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Case Study: Weird Wonderful Walter

Case Study: Weird Wonderful Walter. Jayanna Slayten, MS, MT(ASCP)SBB Manager, IBC-IRL and SBB Program Education Coordinator Indiana Blood Center. Case History. Patient History Mr. Walter Wright - 80 year old Male Diagnosed with anemia Patient had hip surgery in July 2009

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Case Study: Weird Wonderful Walter

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  1. Case Study: Weird WonderfulWalter Jayanna Slayten, MS, MT(ASCP)SBB Manager, IBC-IRL and SBB Program Education Coordinator Indiana Blood Center

  2. Case History • Patient History • Mr. Walter Wright - 80 year old Male • Diagnosed with anemia • Patient had hip surgery in July 2009 • Has been anemic for the last 6 months • Current values have been 7.0-9.5 g/dL • History of transfusion • July 2009 • At that time, patient had a cold reactive antibody that “prewarmed” away

  3. Initial Blood Bank Testing • Sample sent to lab • ABO/RH: A, D Positive • DAT: Polyspecific = 3+ • Antibody Screen: 4+ with all cells by Echo • Autocontrol (AC): Positive

  4. Investigation • Results • A, D Positive • DAT Positive • Panel testing • PEG-AHG • Ortho Gel

  5. Panel Testing

  6. Eluate Testing

  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 cells • Reactive by PEG-AHG (1+) • Reactive by Gel (2+) • Reactive with the eluate (3+) E c K S

  8. Confusion and Delay!! • Possibilities to consider… • Transfusion Reaction? • The patient has not been recently transfused • Autoantibody • All panel cells reactive • DAT positive, eluate is panreactive • Pursue autoadsorption • Prove autoantibody • Exclude any underlying alloantibodies.

  9. Panel Testing

  10. Initial Conclusions • Autoantibody • Patient’s autoantibody is not removed by a 4x autoadsorption? • What about provision of blood?

  11. Additional Testing • Started alloadsorption • Same results as autoadsorption! • 4+ with all cells….. • Completed Crossmatches Matched LISS-AHG • Unit 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 !

  12. Gp A Panel Testing

  13. Further Investigation • Autoantibody • Verified auto with positive DAT and eluate • Serum reactivity in PEG-AHG and LISS-AHG consistent with autoantibody • Is this a preference for ABO specific cells? • Repeat panel testing found • Group O panel washed x 1 = demonstrated anti-c • This disproved a preference for ABO cells (rare)

  14. Conclusions • Autoantibody reactivity in this case was enhanced when tested with • Reagent red cells (re-suspended in diluent) • Autoantibody not detected when tested with washed cells (donor or panel)

  15. Conclusion • The patient’s sample demonstrated • Anti-c • Warm autoantibody • This is an atypical presentation of an autoantibody……… • Patient received xm compatible E-c-K-S- units

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