lacs

Hi Malcolm, We wouldn't be able to elute if off if WAA is IgA, would we?

Thank-you Malcolm, I am sticking to that theory also since we ruled out ITP, passive antibody and D variant.

Hi Malcolm, What about the D pattern after adsorption with D- cells then? It comes and goes.

Hi Malcolm, I don't have the exact info, but we use Immucor AHG, IgG and C3 for all WAA workups

Multi-racial patient in May 2011 APOS, R1rK-Fya-Jkb-S-, reacting with all cells, including auto, and reacting stronger w/D+ cells. Eluate pan-reactive w/all screen cells in tube. Patient’s DAT negative reactive w/eluate and plasma=WAA D typing w/BioClone 4+ IS; 3+ W/Immucor/Gamma Adsorption w/Rh- cells left behind D Panel against Cord cells (to rule out LW)-negative DTT treatment of red cells against adsorbed plasma–stayed positive-true D. Aug 2011, reactions match a typical WAA exactly. Removed w/Rh+, pheno-similar Sept 14 workup- Looks like a warm. Adsorbed against Rh looks like anti-E and D, Lua left behind. Is this WAA w/D-variant? Anti-LW or WAA w/D, E and Lua? Why was D disappearing w/2nd workup? Patient is Rh+

Thank-you Malcolm. This was the first for us too. Fortunately, she's doing ok now. If transfusion is really necessary, she'll received R2R2 K- units next time...... lacs

We ran the post sample with an untreated panel and ficin-treated panel; everything was negative. We also ran against a few low freq. antigen; result was negative.

We crossmatched the post transfusion samples with crossmatch units. Everything was NEGATIVE.

She's OPOS R2R2 K-Fya-Jkb-S- and has a hx of anti-C and e (id'd somewhere else). From what we can tell, hx was not avail. until after she'd been transfused with random units. Doctor ruled out other conditions. She came from a hospital so we did not have the Hh at prev. discharge or Haptoglobin result. We did find an article dated 1985? about DHTR that could only be detected by Cr study. I don't have it to elaborate right now. I was just wondering if anyone else experienced the same/similar thing.

Hi Malcom, This is what I have on the patient 44 yo Hispanic lady. History of Gyn bleeding, iron deficiency, past transfusions and “transfusion reaction”. Treated at the hospital last month for GI bleeding; Negative screen and DAT, transfused with 4(!) Units. Had appropriate response, normal labs, short episode of fever, but discharged. Returned to the hospital ER last night (~9/2) with hematuria/flank pain, no fever. Hemoglobin at 8.5, indirect bili is >6 (icteric serum). T&S still negative, DAT still negative. more work done. Thanks, lacs Cold Antibody screen- neg at RT and 18 degree C Post sample Repeat DAT- IgG neg C3d neg at 5 mins Post sample Gel antibody screen neg on Pre and Post samples Pre sample- serum normal color 8-25-11 Post sample- serum icteric and hemolysed 8-31-11

Has anyone seen a DHTR with negative results after transfusion? That includes DAT, AB screen with untreated and treated cells, eluate, autocontrol... Her clinical information screams DHTR but we could not find anything anywhere

We've had the same issue on and off too.

Never mind, I read it again and I got it.....................

If, originally, there was only an anti-G present, the r'r red cells will not react with the plasma adsorbed with the Ro red cells, and the Ro red cells will not react with the plasma adsorbed with the r'r red cells. Malcom, Maybe I am over-reading your post or I am too sleepy to understand (since it's midnight now:), I am a bit confused about your paragraph above. I learned that G is present on most C+ and some D+ red cells, so your adsorbed plasma from Ro adsorption, if contains anti-G SHOULD react with r'r (dCe/dce) red cells AND plasma adsorbed w/r'r red cells (if has anti-G) would react w/Ro (Dce/Dce) red cells, correct? Maybe it's the terms that confused me. When you say plasma adsorbed with etc, did you mean what's left behind (vs what's pulled out)????

At issue for us means when they are ready to leave our facility. We do pH QC on plateletpheresis monthly but not at issue. It's the hospital's responsibility to pH them.

We used to assign tasks equally to every one, including reviews since we have soooo many. Now we have someone to take care of the reviews and QC investigations, validations. Maintenance is still split up and we have a deadline for each. Our problem is to motivate a couple of techs and to keep OT under control.

I am assuming you're talking about platelet concentrate. We only test count on QC batch-2 batches of 10/ month but we pH every single one at issue.

Hi all, I know pros and cons for both equipment above but I still want to hear some inputs. Which have you used and which would you really prefer? Please tell me your overall experience. Thanks for all your help, lacs

Sounds like we are on the same page as far as sample handling:)

Our Ref lab uses 3 # media. After running enough tests and if we determine if it's not significant, we back away from the most sensitive method. If everything is ruled out but specificity can't be determined, we send xm compatible units, using (usually) most sensitive method.

We use BBCS for our transfusion and Ref lab extensively. Let me know if you have any other questions

Thanks Angela. I think it's redundant too but it states in the technical manual. I think I'll just note to run that only if all Coombs results are positive, even if the DAT is negative.

to run in parallel with EGA-treated cells when antigen typing red cells post EGA treatment as a control. I forgot the reason for doing this. Could someone remind me? I thought it's to check for polyagglutination when your treated cells expose to anti-T? but we're running this against manufactured antisera and not against patient serum (which has anti-T)....

Thank you David and Malcolm. I think I got threw off b/c we adsorbed w/E- cells and normally ones w/specificity would be removed anyways but your explanation made sense. I did read it somewhere too:)

We have a patient with a warm-reactive auto and after adsorption, it reacts with all E+ but the patient is typed E+ (strong). Any thoughts on this?