We had a dialysis patient this morning with a positive antibody screen and a negative panel except that auto control was positive. The DAT was positive with the polyspecifc reagent and anti-IgG but negative with complement.

My co-worker mentioned that 'back when we did auto-controls on everybody' that we frequently saw positive autos with dialysis patients. I've never heard of this. Has anyone else? If so, what is the cause?

Thanks!

Well, there are two possibilities that are comparatively common.

 

The first is that the patient has a positive DAT for no particular reason, as do a certain number of healthy donors, in whose circulation red cells exist normally, with no shortening of the normal life span.

 

The other is that the dialysis machine has been cleaned/sterilised by the use of formaldehyde, where they can make anti-Nf, but I doubt this one, as the effect has been known about now for about 44 years, and the antibody is not normally an auto-antibody (so you would not expect a positive DAT) and it is usually not active above about 20^oC, but it remains a possibility.

 

I'm certain that others will have better answers to your query.

My guess would be either (if you are working in gel):

The antibody screen was not really positive, just fibrin or some other plasma protein interfering

OR A slight difference in method meaning your temperatures were not identical between the panel and the screen

OR A different cell buffer screening cells and panel cells (different manufacturer) with an anti-buffer

As for the pos DAT, if he hasn't had any blood recently either drug-related or, as Malcolm says, pos for no particular reason....

In our hospital I have noticed that dialysis patients and patients with renal disorders seems to have positive DATs and autocontrols (not all!). I haven't found any research about connections between renal disorder, positive DAT and autoantibodies (panagglutinin). Can this be drug-related? If anyone have more information about this topic I'll be happy to learn.

I've seen it when Methyldopa is used to reduce hypertension in chronic renal failure - it's reported that 10=20% of patients will develop a positive DCT

Long ago and far away ... when methyldopa was routinely used to treat hypertension we saw positive DATs fairly often. It is used fairly commonly now to treat OB patients with hypertension. I've seen a few positive DATs in that population that seem likely to have been drug related.

I had discussed this with a renal doctor, he said it is maybe because some renal disease is caused by  immunologic disorder.

I'm topping this, does anyone have any sources regarding this topic? Have there been any research about connection between renal patients and panagglutinin or is the information based on experiences only? 

7 minutes ago, KatarinaN said:

I'm topping this, does anyone have any sources regarding this topic? Have there been any research about connection between renal patients and panagglutinin or is the information based on experiences only? 

And one more question..

Could it be AGE that is causing this? (advansed glycosylation end-products) Though one research says that AGE is in serum. How about in plasma? Any experiences?