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?

Many times an autoab will have an apparent specificty for the Rh phenotype of the patient. I have seen more than a few instances of this - the pt is E+, the auto is 2-3+ with all cells except the E+ cells, which will be 4+. It is an autoab.

I agree entirely with David.

Just to give you a steer, have a look at Dwyre DM, Clapper A, Heintz M, Elbert C, Strauss RG. A red blood cell autoantibody with mimicking anti-E specificity. Transfusion 2004; 44: 1287-1292.

In this, I may add, they say that this is uncommon. I can assure you that, inmy experience, it is not at all uncommon!!!!!!!!

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:)

Sometimes, we found auto-E ( maybe combine with allo anti-cE), or auto-e ( patient's phenotype cCDee ). my question is : which blood would be selected for this auto antibodies?

Unless giving blood expressing the auto-anti-E (in the case of an R2R2) or auto-anti-e (in the case of an R1R1, R1r or rr) does not result in a higher Hb, even for a short number of days (a very rare event), I would ALWAYS give E+ or e+ blood respectively to these patients.

The last thing you want is for the former to make an alloanti-e or the latter an allo-anti-E, as this makes cross-matching near impossible, resulting in a much higher risk of a haemolytic transfusion reaction.