CASE STUDY. Medical History: ◦ 70 year old male ◦ Diagnosis - Malaise and Fatigue ◦ Previous...
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Transcript of CASE STUDY. Medical History: ◦ 70 year old male ◦ Diagnosis - Malaise and Fatigue ◦ Previous...
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