October 2011 MVRBC TAC Meeting

CASE STUDY

Medical History:

◦ 70 year old male

◦ Diagnosis - Malaise and Fatigue

◦ Previous Transfusion History No previous antibodies identified Last transfused on 9/13/2011

◦ Medications - Oxycodone – Acetaminophen, Cholestyramine, Pantoprazole, TraZODone

Patient History

Antibody screen 4+ with SCII in Gel

Panel all positive except for 2 cells

Auto control was positive

DAT 4+ in Gel

Hospital Reactivity

ABO / Rh and DAT Results

Anti-A Anti-B Anti-A,B Anti-D A1 Cells B Cells ABO Interpretation

0 0 0 4+ 4+ 4+ O Rh Positive

Polyspecific Anti-IgG Anti-C3

1+ 1+ 0√

Testing performed in tubes

Antibody Screen

Rh Kell Duffy Kidd MNS P Lutheran RT-30

Min

AHG -

PeGD C c E e K k Fya Fyb Jka Jkb M N S s P1 Lua Lub

I + + 0 0 + + 0 3+ + + 0 + 0 + 0 + 0 + 4+ 4+

II + 0 + + 0 0 + 3+ 0 + + 0 + 0 + + 0 + 3+ 3+

III 0 0 + 0 + 0 + 0 0 0 + + 0 + + + 0 + 3+ 2+

Auto Control 0 1+

Antibody Panel – Neat PlasmaRh Kell Duffy Kidd MNS P Lutheran

PlasmaGelD C c E e K k Fya Fyb Jka Jkb M N S s P1 Lua Lub

1 + + 0 0 + + + 0 + + 0 + + 0 + + 0 + 1+2 + + 0 0 + 0 + 0 + + 0 + + 0 + 0 0 + 03 + 0 + + 0 0 + 0 + 0 + 0 + 0 + + 0 + 4+4 + 0 + 0 + 0 + 0 0 + 0 + + 0 0 0 0 + 3+5 0 + + 0 + 0 + + 0 0 + + 0 + 0 + 0 + 3+6 0 0 + + + 0 + + + 0 + + + + + + 0 + 4+7 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 + 3+

10 + + 0 0 + 0 + + 0 0 + + 0 + + 0 0 + 0Auto Control 1+

Additional Antibody PanelRh Kell Duffy Kidd MNS P Lutheran

PlasmaGel

P1 Sub GelD C c E e K k Fya Fyb Jka Jkb M N S s P1 Lua Lub

1 + + 0 0 + + + 0 + + 0 + + 0 + + 0 + 1+ 02 + + 0 0 + 0 + 0 + + 0 + + 0 + 0 0 + 0 03 + + 0 + + 0 + 0 + 0 + 0 + 0 + 0 0 + 2+ 2+4 + 0 + 0 + 0 + 0 0 + 0 + + 0 0 + 0 + 3+ 3+5 0 + + 0 + 0 + + 0 0 + + 0 + 0 + 0 + 3+ 3+6 0 0 + + + 0 + + + 0 + + + + + + 0 + 3+ 3+7 + + 0 0 + + + + + + + 0 + + + + + + 0 08 + + 0 0 + 0 + + 0 0 + + 0 + 0 + 0 + 2+ 09 + + 0 0 + 0 + + + + 0 0 + + + 0 0 + 0 0

Additional Panel ResultsRh Kell Duffy Kidd MNS P Lutheran

PlasmaGel

P1 Sub GelD C c E e K k Fya Fyb Jka Jkb M N S s P1 Lua Lub

1 + + 0 0 + + + 0 + + 0 + + 0 + + 0 + 1+ 02 + + 0 0 + 0 + 0 + + 0 + + 0 + 0 0 + 0 03 + + 0 + + 0 + 0 + 0 + 0 + 0 + 0 0 + 2+ 2+4 + 0 + 0 + 0 + 0 0 + 0 + + 0 0 + 0 + 3+ 3+5 0 + + 0 + 0 + + 0 0 + + 0 + 0 + 0 + 3+ 3+6 0 0 + + + 0 + + + 0 + + + + + + 0 + 3+ 3+7 + + 0 0 + + + + + + + 0 + + + + + + 0 08 + + 0 0 + 0 + + 0 0 + + 0 + 0 + 0 + 2+ 09 + + 0 0 + 0 + + + + 0 0 + + + 0 0 + 0 0

We have identified the anti-P1, -c and –E in the patient’s plasma.

However, we have more to do…

◦ The DAT was positive with anti-IgG◦ The AC was also positive

◦ Causes – Warm Auto developing, Meds, antibody?

More Investigation Required

Antibody Panel – Plasma / EluateRh Kell Duffy Kidd MNS P Lutheran

PlasmaGel

Eluate GelD C c E e K k Fya Fyb Jka Jkb M N S s P1 Lua Lub

1 + + 0 0 + + + 0 + + 0 + + 0 + + 0 + 1+ 02 + + 0 0 + 0 + 0 + + 0 + + 0 + 0 0 + 0 03 + + 0 + 0 0 + 0 + 0 + 0 + 0 + + 0 + 4+ 1+4 + 0 + 0 + 0 + 0 0 + 0 + + 0 0 0 0 + 3+ 3+5 0 + + 0 + 0 + + 0 0 + + 0 + 0 + 0 + 3+ 3+6 0 0 + + + 0 + + + 0 + + + + + + 0 + 4+ 3+7 0 0 + 0 + + + 0 + + + + + + 0 + 0 + 3+ 3+8 0 0 + 0 + 0 + + 0 + + 0 + + 0 + 0 + 3+ 3+9 0 0 + 0 + 0 + 0 + 0 + + + + + + 0 + 3+ 3+

10 + + 0 0 + 0 + + 0 0 + + 0 + + 0 0 + 0 0Auto Control 1+ NA

Plasma / Eluate ResultsRh Kell Duffy Kidd MNS P Lutheran

PlasmaGel

Eluate GelD C c E e K k Fya Fyb Jka Jkb M N S s P1 Lua Lub

1 + + 0 0 + + + 0 + + 0 + + 0 + + 0 + 1+ 02 + + 0 0 + 0 + 0 + + 0 + + 0 + 0 0 + 0 03 + + 0 + 0 0 + 0 + 0 + 0 + 0 + + 0 + 4+ 1+4 + 0 + 0 + 0 + 0 0 + 0 + + 0 0 0 0 + 3+ 3+5 0 + + 0 + 0 + + 0 0 + + 0 + 0 + 0 + 3+ 3+6 0 0 + + + 0 + + + 0 + + + + + + 0 + 4+ 3+7 0 0 + 0 + + + 0 + + + + + + 0 + 0 + 3+ 3+8 0 0 + 0 + 0 + + 0 + + 0 + + 0 + 0 + 3+ 3+9 0 0 + 0 + 0 + 0 + 0 + + + + + + 0 + 3+ 3+

10 + + 0 0 + 0 + + 0 0 + + 0 + + 0 0 + 0 0Auto Control 1+ NA

Performed on reticulocytes.

Antigen Testing

-c -E -P1

0 0 0

O positive Positive DAT with anti-IgG Antibodies in plasma: anti-P1, -c, -E Antibodies in Eluate: anti-c, -E

Transfusion recommendations: Transfuse, P1-, c- and E- AHG crossmatch compatible RBCs.

Final Results