Recently we had 4 patients with WARM AUTO & COLD AUTO Antibodies (all within less than 2 weeks). We perform GEL type & screen and DAT testing, then tube testing (Screens/Panels with LISS and some with out additives) and elutions -all Panagglutination. We did cold absorptions, prewarm, etc . We use to keep RESt and W.A.R.M reagents until they expired, rarely had to use them, now the cost is too high. Our Chloroquine Diphosphate and EGA reagent haven't been replenished either, so we sent specimens to our blood supplier ref. lab to do further testing for alloantibodies, and DNA phenotypes, etc.

We have had 3 out of 4 of these patients who had incompatible crossmatches, so we are giving them antigen negative RBCs and our biological crossmatch procedure. We perform an H/H, DAT, LDH, Tbil, and a UA prior to each transfusion and after the first 50ml of blood transfused. When the patient's blood bank armband expires, we repeat a Type/Screen/Panel/DAT/Crossmatches.

How often do others see WARM & COLD Auto antibodies on patients? What testing do you perform?

Thank you for any help you have offer.

If no Chloroquine Diphosphate on shelf, I will use 45 degree C 15 min to elute the the autocell, then do adsorbtion in 37 degree C 30min, if not complete, then again adsorbtion until the auto reaction ( eluted auto cells to auto plasma reaction )is neg.

Then use the adsorbed plasma to do antibodies testing use cell panel to see if there is any alloantibodies underlying.

To use this method the patient have not transfused with red cells during the pre 3 months, if not, I will use 3 tube Rh cells ( SORRY I forget how to call it, it is R1R1, R2R2and rr cells)to adsorb the plasma.

Recently we had 4 patients with WARM AUTO & COLD AUTO Antibodies (all within less than 2 weeks). We perform GEL type & screen and DAT testing, then tube testing (Screens/Panels with LISS and some with out additives) and elutions -all Panagglutination. We did cold absorptions, prewarm, etc . We use to keep RESt and W.A.R.M reagents until they expired, rarely had to use them, now the cost is too high. Our Chloroquine Diphosphate and EGA reagent haven't been replenished either, so we sent specimens to our blood supplier ref. lab to do further testing for alloantibodies, and DNA phenotypes, etc.

We have had 3 out of 4 of these patients who had incompatible crossmatches, so we are giving them antigen negative RBCs and our biological crossmatch procedure. We perform an H/H, DAT, LDH, Tbil, and a UA prior to each transfusion and after the first 50ml of blood transfused. When the patient's blood bank armband expires, we repeat a Type/Screen/Panel/DAT/Crossmatches.

How often do others see WARM & COLD Auto antibodies on patients? What testing do you perform?

Thank you for any help you have offer.

I must admit that I was quite surprised when I read this post, as genuine mixed warm and cold autoimmune haemolytic anaemia is quite rare. I am not saying for one minute that it would be impossible for you to have four cases in two weeks, just that it would be amazingly rare.

For this kind of AIHA to be diagnosed, there are a huge number of tests that have to be performed, at different temperatures, in different media and after different treatments (such as treatment with 0.01 dithiothreitol).

One has to show that there is a "cold-reacting" wide thermal amplitude (usually) IgM auto-antibody present that is reacting to at least 30oC, and a "warm-reacting" (usually) IgG auto-antibody also present.

This is NOT the same as an individual with AIHA who has a "cold-reacting" IgM auto-antibody that may have a wide thermal amplitude, but which does not react up to, and including, 30oC, and an "warm-reacting" IgG auto-antibody. In this case, the IgM auto-antibody is, for want of a better way of putting it, coincidental.

What I have said above may sound like I am splitting hairs, but, in this particular case anyway, I am not.

The treatment of a patient with a warm AIHA and a coincidental "cold-reacting" auto-antibody is quite different to an individual with a mixed cold and warm auto-immune haemolytic anaemia.

In the former case, it is usual to treat the patient to ameliorate the effects of the IgG auto-antibody, and ignore the IgM auto-antibody, but in the latter, it is usually vital to ameliorate the effects of both auto-antibodies, with the emphasis of treatment of the IgM antibody with steroids.

:whew::whew:

Thank you Malcolm. We also think this was very bizarre. We noticed this appeared as soon as our night temperatures were near freezing, our "cold" patients usually come in and give us extra work during these times...it is going to be a long winter if this keeps up! The WARMs we believe are due to the heart patients on certain drugs &/or disease states. We noted about 5 years ago in the month of January, we had similar issues with three heart patients (not WARM & COLD Autos, but WARM AUTO), one of these patients had a valve issue that caused hemolytic anemia, surgery was performed, after a few months we did not see this patient in blood bank but saw here H/H was good, she continued without blood for about a year and a half, when she came in for another surgery, the antibody screen is it was negative. It paid off giving her specific antigen negative blood.

Thanks for the update.