We have a patient who had a delayed hemolytic transfusion reaction lat month due to an undetectable unknown to us historical Fya. He also made a C which we could only pickup by enzyme. He went to another hospital with diagnosis of uremia on top of his myleodysplastic syndrome and liver cancer. He survived that bout, and is back for transfusion again. He now has Fya, C, Jka, and we could not rule out K and E, however he is E antigen pos. Units negative for all but E are 1-2+ incompatible. We got a unit in that was deglyced and negative for for Fya, C, Jka, K and E and it is completely compatible. The DAT is negative, so E mosaic anyone? Auto E with negative DAT? Any insight or experience?

He is to be transfused again tomorrow.

Thanks in advance!

When was he antigen typed for E? Greater than three months after a transfusion? Other wise it could be donor cells, unless I'm missing something.

He had a micro array done in July because he had been recently transfused. He typed E antigen pos then. We also did a tube serology test here Friday as we were just about 3 months to the day post transfusion, and he was 4+ that way.

I would bet on a E mosaic. The micro array won't pick up single nucleotide changes (and missing pieces or parts) in the RhCE allele. Particularly since he seems to like units that are negative for E along with his other favorite flavors. To prove it of course you would need to have the gene sequenced - somewhere like NY Blood Center. You didn't mention his race. We seemed to see more RhD and RhCE mosaics in our African-American patients.

He is actually white, and I did decide to send him off. Lifeshare is getting to play with it, He also may have a SC or Dombrock or perhaps some other low, as the second unit we got in identically phenotyped as the first was 1+ incompatible, so strange! I sent JoAnn Moulds my workups and a specimen so we will see what we get. I will update as soon as I get the report. Only us blood bank geeks like this stuff, so exciting!

Look forward to hearing JoAnn's results.

Dombrock antibodies, if there is a Dombrock antibody, can be a blank, blank nuisance!!!!!!!!!!