Presentation on theme: "Case Study: Weird Wonderful Walter"— Presentation transcript:
1 Case Study: Weird Wonderful Walter Jayanna Slayten, MS, MT(ASCP)SBBManager, IBC-IRL andSBB Program Education CoordinatorIndiana Blood Center
2 Case History Patient History Mr. Walter Wright - 80 year old Male Diagnosed with anemiaPatient had hip surgery in July 2009Has been anemic for the last 6 monthsCurrent values have been g/dLHistory of transfusionJuly 2009At that time, patient had a cold reactive antibody that “prewarmed” away
3 Initial Blood Bank Testing Sample sent to labABO/RH: A, D PositiveDAT: Polyspecific = 3+Antibody Screen: 4+ with all cells by EchoAutocontrol (AC): Positive
4 Investigation Results A, D Positive DAT Positive Panel testing PEG-AHG Ortho Gel
7 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 cellsReactive by PEG-AHG (1+)Reactive by Gel (2+)Reactive with the eluate (3+)EcKS
8 Confusion and Delay!! Possibilities to consider… Transfusion Reaction?The patient has not been recentlytransfusedAutoantibodyAll panel cells reactiveDAT positive, eluate is panreactivePursue autoadsorptionProve autoantibodyExclude any underlying alloantibodies.
10 Initial Conclusions Autoantibody Patient’s autoantibody is not removed by a 4x autoadsorption?What about provision of blood?
11 Additional Testing Started alloadsorption Completed Crossmatches Same results as autoadsorption!4+ with all cells…..Completed CrossmatchesMatched LISS-AHGUnit 1 Gp A+ E-c-K-S- Compatible!Unit 2 Gp A+ E-c-K-S- Compatible !Unit 3 Gp A+ E-c-K-S Compatible !
13 Further Investigation AutoantibodyVerified auto with positive DAT and eluateSerum reactivity in PEG-AHG and LISS-AHG consistent with autoantibodyIs this a preference for ABO specific cells?Repeat panel testing foundGroup O panel washed x 1 = demonstrated anti-cThis disproved a preference for ABO cells (rare)
14 ConclusionsAutoantibody reactivity in this case was enhanced when tested withReagent red cells (re-suspended in diluent)Autoantibody not detected when tested with washed cells (donor or panel)
15 Conclusion This is an atypical presentation of an autoantibody……… The patient’s sample demonstratedAnti-cWarm autoantibodyThis is an atypical presentationof an autoantibody………Patient received xm compatible E-c-K-S- units