Jump to content
Lingkwyz

The Kidds

Recommended Posts

What would your approach be or your "gameplan" on dealing with a possible Kidd antibody?

My experience recently:

27 YO Female

B Pos

DAT: Neg AC: Neg

Rh Phenotype: R2r K=

Kidd Phenotype: Jk (a+b=)

 

Solid Phase:

Screen Pos (3 pos grade Jkb + cell)

Antibody Identification: Pos to multiple cells (pointing to Jk b exhibiting dosage phenomenon on some hetero Jkb cells)

 

Gel Card Method:

Screen and Antibody Panel Negative to both regular and enzyme-treated Cells. Autocontrol Negative.

 

Tube Method:

Negative to Screen 3 (Panocell 3).

-Sample QNS for further testing.

Share this post


Link to post
Share on other sites


1.  Test in gel with enzyme treated red cells on Coombs, with 15mins incubation at 37°C.  If that is negative I would suspect a false pos in your solid phase due to parabens.

2.  Check to see whether this patient has ever been transfused or pregnant before.  If not, then confirms that she can't have an anti-Jkb

Share this post


Link to post
Share on other sites

1.  Do you run enzyme treated cells on Poly/Coombs? Our SOP only allows us to run enzyme treated cells on neutral.              

  -I did try to test the patient's plasma with regular cells on Coombs/Poly cards, they were negative.          -(if weak pos, it would be very faint for my eyes.)

 

2. No history taken since the patient was an "out-patient", sorry.

 

 

 

Edited by Lingkwyz

Share this post


Link to post
Share on other sites

You probably know this already, but literature and texts tend to see techniques such as a gel or solid-phase a bit too sensitive.  To the point where you may pick something up that is just not going to be clinically significant.  You did an enzyme method that was negative--it seems like if anti-Jkb was present in any significant amount you should have seen a positive reaction there.

Having said that, at our lab in a situation like this, we would probably call our reference lab for advice, as they would be the ones we would have do further testing anyway.

Scott

Edited by SMILLER

Share this post


Link to post
Share on other sites
2 hours ago, SMILLER said:

You probably know this already, but literature and texts tend to see techniques such as a gel or solid-phase a bit too sensitive.  To the point where you may pick something up that is just not going to be clinically significant.  You did an enzyme method that was negative--it seems like if anti-Jkb was present in any significant amount you should have seen a positive reaction there.

Having said that, at our lab in a situation like this, we would probably call our reference lab for advice, as they would be the ones we would have do further testing anyway.

Scott

I see this as a current dilemma in our lab since our "seniors" are too fond of the "Nonspecific Reaction" dump. And, if you have read my previous post tilted: "Missing Plasma Protocol", we have faced a patient who had a transfusion reaction which apparently had Anti-Jka but was misdiagnosed as a Nonspecific reaction. I would want to ask for ideas so I could ,at least, evade this problem.

 

Thanks Smiller.

Share this post


Link to post
Share on other sites

I believe the Kidds are known to react best using PeG.  You didn't indicate what enhancement you used in tube.

Share this post


Link to post
Share on other sites
17 hours ago, jnadeau said:

I believe the Kidds are known to react best using PeG.  You didn't indicate what enhancement you used in tube.

The enhancement possible for us was LISS. That's it. 

So you mean PEG would be the best to use dealing with Kidd antibodies?

Share this post


Link to post
Share on other sites

My game plan with the kidds is to honor what antibody I think I see (assuming it agrees with their phenotype). Because titers with kidds are notorious for falling quickly, and their transfusion reactions can be particularly unpleasant, I always think its better to be safe than sorry.

 

Share this post


Link to post
Share on other sites
20 hours ago, jmphil4 said:

My game plan with the kidds is to honor what antibody I think I see (assuming it agrees with their phenotype). Because titers with kidds are notorious for falling quickly, and their transfusion reactions can be particularly unpleasant, I always think its better to be safe than sorry.

 

 

19 hours ago, AMcCord said:

Better safe than sorry is my game plan, too.

What I'm getting at your suggestions is that; if the patient has this "Non-specific Reactions", I must assure myself that neither of the Kidd antigens are negative, which means, all "Nonspecific Reactions" must be antigen typed for Kidd. 

Am I getting it right guys?

