Presentation on theme: "Case Study: Weird Wonderful Walter"— Presentation transcript:
1Case Study: Weird Wonderful Walter Jayanna Slayten, MS, MT(ASCP)SBBManager, IBC-IRL andSBB Program Education CoordinatorIndiana Blood Center
2Case 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
3Initial Blood Bank Testing Sample sent to labABO/RH: A, D PositiveDAT: Polyspecific = 3+Antibody Screen: 4+ with all cells by EchoAutocontrol (AC): Positive
4Investigation Results A, D Positive DAT Positive Panel testing PEG-AHG Ortho Gel
7Further 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
8Confusion 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.
10Initial Conclusions Autoantibody Patient’s autoantibody is not removed by a 4x autoadsorption?What about provision of blood?
11Additional 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 !
13Further 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)
14ConclusionsAutoantibody 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)
15Conclusion 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