Hi

Patient blood group is A Rh D positive and antibody screen negative. Set up 4 units of A Pos unit and found to be incompatible. Then we set up 3 A Rh D negative units and found to be incompatible.  Therefore panel was set up and found to negative in all cell line.  We set-up 4 unit O Rh D negative and found to be COMPATIBLE.  However DAT is positive in IgG 2+. But why was cross match was incompatible in A red cell but COMPATIBLE with O red cell. 

Could be an anti A1 but curious as to why this did not show up in reverse type?    Also, what type of crossmatches are you doing?   Immediate spin?

No problem in reverse group. Negative with A1 cell and 3+ reaction in B cell. We used IAT techniques for all our X match .

Might be a rare IgG anti-A1 - you may not see in in the Reverse (presumably IS or buffer-only gel card), but is detected when you do anything with an antiglogulin reagent. You could try doing the Reverse by IAT. The DAT may just be a red herring, but it might represent a weird autoantibody that favors group A cells.

Edited March 22, 20187 yr by exlimey
typo

The patient's DAT is positive, right?  Has the patient received ABO incompatible platelets lately?  Or received Immunoglobulin therapy (gamma globulins)?  I have seen both of those scenarios cause incompatibilities with the patient's own type.  Could be either Anti-A or Anti-A,B from O platelets or the gamma globulin therapy.  

9 hours ago, BldBnker said:

The patient's DAT is positive, right?  Has the patient received ABO incompatible platelets lately?  Or received Immunoglobulin therapy (gamma globulins)?  I have seen both of those scenarios cause incompatibilities with the patient's own type.  Could be either Anti-A or Anti-A,B from O platelets or the gamma globulin therapy.  

Good thinking. Might be interesting to see if there's anything in an eluate....

Have you looked into the possibility of patient having  low incident antibody?   Low incident antibody are  usually picked up during crossmatch.

 

1 hour ago, cheru26 said:

Have you looked into the possibility of patient having  low incident antibody?   Low incident antibody are  usually picked up during crossmatch.

 

This doesn't fit the pattern for an antibody to a low incidence antigen - in this case, all 7 group A units are incompatible and the 4 group O units are compatible.

On 3/21/2018 at 7:08 AM, gagpinks said:

Hi

Patient blood group is A Rh D positive and antibody screen negative. Set up 4 units of A Pos unit and found to be incompatible. Then we set up 3 A Rh D negative units and found to be incompatible.  Therefore panel was set up and found to negative in all cell line.  We set-up 4 unit O Rh D negative and found to be COMPATIBLE.  However DAT is positive in IgG 2+. But why was cross match was incompatible in A red cell but COMPATIBLE with O red cell. 

On another track......why the switch to Rh-negative units ?

We did 4 A Rh D negative and they all were compatible.  Waiting for eluate result.  Patient had 1 B neg platelet. 

Edited March 23, 20187 yr by gagpinks

9 minutes ago, gagpinks said:

We did 4 A Rh D negative and they all were compatible.  Waiting for eluate result.  Patient had 1 B neg platelet. 

That conflicts with you original post: "Set up 4 units of A Pos unit and found to be incompatible. Then we set up 3 A Rh D negative units and found to be incompatible."

I'm confused.

Sorry I meant all 4 Rh D negative were incompatible.  It's typo.  Sorry for confusion