Dib, Vel,Sc,Cromer, Knops and Kell.

If you have the reagent,you can test the patient first, to see what kind of high frequency antigen he lack .

Edited July 30, 2014 by shily

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Edited June 3, 2015 by RollSlow10