Share this post


Link to post
Share on other sites

I wouldn't suggest that with all non-specific reactions. Just if you get an impression that there might be a kidd, it's better to error on the side of caution. I've certainly called my fair share of unknown/non-specific reactions. I've seen several antibodies who don't react even with all of the homozygous expressions. Honestly, sometimes its not much more than your blood bank "spidey-sense" that leads you to the antibody ID, when you would have been completely correct (per SOPs) to call something unknown.

Share this post


Link to post
Share on other sites

Not all 'nonspecific reactions' must be antigen typed for Kidd antigens. Evaluate the reactions you see - what do they have in common? Are the reactions occurring where a Kidd antigen is present, especially where it is expressed as a double dose (example: Jka+Jkb-) and not occurring where Kidd antigens are not present. Are the single dose cells (example: Jka+Jkb+) not reacting - which could be the case with an antibody that has a low titer. Keep in mind that some antigen positive cells may not react with an antibody with a low titer, even the double dose cells may not react. If this is what you see, and it looks anti-Jka-ish or anti-Jkb-ish, I would antigen type the patient for the appropriate Kidd antigen.

Evaluate your reactions in this way for any antibody that can show dosage, not just potential Jk antibodies, though they are notorious for behaving this way and notorious for causing delayed reactions. You might also see this sort of behavior with newly forming antibodies whose titers are just starting to rise.

Edited by AMcCord
additional info

Share this post


Link to post
Share on other sites

I agree with the above.  Non-specific reactions of any kind cannot be ignored out of hand.  You must be careful as with everything in the Lab.  Any set of non-specific reactions could indicate an emerging antibody as someone mentioned above.  That is why we end up doing an AHG crossmatch when we have such patients, even though there are no other specific allo-antibodies present.

Scott

 

Share this post


Link to post
Share on other sites
1 hour ago, AMcCord said:

Keep in mind that some antigen positive cells may not react with an antibody with a low titer, even the double dose cells may not react. If this is what you see, and it looks anti-Jka-ish or anti-Jkb-ish, I would antigen type the patient for the appropriate Kidd antigen.

I could not agree more.

You will see in many text books that there are 14, 000 Kidd antigens per red cell, BUT, if you read around, this is a mean number, with some workers finding as many as 32, 000 antigen sites per red cell, while others as few as 7, 000 antigen sites per red cell.  Now, all of these are "estimates" and, of course, it also depends upon the expression of the Kidd antigens (or any other antigens, come to that) of the individual being studied.

Let us think for the minute, therefore, about the red cells represented on any antibody identification panel.  They will be, to all intents and purposes, representative of the general population (save for the fact that they are often selected because they express homozygosity for many antigens, and because they complement the other red cells represented in the panel, so that the panel is "useful") and so some of the red cells will express the Kidd antigens at the higher end of the scale, and some at the lower end of the scale.  Those at the lower end of the scale are those about which AMcCord is talking (I think!).

Share this post


Link to post
Share on other sites

I will try to collate all your inputs in one word: "PRAGMATISM".

I would rather say that as I learn from you guys, I always bump back into this word. Well.. wait! Hold your horses.. I might get a double-dosed sermon with this, but let me try to explain further:

Although there are SOPs, AABB Methods, Guidelines, PPs, (Policies and Procedures), I could only imagine how you do your stuff in the field we all love. Its that: "Hold my beer, I got this!" moment that really starts it all, then comes the protocol for Kidd, or the necessity of  enhancement techniques or the pesky procedures for adsorptions.

If I may quote Malcolm's reply on one of my started  threads:

 

On 07/07/2016 at 10:15 AM, Malcolm Needs said:

Yes, I can see from where you are coming.  It can be so difficult on occasions (which is why I have always maintained that we should be paid our worth)!!!!!!!!!!!!!

The "worth" this great person might be pertaining to is that: Wait-a-minute.. I-know-this-antibody-moment, or the "Oh I see you Mister antibody.." moment plus the eureka dance..:P

Though its  the science is what brings us together, I just love the way you how share your approach and "hunches" to our field. I might be too premature to this field myself. I need to develop that 3rd eye. That  stare to the antigram that looks beyond to the pluses and minuses. Nevertheless, I learned a lot from all of you guys.:)

Edited by Lingkwyz

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now

  • Advertisement

×

Important Information

We have placed cookies on your device to help make this website better. You can adjust your cookie settings, otherwise we'll assume you're okay to continue.