hello everybody!

i would like to know, how do you evaluate an antibody that reacts with I, II and III screening cells, no especifity determinated with panel (all positive 2+)?

this case, doesn´t present a history of transfusion or pregnacy. he is a candidate for renal transplantation donor.

what is your regular work flow in this cases???

What is the patient's auto contol or DAT result?

Auto control and DAT negative!

hello everybody!

i would like to know, how do you evaluate an antibody that reacts with I, II and III screening cells, no especifity determinated with panel (all positive 2+)?

this case, doesn´t present a history of transfusion or pregnacy. he is a candidate for renal transplantation donor.

what is your regular work flow in this cases???

What ABO/Rh group is the patient? Did you crossmatch units and were they incompatible? Is this IgG or IgM antibody?

Possibilities off top of my head - Anti-H or IH in A, B or AB pt, antibody to preservative in screening cells (try with washed cells), high incidence antibody (what is patient negative for).

Did you try a different testing method such as LISS?

Try the Coombs crossmatch first. If it is incompatible, definitely check for cold reactive and high frequency antibodies as well as trying a different enhancement medium. If it is compatible, the antibody could be against a preservative in the reagent cells. Was there any problem with the back type?

Just a minor technical point. In this case it is very important that the autocontrol is performed in exactly the same way as the screen and ID panel. By that, I ,ean that the patient cells must be washed in exactly the same diluent as the panel cells. If not, you can really end up in a tangle. As commented by Bshepherd, you can see antibodies behave like that are reacting to diluent components (commonly antibiotics). If you make the autocontrol cell suspension in saline or buffered saline you can miss these and be confused.

A few other suggestions:

Test cord cells - looking for lack of I (big I) reactivity

Try changing temperature. What are the RT reactions?

Remove LISS from the testing process. Try a 4 drop 30 minute saline -> IAT screen with no LISS additive.

Likely to be an anti-I or HI but there are a few other possibilities like an antibody to high incidence antibodies.

Far fetched, but the patient is not an Oh (Bombay or Para-Bombay)???

PS. And a few other things.

If he is a renal transplant candidate he is likely to be on dialysis. It is not uncommon for dialysis patients to make alloantibodies from dialysis and they also are transfusion recipients.

It is also worth making sure the sample was collected properly and not form a site near an IV line with a colloid or other high Molecular weight infusion.

If the patient BG look like O pos or Neg and the Ab screen pos in all phases, I would think that the patient has antibody to high prevalence such as Anti-H in bumpy blood group or Anti-HI, Anti-I, Anti-Vel, Anti-Tja etc….

Send it to Malcolm! (Could make a mess of his TATs though)

JohnT

who is Malcolm and what do you mean by TATs?

Are you talking to me?

Abid

My apologies for being flippant - I was referring to one of the gurus on this site, Malcolm Needs at the National Blood Service in the UK. There was a discussion on another thread about turn round times (TAT) and my inference was that sending your sample to him would adversely affect his laboratory's performance in light of the great distance between you.

Once again my apologies for hi-jacking your thread with a flippant post.

JohnT:redface:

Thank you very much JohnT!!!!!!!!!!!!!!

:rolleyes::rolleyes:

I agree with TimOz, but I would also say that there is a possibility that the patient may have made an anti-N that is strong enough to react with the 'N' antigen.

Several years ago, there was a spate of patients that had been on renal dialysis who made just such an antibody. It turned out that the fluid used to clean the dialysis machines, if it was not thoroughly removed from the machine afterwards was reacting with the red cells in such a way as to expose more of the N and 'N' antigens, and so the patients were producing this very strong (apparent allo, but actually auto) anti-N.

The practice of using this cleaner (or of using the cleaner without thorough rinsing afterwards) is supposed to have stopped, but we do still see extremely rare cases.

It's an unlikely answer, but should be borne in mind, just in case.

:confused:

There is a good paper in Transfusion Vol 29 August 2009 pp 1540 - 1545 entitled:

How do we evaluate panagglutinating sera.

Might be helpful

I usually ask my techs to run a tube panel if this is happening on gel. If it still reacts, we do a DAT and auto and if those are negative, it depends on the patient's situation. If we have time, we send it our reference lab, if not I try to start full crossmatching to find least incompatible while it is being worked on at the reference lab.