AutoAllo Spring Workshop 2010 - Indiana State Association of
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Transcript AutoAllo Spring Workshop 2010 - Indiana State Association of
Case Study:
Weird Wonderful
Walter
Jayanna Slayten, MS, MT(ASCP)SBB
Manager, IBC-IRL and
SBB Program Education Coordinator
Indiana Blood Center
Case History
Patient History
Mr. Walter Wright - 80 year old Male
Diagnosed with anemia
Patient had hip surgery in July 2009
Has been anemic for the last 6 months
Current values have been 7.0-9.5 g/dL
History of transfusion
July 2009
At that time, patient had a cold reactive
antibody that “prewarmed” away
Initial Blood Bank Testing
Sample sent to lab
ABO/RH:
DAT:
Antibody Screen:
Autocontrol (AC):
A, D Positive
Polyspecific = 3+
4+ with all cells by Echo
Positive
Investigation
Results
A, D Positive
DAT Positive
Panel testing
PEG-AHG
Ortho Gel
Panel Testing
Rh
Kell
Duffy
Kidd
P
Lewis
MN
Serum
CELL
D
C
E
c
e
K
k
Fya
Fyb
Jka
Jkb
Lea
Leb
P1
M
N
S
s
PEG
Gel
1
+
0
+
+
+
0
+
0
+
+
+
0
+
+
+
0
0
+
1+
2+
2
+
0
+
+
0
+
+
+
0
0
+
+
0
+S
+
+
0
+
1+
2+
3
+
+
0
0
+
0
+
+
0
+
0
0
+
0
+
0
0
+
1+w 2+
4
+
0
+
+
+
0
+
+
+
0
+
+
0
+
+
0
0
+
1+w 2+
5
+
0
+
+
+
0
+
0
+
+
0
0
+
+
0
+
0
+
1+
6
+
0
0
+
+
0
+
+
0
+
0
0
0
+
0
+
0
+
1+w 2+
7
+
+
0
+
+
0
+
0
0
0
+
+
0
0
+
+
0
+
+w
1+
8
+
+
0
+
+
0
+
0
0
0
+
+
0
0
+
+
0
+
+w
1+
9
+
+
0
0
+
+
+
0
0
0
+
+
0
0
+
+
+
0
+w
1+
10
+
0
+
+
+
0
+
+
+
+
0
0
0
+
+
+
0
+
1+w 2+
Autocontrol 3+
2+
3+
Eluate Testing
Kidd
Duffy
Kell
Rh
Eluate
MN
P
Lewis
CELL
D
C
E
c
e
K
k
Fya
Fyb
Jka
Jkb
Lea
Leb
P1
M
N
S
s
IgG LW
1
+
0
+
+
+
0
+
0
+
+
+
0
+
+
+
0
0
+
3+
0
2
+
0
+
+
0
+
+
+
0
0
+
+
0
+S
+
+
0
+
3+
0
3
+
+
0
0
+
0
+
+
0
+
0
0
+
0
+
0
0
+
3+
0
4
+
0
+
+
+
0
+
+
+
0
+
+
0
+
+
0
0
+
3+
0
5
+
0
+
+
+
0
+
0
+
+
0
0
+
+
0
+
0
+
3+
0
6
+
0
0
+
+
0
+
+
0
+
0
0
0
+
0
+
0
+
3+
0
7
+
+
0
+
+
0
+
0
0
0
+
+
0
0
+
+
0
+
3+
0
8
+
+
0
+
+
0
+
0
0
0
+
+
0
0
+
+
0
+
3+
0
9
+
+
0
0
+
+
+
0
0
0
+
+
0
0
+
+
+
0
3+
0
10
+
0
+
+
+
0
+
+
+
+
0
0
0
+
+
+
0
+
3+
0
EGA-treated Autocontrol (DAT Negative) 3+
0
Further Investigation
Results (continued)
Full phenotype:
R1 R1 (D+C+E-c-e+)
K-; Fy(a+b+); Jk(a+b+);
M+S-s+, A1+, Le(a-b-), P1-
Tested phenotypically similar cells
Reactive by PEG-AHG (1+)
Reactive by Gel (2+)
Reactive with the eluate (3+)
E
c
K
S
Confusion and Delay!!
Possibilities to consider…
Transfusion Reaction?
The patient has not been recently
transfused
Autoantibody
All panel cells reactive
DAT positive, eluate is panreactive
Pursue autoadsorption
Prove autoantibody
Exclude any underlying alloantibodies.
Panel Testing
Rh
Kell
Duffy
Kidd
P
Lewis
Auto
Absorb x 4
MN
CELL
D
C
E
c
e
K
k
Fya
Fyb
Jka
Jkb
Lea
Leb
P1
M
N
S
s
LISS-AHG
1
+
0
+
+
+
0
+
0
+
+
+
0
+
+
+
0
0
+
3+
2
+
0
+
+
0
+
+
+
0
0
+
+
0
+S
+
+
0
+
3+
3
+
+
0
0
+
0
+
+
0
+
0
0
+
0
+
0
0
+
3+
4
+
0
+
+
+
0
+
+
+
0
+
+
0
+
+
0
0
+
3+
5
+
0
+
+
+
0
+
0
+
+
0
0
+
+
0
+
0
+
3+
6
+
0
0
+
+
0
+
+
0
+
0
0
0
+
0
+
0
+
3+
7
+
+
0
+
+
0
+
0
0
0
+
+
0
0
+
+
0
+
3+
8
+
+
0
+
+
0
+
0
0
0
+
+
0
0
+
+
0
+
3+
9
+
+
0
0
+
+
+
+
0
0
+
+
0
0
0
+
+
0
3+
10
+
+
0
0
+
0
+
0
+
+
0
0
+
+
+
0
0
+
3+
Autoantibody Stronger? Initial Panel 1-2+, now it’s 3+?
Initial Conclusions
Autoantibody
Patient’s autoantibody is not removed by a
4x autoadsorption?
What about provision of blood?
Additional Testing
Started alloadsorption
Same results as autoadsorption!
4+ with all cells…..
Completed Crossmatches
Matched
Unit 1 Gp A+
Unit 2 Gp A+
Unit 3 Gp A+
E-c-K-SE-c-K-SE-c-K-S
LISS-AHG
Compatible!
Compatible !
Compatible !
Gp A Panel Testing
Rh
Kell
Duffy
Kidd
P
Lewis
MN
Gp A
CELL
D
C
E
c
e
K
k
Fya
Fyb
Jka
Jkb
Lea
Leb
P1
M
N
S
s
LISS-AHG
1
+
0
+
+
+
0
+
0
+
+
+
0
+
+
+
0
0
+
3+
2
+
0
+
+
0
+
+
+
0
0
+
+
0
+S
+
+
0
+
3+
3
+
+
0
0
+
0
+
+
0
+
0
0
+
0
+
0
0
+
0√
4
+
0
+
+
+
0
+
+
+
0
+
+
0
+
+
0
0
+
3+
5
+
0
+
+
+
0
+
0
+
+
0
0
+
+
0
+
0
+
3+
6
+
0
0
+
+
0
+
+
0
+
0
0
0
+
0
+
0
+
3+
7
+
+
0
+
+
0
+
0
0
0
+
+
0
0
+
+
0
+
3+
8
+
+
0
+
+
0
+
0
0
0
+
+
0
0
+
+
0
+
3+
9
+
+
0
0
+
+
+
+
0
0
+
+
0
0
0
+
+
0
0√
10
+
+
0
0
+
0
+
0
+
+
0
0
+
+
+
0
0
+
0√
What antibody is present?
Further Investigation
Autoantibody
Verified auto with positive DAT and eluate
Serum reactivity in PEG-AHG and LISS-AHG
consistent with autoantibody
Is this a preference for ABO specific cells?
Repeat panel testing found
Group O panel washed x 1 = demonstrated anti-c
This disproved a preference for ABO cells (rare)
Conclusions
Autoantibody reactivity in this case was
enhanced when tested with
Reagent red cells (re-suspended in diluent)
Autoantibody not detected when tested with
washed cells (donor or panel)
Conclusion
The patient’s sample demonstrated
Anti-c
Warm autoantibody
This is an atypical presentation
of an autoantibody………
Patient received xm compatible E-c-K-S- units