Male boy of age 10 months, known case of Beta Thalassemia major, developed antibodies and not maintaining the Hemoglobin despite regular tansfusion i.e 2/ weeks.

Patient Blood Group is

Forward: A 3+, B3+, D4+ Reverse: anti A 2+, anti B 2+ Auto Weak+

37: Forward: A0, B4+, D4+, Reverse anti A 4+, anti B0, Auto 0.

E 0, C+, c+,e+ k+-, Jk+-

All blood is incompatable, only least incompataible blood is available, but hemoglobin droped in one week by 2 to 3 grams, LDH increased.

Can any boby give suggestion

Dr. tariq

At first glance, and I'm sorry to say this, it looks like he may have made a clinically significant antibody directed against a high frequency antigen.

The reason I say this is because he is not maintaining his Hb, and it looks like he is destroying the transfused red cells, because his auto is only weak (remaining few transfused cells in his circulation????), whereas the B cells in the reverse group are reacting at 2+.

I realise that this does not explain the strong reaction of his red cells with the anti-A in the forward group. I'll have to think about that one.

In forward grouping we use Anti-A and Anti-B ,in reverse we use A cells and B cells ,The way you have reported is creating some confusions.

I need to ask some clarifying questions. 1- what about your Ab.screening ?

2- what was the result of your DAT? if positive was it mixed field?

3- did you do a prewarm technique?

4-If what you have reported at the end is the patient's phenotype then what do you mean by k NOT K (+-) and Jk (a or ?

Edited March 8, 201312 yr by Abdulhameed Al-Attas

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Patient Blood Group is

Forward: A 3+, B3+, D4+ Reverse: anti A 2+, anti B 2+ Auto Weak+

37: Forward: A0, B4+, D4+, Reverse anti A 4+, anti B0, Auto 0.

E 0, C+, c+,e+ k+-, Jk+-

You give 2 different sets of forward and reverse groups; which set is the patient's result, and what does the other result represent?

Male boy of age 10 months, known case of Beta Thalassemia major, developed antibodies and not maintaining the Hemoglobin despite regular tansfusion i.e 2/ weeks.

Patient Blood Group is

Forward: A 3+, B3+, D4+ Reverse: anti A 2+, anti B 2+ Auto Weak+

37: Forward: A0, B4+, D4+, Reverse anti A 4+, anti B0, Auto 0.

E 0, C+, c+,e+ k+-, Jk+-

All blood is incompatable, only least incompataible blood is available, but hemoglobin droped in one week by 2 to 3 grams, LDH increased.

Can any boby give suggestion

Dr. tariq

I am wonder the room temp A antigen typing is disturbed but why the E antigen typing seems normal?

I will do 37 degree C antibody screening and indirect anti-globulin test use tube, because the antibodies can interference the room temp test and some auto and cold antibodies will react stronger in gel.

I agree with Malcolm it is anti-HFA.

Have you done this patient's DAT? What is the result? Also, what is the typing reaction at 4 C especially with anti-A?

If it is autoantibody, transfusion just can be used for saving life, the drug will depress the autoantibody and reduce the destroy of auto and transfused cells.

But if it is allo to HFA, I think it will be a headache case.