Last week I worked up an elderly man with no history of transfusions; results as follow:

Via MTS gel method: 3+ reactions on the 3 cell screen and all 11 cell panel cells and patient autocontrol.

Via tube method: DAT 1+ with both anti-IgG and anti-C3BC3d

Gamma Elukit 2/Tube method: Eluate: 3+ reactive with 3 cell screen and with 12 panel cells.

Compatability with IgG gel crossmatches with partial phenotype matched units: COMPATIBLE x 4 units!

:confused: Any ideas?

What's your patient's blood type? Diagnosis? Meds?

He's age 93, O+, current diagnosis is renal failure and anemia. None of the meds are atypical, insulin, claritin, lopressor, synthroid, tylenol, etc. The only unusual Rx is Flutamide, which I looked up to see it's for prostate Ca, however that is not listed in his dx. He took it in 2008 and again now.

He has no laboratory evidence of hemolysis.

Last week I worked up an elderly man with no history of transfusions; results as follow:

Via MTS gel method: 3+ reactions on the 3 cell screen and all 11 cell panel cells and patient autocontrol.

Via tube method: DAT 1+ with both anti-IgG and anti-C3BC3d

Gamma Elukit 2/Tube method: Eluate: 3+ reactive with 3 cell screen and with 12 panel cells.

Compatability with IgG gel crossmatches with partial phenotype matched units: COMPATIBLE x 4 units!

:confused: Any ideas?

I must admit that I am more than a little surprised that you were able to obtain compatible blood via the gel technique, given that your antibody screen and panel were all positive.

We often find (in about 33% of the WAIHA cases sent in by our hospitals) that we can get compatible blood by use of the LISS tube IAT. This is because the gel technology is very good at detecting "cold" auto-antibodies of wide thermal range, and the fact that it is sooooooooo much more sensitive than the LISS tube IAT, although the LISS tube IAT is quite sensitive enough to detect clinically significant alloantibodies.

I have no explanation of ryour findings in the last sentence (except to say that, in such a situation, we would always give Rh and K matched blood, as a matter of course).

:confused::confused:

I must admit that I am more than a little surprised that you were able to obtain compatible blood via the gel technique, given that your antibody screen and panel were all positive.

Yes Malcolm, this is the conundrum! As I did the initial workup and the next shift did the crossmatches, we repeated it right away, and there's no question, they are perfectly compatable in gel.

I was thinking perhaps a drug induced warm auto that is non-reactive with cells not coated with that drug, but his med list isn't really great for that theory.

I agree....The compatible gel crossmatches don't make sense. I would be interested to see what kind of reactions/pattern you would get with a PeG tube technique panel.

Donna

I was thinking perhaps a drug induced warm auto that is non-reactive with cells not coated with that drug, but his med list isn't really great for that theory.

Yes, I was thinking that. However, the reagent cells we use for screening/paneling in gel have a different antibiotic than the reagent cells we test out eluates with. Still might be 2 processes going on. I'm testing that theory now...

I amy be off the mark here.....but is it possible that the patient has an antibody to the diluent used in prepared red cells?? That would explain why the units were compatible (since the units do not contain the same diluent). We have seen this in the past. The DAT may be another issue all together. What we have done in the past is washed alliquots of our 3% red cells, converted them to a 0.8% solution and then ran them in gel.

~Shaunna:confused:

have you repeated this manually in tubes? pre-washing all the cells used would likely sort out the possible anti-biotic ab if that is the issue....

I amy be off the mark here.....but is it possible that the patient has an antibody to the diluent used in prepared red cells?? That would explain why the units were compatible (since the units do not contain the same diluent). We have seen this in the past. The DAT may be another issue all together. What we have done in the past is washed alliquots of our 3% red cells, converted them to a 0.8% solution and then ran them in gel.

~Shaunna:confused:

Precisely my thoughts, Shaunna!! I "played" with the sample a bit with this in mind, but as I was off yesterday I couldn't report my findings until now.

The Ortho 0.8% Surgiscreen & Resolve panels are suspended in diluent containing Trimethoprim/Sulfamethoxazole. He reacts 2-3+ with these cells.

The Ortho 3% Surgiscreen is suspended in Chloramphenicol/Trimethoprim/Neomycin. I diluted this to 0.8% and tested him again, getting a negative reaction on cells 2 & 3, but on cell 1 it had a topline reaction with most cells at the bottom. I also used these cells to test by tube method, which all 3 were negative at I.S. and IgG, but at 37C he was 1+ reactive on cell 1. That was the end of my shift and I didn't go any further at this point.

I had encountered some specime give 4+ reaction in polybrene morning when it is drown and neg afternoon just the same specimen the same method and another specimen which is drown afternoon. This is strange but it is true.

I've seen patients with funky reactions shortly after they've had imaging procedures with contrast. Once the contrast media clears their system, everything is better again. It can be helpful to ask about what's been going on with the patient prior to specimen draw, including meds given.

Precisely my thoughts, Shaunna!! I "played" with the sample a bit with this in mind, but as I was off yesterday I couldn't report my findings until now.

The Ortho 0.8% Surgiscreen & Resolve panels are suspended in diluent containing Trimethoprim/Sulfamethoxazole. He reacts 2-3+ with these cells.

The Ortho 3% Surgiscreen is suspended in Chloramphenicol/Trimethoprim/Neomycin. I diluted this to 0.8% and tested him again, getting a negative reaction on cells 2 & 3, but on cell 1 it had a topline reaction with most cells at the bottom. I also used these cells to test by tube method, which all 3 were negative at I.S. and IgG, but at 37C he was 1+ reactive on cell 1. That was the end of my shift and I didn't go any further at this point.

Looks like you are are definitely on to something...keep us posted!

I had encountered some specime give 4+ reaction in polybrene morning when it is drown and neg afternoon just the same specimen the same method and another specimen which is drown afternoon. This is strange but it is true.

This could also be due to the administration of such medicines as anti-lymphocyte or anti-granulocyte globulin. Fairly soon after adminstration, the DAT of the patient is often positive, as is the panel, but a few hours later, the DAT is completely negative, as is the panel.

:eek::eek: