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What Lies Beneath

What Lies Beneath. Peggy Ball, MT(ASCP) IRL Manager. 62 year old female Lupus Prednisone, Prozac, Prilosec No transfusion history History of pregnancy is unknown. Patient History. Initial Findings. Group A Positive DAT Negative Antibody Screen

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What Lies Beneath

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  1. What Lies Beneath Peggy Ball, MT(ASCP) IRL Manager

  2. 62 year old female Lupus Prednisone, Prozac, Prilosec No transfusion history History of pregnancy is unknown Patient History

  3. Initial Findings Group A Positive DAT Negative Antibody Screen Positive with all 3 screening cells in Gel Sample referred to IRL

  4. IRL Testing Group A Positive DAT Negative with Poly, IgG, and C3b-C3d using a tube technique Panel tested Gel

  5. Panel 1

  6. IRL Testing The positive autocontrol in Gel was confusing as the DAT in the tube was negative Tested the DAT in Gel

  7. IRL Testing DAT (IgG) tested in Gel was 3+

  8. What now? Possible reasons for reactivity Autoantibody with the expected positive DAT Multiple alloantibodies with an unrelated positive DAT Transfusion history is incorrect and patient has been recently transfused and has newly forming multiple alloantibodies. Antibody to a high frequency antigen with an unrelated positive DAT Now, what do I do…

  9. Ideas I could… Run another panel in Gel and hope to get a non-reactive cell? Waste of time and resources with no goal in mind Prewarm and hope reactivity goes away? Could be dangerous if patient was recently transfused Must have a specific goal in mind if choosing prewarm technique Run prewarm in Gel? In tube? Test using another method such as ficin-treated panel cells or panel cells in PeG

  10. Decisions, Decisions Contacted the submitting facility and had them confirm with the patient and with the physician that the patient had NOT been recently transfused. Testing a panel in tube with PeG may give me some additional information. Phenotype may give me additional information

  11. Panel 1… again

  12. Patient antigen typing

  13. Panel 2

  14. What next? DAT negative (EGA-Treated) autocontrol in Gel. This will include a DAT in Gel Help to eliminate the possibility of an antibody to a high frequency antigen

  15. EGA-treated patient cells

  16. Gel Reactivity Reactivity in Gel is most likely due to an autoantibody. A DAT negative autocontrol is reacting 2+ when tested with the patient’s serum

  17. Panel 1… one more time

  18. CONCLUSIONS Patient’s plasma contains: Anti-P1 reacting in PeG An antibody reacting with all cells tested including phenotypically similar cells and the EGA treated, DAT negative, autocontrol in Gel, with no apparent specificity Clinical significance is doubtful

  19. Anti-P1 Anti-P1 is not considered to be clinically significant in transfusion therapy.

  20. Transfusion recommendations If transfusion therapy is indicated issue red cells that are Group A Positive Crossmatch compatible Testing in tube is recommended

  21. Thank YouQuestions?ballp@usa.redcross.org260-480-8272

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