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yaya

5 months with all positive tests!

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A 5 months pediatric specimen received and these are the results obtained :

‘forward and reverse blood grouping are 4+ reaction including Rh and ctrl  (using ortho cards on autovue )

antibody screening and identification all cells are 4+ reaction  (using ortho cards on autovue )

‘antibody identification 4+ using bio rad cards

DCT 4+ with IgG specificity 

no history of transfusions ! 

Medication ( not clear but suspecting steroids )

hgb 6g/dL

I will appreciate any help or suggestions 

Forgive my poor English 😔

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So you have a forward group that is positive with anti-A, -B, -AB, -D and the control; and the reverse group is positive in all cells and the antibody screen and panel (and, I imagine the auto control) is positive in everything.  It sounds as though you do not have a single negative result.

This sounds to me like a cold AIHA, possibly due to medication, possibly secondary to another hematological disease (leukaemia?), possibly post infection.

 

Do you have any other clinical information you can give us?

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Have you tried any other methods for your testing? Perhaps try running your sample using tube reagents. I have worked in a pediatric facility for more than 20 years and find that sometimes going back to basics is a good place to start.

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thanx galvania and milkmaid for you reply .

yes i did try it with tube but it is given almost the same results 

is IgG coating cells possible to occur with cold AIHA  and is it possible for 5 months newborn to have auto immune?

unfortunately no history is available for this patient !

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Most certainly IgG can coat red cells at low temperatures, perhaps the best (or most famous) example being IgG anti-P, the so-called Donath-Landsteiner antibody.

In addition, babies will start producing low levels of IgG from birth, but, normally, this is only detectable from 3 months of life.  BUT, never forget that such things are the "norm".  Some babies will have IgG antibodies only detectable well after three months of life, and some before three months of life.  In addition, do not forget that, in some cases, their will be maternal IgG in the circulation of some babies, not necessarily with a blood group specificity.

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Along with anti-P1 you might want to look at the possibility of polyagglutination (if you are using human derived antisera not monoclonal) especially if the patient has bacterial infection which can cause T, Tk, Th, Tx,  acquired B, and/or VA polyagglutination.  There are also inherited and nonmicrobial associated polyagglutination as well.  I would try testing with washed patient cells and donor plasma.  The Blood Bank Guy has a good blog on it:  http://bbguy.blogspot.com/2011/03/perils-of-polyagglutination.html

Either way you will most likely have to send this testing out if you are not in an immunohematology reference lab.

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On 5/25/2018 at 10:09 PM, yaya said:

A 5 months pediatric specimen received and these are the results obtained :

‘forward and reverse blood grouping are 4+ reaction including Rh and ctrl  (using ortho cards on autovue )

antibody screening and identification all cells are 4+ reaction  (using ortho cards on autovue )

‘antibody identification 4+ using bio rad cards

DCT 4+ with IgG specificity 

no history of transfusions ! 

Medication ( not clear but suspecting steroids )

hgb 6g/dL

I will appreciate any help or suggestions 

Forgive my poor English 😔

Looking at this kid's clinical information may be a good start. What is the diagnostics? is the kid actively hemolyzed? What is the medication history? 

did you try washing this patient's cells with warm saline and try ABO/D typing with warm-washed cells? That is feasible to do in hospital lab. I would even try using DTT if you have some in-house. 

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