David Saikin Posted September 5, 2017 Share Posted September 5, 2017 (edited) Have only done preliminary studies on this but would like any/all opinions. Routine ABORh: front types as group A, Rh(o)D Negative. Reverse group w A1 Cells is 2+/B cells: 4+. Testing is in gel. Had the tech run the pt plasma in buffered gel vs A1, A2, S1, S2, S3 and auto ct. 15 min @ rt. Only the A1 cell reacted 2+. Yes it is the same A1 cell. Pt types 4+ with A1 lectin (controls as anticipated). I do not have a different lot commercial A1 cells. Will find some donor A1s tomorrow. Gel antibody screen is negative with IgG card. Do not know the diagnosis. Open to any/all comments and opinions. Thanks in advance Edited September 5, 2017 by David Saikin left out IgG screen result Link to comment Share on other sites More sharing options...
Yanxia Posted September 6, 2017 Share Posted September 6, 2017 (edited) The reagent A1 cells we used is a combination of three donor cells which produced by the factory.If the reaction with A1 cells is due to low antigens, maybe we can see mixed field reaction. I totally agree with your choice of choosing another A1 cells to do the test. Edited September 6, 2017 by yan xia AuntiS 1 Link to comment Share on other sites More sharing options...
Malcolm Needs ☆ Posted September 6, 2017 Share Posted September 6, 2017 By anti-A1 lectin, I presume you mean Dolichos biflorus (Horse gram)? Whilst I am not for one minute saying that this is the answer, but it has to be remembered that Dol b is by no means specific for the A1 antigen. Not only will it also react with Tn+ red cells and Cad+ red cells, but, unless the lectin is diluted correctly, it will react with the A antigen, rather than just the A1 antigen. In addition, of course, the number of antigen sites varies widely from one individual to another. In an A1 adult, the number of sites can vary from about 810, 000 to 1, 170, 000. If your A1 reverse red cell is derived from an individual towards the higher end of this range, and your Dol b is diluted close to the tipping point where it will react with some (but not all) A2 red cells, this may explain your enigmatic situation (it also may not, of course!). I agree entirely with yan xia that performing the test with another sample of A1 red cells, but I would suggest that testing with a range of A1 samples (say four) would be even better. Yanxia, AuntiS and David Saikin 3 Link to comment Share on other sites More sharing options...
David Saikin Posted September 6, 2017 Author Share Posted September 6, 2017 I planned on finding a few amongst my A red cell inventory. Thanks to both of you - at least it seems I am on the right track . . . we'll see. Malcolm Needs 1 Link to comment Share on other sites More sharing options...
exlimey Posted September 6, 2017 Share Posted September 6, 2017 Passive anti-A from a transfusion ? Possibly from a platelet product ? I agree with testing more group A cells. Link to comment Share on other sites More sharing options...
Malcolm Needs ☆ Posted September 6, 2017 Share Posted September 6, 2017 37 minutes ago, exlimey said: Passive anti-A from a transfusion ? Possibly from a platelet product ? I may be wrong, but would not such anti-A be adsorbed onto the patient's own red cells, and, considering that ABO antigens are histo-antigens, onto the patient's tissue cells? exlimey 1 Link to comment Share on other sites More sharing options...
exlimey Posted September 6, 2017 Share Posted September 6, 2017 9 minutes ago, Malcolm Needs said: I may be wrong, but would not such anti-A be adsorbed onto the patient's own red cells, and, considering that ABO antigens are histo-antigens, onto the patient's tissue cells? Very true and quite possible, especially neutralization by serum antigens. One might even see a positive DAT if the patient's cells sucked-up passive anti-A. On the other hand, a large enough dose of out-of-group platelets might leave some isogglutinins available to mess up the ABO results. Just throwing out ideas. Malcolm Needs 1 Link to comment Share on other sites More sharing options...
galvania Posted September 6, 2017 Share Posted September 6, 2017 I too would go for an antibody outside of the ABO system, active at RT that was present on the original A1 cell. If this A1 cell is from a single donor, that makes it even more likely. As Yan Xia said above, if it's a pool, then you might well see a mixed field. So I would test against (as Malcolm says) at least 4 other A1 cells; and I would test the original A1 cell also at 37°C to see if you are looking at something you need worry about or not exlimey 1 Link to comment Share on other sites More sharing options...
David Saikin Posted September 7, 2017 Author Share Posted September 7, 2017 I ran 3 more A1 cells, one reacted 2+ in buffered gel. Set up a room temp id. All cells negative. I think I am just going to go with an anomalous reverse grouping. But I am open to any other suggestions. Patient is not a transfusion candidate. Link to comment Share on other sites More sharing options...
Yanxia Posted September 8, 2017 Share Posted September 8, 2017 Maybe it is some kind of combined antibody, such as anti-Alea? Link to comment Share on other sites More sharing options...
Malcolm Needs ☆ Posted September 8, 2017 Share Posted September 8, 2017 9 hours ago, yan xia said: Maybe it is some kind of combined antibody, such as anti-Alea? I have heard of anti-ALeb, but not of anti-ALea. I would have thought that, if it was a case of anti-ALeb, it would have reacted with more examples. Link to comment Share on other sites More sharing options...
NicolePCanada Posted September 8, 2017 Share Posted September 8, 2017 What about a room temp Anti-M, have you tried your reverse with M Neg, A1 cells? Link to comment Share on other sites More sharing options...
NicolePCanada Posted September 8, 2017 Share Posted September 8, 2017 Sorry I see you did the Room temp screen and it was negative. Forget my previous comment. Link to comment Share on other sites More sharing options...
Yanxia Posted September 9, 2017 Share Posted September 9, 2017 14 hours ago, Malcolm Needs said: I have heard of anti-ALeb, but not of anti-ALea. I would have thought that, if it was a case of anti-ALeb, it would have reacted with more examples. Sorry, it was my mistake. I am very sorry. Link to comment Share on other sites More sharing options...
Malcolm Needs ☆ Posted September 9, 2017 Share Posted September 9, 2017 Don't be Yanxia. Everybody makes mistakes - me more than most! Yanxia 1 Link to comment Share on other sites More sharing options...
galvania Posted September 11, 2017 Share Posted September 11, 2017 Do your commercial ABO cells come from the same supplier as your screening/panel cells? Link to comment Share on other sites More sharing options...
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