Female patient unknown transfusion history with mycoplasma pneumoniae what exclusions and further testing would you perform ?
When would you perform a titre ? Reactions greater than 3+. If emergency units required with titre greater than 64 what is your protocol ?
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!?
I feel like I was just struck by a blinding flash of the obvious with a little dash of "we've always done it that way."
When we do an elution, we perform an antibody screen with the eluate and the last wash, and an antibody ID panel for positives (or selected cells in rare cases when a lower incidence antibody is considered).
86860 is to cover the process that makes the elution; are we completely failing to charge for the additional antibody screen and antibody ID?