We have had 2 patients recently (which is already too high of odds for me) which have shown:

1. Rh Positive Patient (3-4+)

2. Appears to be a clear-cut Anti-E (1+ Reactions on 1 patient; 3+ Reactions on

another patient).

3. First patient had a Negative Autocontrol; 2nd Patient has a 2+ Autocontrol

(DAT Neg with IgG and C3).

4. We sent the first patient out to our Reference Lab to see if they could identify

a Partial D with Anti-D. First, they do not carry that special D Panel. 2nd,

they obtained Negative results in GEL, LISS and PeG; weak in Ficin (which

they prewarmed away). They performed a Cold Panel and said it was a Cold

Agglutinin.

5. So, I am sitting here with this 2nd one in front of me (pregnant woman); with

3+ on all D+ cells and a 2+ Positive Autocontrol with Negative DAT. I could

also perform a Cold Panel here, but I am just not convinced that is what is

going on here. If we send it to them again, they can send it to the National

Reference Lab to determine if it is a Partial D, but that would be expensive

(and we would give D- RBCs anyway).

In talking to the Reference Lab Supervisor, she said they had another similar patient recently. So, I am just wondering if anyone has heard of anything unusual with Rh POS patients appearing to have Anti-D, just in GEL (though we did not Test this 2nd patient in any other method yet).

This seems like too many either: Partial D with Anti-D, or Auto Anti-D Patients in a short period of time, given the size of our Institution.

Thanks for any input!

Brenda Hutson, CLS(ASCP)SBB

Did you test either of them with O Neg cord cells just out of curiousity? I've always wanted to find one of those antibodies but never have.

Oh and as a side note Brenda, whereas I'm not saying to disregard odd occurrences that happen frequently in a short span of time, I have to admit that I've come to realize the weird ironies in immunohematology. Last year we had two different patients on the same day who both had positive antibody screens, positive auto-controls, positive DATs and anti-e identified in the eluate - both patients were phenotyped to be e-positive. Both required transfusion.

Further investigation revealed that one patient had a warm auto with e-specifity, oncology patient. The other was a sickle cell patient with an e-variant phenotype.

Edited June 22, 201213 yr by goodchild

Thanks.

So what is running an O NEG Cord going to do for me? :tongue:

And yes, I too have had "those days" where things are suspiciously similar.

Also, I think I forgot to mention; the Reference Lab said they had received another work-up )from somewhere else) that came up with the same thing (except they could not rule-out the Anti-C or Anti-E on that one).

Brenda

Did you test either of them with O Neg cord cells just out of curiousity? I've always wanted to find one of those antibodies but never have.

Oh and as a side note Brenda, whereas I'm not saying to disregard odd occurrences that happen frequently in a short span of time, I have to admit that I've come to realize the weird ironies in immunohematology. Last year we had two different patients on the same day who both had positive antibody screens, positive auto-controls, positive DATs and anti-e identified in the eluate - both patients were phenotyped to be e-positive. Both required transfusion.

Further investigation revealed that one patient had a warm auto with e-specifity, oncology patient. The other was a sickle cell patient with an e-variant phenotype.

We had two patients with anti-D that are D positive that we detected within 4 days of each other last winter. One was/is pregnant. Both had rather weak D reactions at IS with Quotient anti-D. One had been tested in years past with similar results with a different anti-D reagent and transfused with D+ blood. Now she has the antibody. We were able to send her for a research project using Quotient's partial D kit and she is looking like a rather strange case--a weak D type I or II (can't remember which) that has made anti-D. We haven't got the final results yet.

It is much more important to be sure what the pregnant lady has since it will help determine the likelihood of HDFN.

anti-LW

Right; if it was a non-pregnant woman (or even a woman who was not of child-bearing age), I would probably just say to give Rh Negative rather than go to the expense of a work-up. But the pregnancy issue changes things.

Brenda

We had two patients with anti-D that are D positive that we detected within 4 days of each other last winter. One was/is pregnant. Both had rather weak D reactions at IS with Quotient anti-D. One had been tested in years past with similar results with a different anti-D reagent and transfused with D+ blood. Now she has the antibody. We were able to send her for a research project using Quotient's partial D kit and she is looking like a rather strange case--a weak D type I or II (can't remember which) that has made anti-D. We haven't got the final results yet.

It is much more important to be sure what the pregnant lady has since it will help determine the likelihood of HDFN.

The sedcond case has pos autocontrol, has she been transfused before?

If not, I will do auto adsorption, to see if I can adsorbed out the free antibody, if I can , then it is autoantibody, and autoantibody rarely cause HDFN.

If it can't been adsorbed out, then I prefer it is a patial D produced anti-D and will send it to reference lab.

To your first case, I don't know what method you used to do the ab screen, if the antibody is cold, a blood bank of hospital can prewarm it out.

By the way....never did figure this mystery out but it stopped soon after this Thread began....so I am "thinking" it was a Lot#/Reagent issue. Just didn't have time to do all of the research and comparisons on the samples.

Sorry....

Brenda Hutson

Just two side variants you may want to consider; actual Ambient temp of your Blood Bank and age and care of your in-date reagents in use. I know that we have experations dates on all of our anti-sera's but I also know that there is a certain amount of evaporatoin of water contained in these reagents upon standing capped at room temp. I had an experience where I was using an indated Albumen reagent to make cytosins of a CSF I was working on and after seeing that the number cells counted did not correlate with the number of cells recovered in the cytospin slide; and after several attempts using this same indated Albumen reagent, I finally didn't use this reagent and got the correlation I was looking for. I openened a new bottle of Albumen and my corelation was correct and my cells had better integrity. I realized that the original bottle of Albumen, although indated, sat at room temp too long with dehydration occuring such that instead of 22% concentration as the lable indicated the actual centration was high enough to form a film over the opening of the cytospin apparatus and therefore trap and prevent the cells from migrating to the slide. I did note this filme after the 2nd or 3rd attempt.

I would aslo like to know if you warm your anti-D reagents to room (ambient) temperature before you use them.

If an anti-D is used straight from the fridge, it can sometimes give weak reactions with D Negative red cells, as, in the cold, there is often an element of the antibody that can look very much like an anti-I, and, therefore, give false positive results.

This is also true of a "freshly-made" human-derived anti-D. If you are unlucky enough to encounter a brand new anti-D in a human (at the IgM stage, before it becomes mostly IgG), it can be a "bad fit" for the D antigen, and can also mimic anti-I.

Did you consider anti-LW? 

Did you consider anti-LW? 

Removed

Edited June 3, 201510 yr by RollSlow10