Sorry for the novel! I have an odd case that I wanted some input on.
Patient History: 66 year old female with CMML. A Pos, with a negative antibody screen, no history of clinically significant antibodies. Has HLA antibodies that have never been detected in our IgG antibody screen testing, but cause her to be refractory to random platelet transfusions. Has been getting HLA-matched platelets. She has received 9 RBCs and 24 apheresis PLTs over the month of September.
Transfusion Reaction: The patient received 1 O Pos HLA-matched apheresis platelet (Anti-A titer <1:200) on 8/29/16 at 1100, and 1 electronically compatible A Pos PCLR right after the platelet was done infusing. After the RBC infusion, the patient developed chills/rigors, flushing, and felt tired and "out of it" according to the RN. Her temperature had increased >2 degrees F, so a transfusion reaction investigation was initiated.
Clerical Check OK Gram stain on both the RBC and PLT were negative. Cultures from both are still pending. Post-Rxn Sample: ABO/Rh = A Pos Poly (IgG/C3) DAT = 1+ Positive Mono IgG DAT = 2+ Positive Mono C3 DAT = 1+ Positive Aby Screen = Negative Plasma color = slightly darker than Pre-Rxn sample, but not visably hemolyzed Pre-Rxn Sample: Poly (IgG/C3) DAT = Negative Aby Screen = Negative Gel/AHG XM of transfused RBC with Pre- and Post-Rxn samples = Negative/Compatible RBC unit DAT = Negative So, we obviously decided to perform an eluate on the post-reaction sample. The eluate was tested against screen cells, A1 cells, B cells, and panel cells, and showed no reactivity. Questioning the original eluate, we performed an eluate on a new post-reaction sample the next morning (8/30), and got the same results.
We decided to try running both eluates against the transfused RBC and the patient's own cells from the pre-reaction (DAT negative) sample. The eluate did not react with the transfused RBC, but reacted 1+ with the patient's Pre-Rxn sample.
How the heck do I explain this!?
Doing an informal survey for anyone willing to contribute. If you're willing to respond but not in the thread itself, please feel free to message me.
When do you perform an elution? (e.g. all positive DATs, all positive DATS within 3 months of transfusion, IgG positive only) What method is utilized for the elution? What method is utilized for testing the eluate? How is the eluate tested? (e.g. screening cells, full panel, specially selected cells) Feel free to mention any special notes/criteria for which I may not have though to ask. Thanks in advance to all participants!
We have a patient who received many units of group/type specific red cells in Jan. of this year. At that time, his antibody screen was negative. His group and type is A, Rh positive using monoclonal typing reagents. The anti-D reactions have been 2+ and 3+.
His current specimen shows an anti-E in the plasma and a panagglutinin in the eluate tested in gel, with stronger reactions in the D+ cells. His eluate tested in tube shows a clear anti-D pattern.
Could this be a D variant? Auto-anti-D? Should he get Rh negative red cells?