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alloantibody and mimicking antibody


Carina

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What is the possible cause?

 

Patient has a known history of anti -E, always receiving  crossmatch compatible E negative RBCs. Patient's phenotype is E negative. However anti -E is eluted from the red cells. I have seen at least three different patients with known anti -E with episodes of anti -E eluted from the red cells. The most recent patient is known K,  also having episodes of K in the eluate.

 

  - the antibodies in the plasma E or K are strong 2+ reactive, no possible to miss in the crossmatch. We do full gel crossmatch

-the donor units are phenotyped both in the donor center and then again prior to crossmatch in transfusion center.

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Hi Carina,

 

The cause is almost certainly a "naturally occurring" (no such thing of course) low level auto-antibody, one mimicking an anti-E and the other mimicking anti-K.

 

I was aware of auto-antibodies mimicking anti-E, but it wasn't until Joyce Poole told me that I became aware of an auto-antibody mimicking an anti-K - I then I found one myself!

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Thank you Malcolm for the quick reply.

I was thinking that as well, but not sure how to prove the case. The patient's surely have alloanti -E or -K as well, for these were known long before the eluate showed the antibody specificity.

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Wash solutions used with some elution kits can cause 'non-specific' uptake of Ig, on to red cells, which can include any alloantibodies that are present. From what I've experienced, anti-K seems to be one of the more commoner specificities affected by this phenomenon. If you did us a kit, for the elution, it would be worth checking the pack insert to see if this is a possibility. An alternative protocol might be given, so it might be worth repeating the elutions.

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