Case Study: Jackie Ensley, MLS(ASCP) CM SBB CM Immunohematology - - PowerPoint PPT Presentation

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Case Study: Jackie Ensley, MLS(ASCP) CM SBB CM Immunohematology - - PowerPoint PPT Presentation

Mar 14, 2023 186 likes •467 views

Case Study: Jackie Ensley, MLS(ASCP) CM SBB CM Immunohematology Reference Laboratory Manager Kentucky Blood Center 1 Objectives 1. To discuss a case study which required more complex antibody detection and identification 2. To review

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SLIDE 1

Case Study:

Jackie Ensley, MLS(ASCP)CMSBBCM

Immunohematology Reference Laboratory Manager Kentucky Blood Center

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SLIDE 2

Objectives

  • 1. To discuss a case study which required more

complex antibody detection and identification

  • 2. To review different methods of antibody

detection

  • 3. To discuss the transfusion recommendations

and blood group involved with the case study

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SLIDE 3

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SLIDE 4

HOSPITAL RESULTS

  • April 2017 patient reported to

hospital with no defined antibody pattern:

  • 1+ reactions in gel
  • No reactions in tube at AHG

Needs 2 units

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SLIDE 5

PATIENT HISTORY

  • Female, 45 years old, Caucasian
  • Last Transfusion in 2014
  • History: B Positive
  • No blood bank history at any of the larger surrounding hospitals
  • Previously had non-specific gel reactivity
  • Hgb 6.2
  • Patient diagnosis includes anemia and cellulitis left leg

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SLIDE 6

ABO/Rh performed DAT Performed

Anti-A Anti-B Anti-D A1 Cell B Cell ABO/Rh 4+ 4+ 4+ B Positive Poly/tube Anti-IgG/ tube Anti-C3/ tube 0√ 0√ 0√

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Reference Lab testing

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SLIDE 7

Reference Lab testing Phenotyping

Be sure to rule out anti-f, -K, -Fyb, -Jkb, -Leb, -M, -s

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Rh System Kell Duffy Kidd Lewis P MNS

D C c E e K Fya Fyb Jka Jkb Lea Leb P1 M N S s + + + + + 0 + + + + 0 + + 0

Most likely R1R2

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SLIDE 8

Reference Lab Testing – Plasma

Rh System Kell Duffy Kidd Lewis P MNS Lutheran

IS AHG-PeG

Cell

D C c E e V Cw K k Kpa Kpb

Jsa Jsb Fya

Fyb

Jka Jkb Lea

Leb P1 M N S s Lua Lub

I

+ + 0 0 + 0 0 + + 0 + 0 + + 0 + 0 0 + + 0 + + + 0 +

1+

II

+ 0 + + 0 0 0 0 + 0 + 0 + + + + + + 0 + + + + 0 0 +

0 0

AC

0 0 8

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SLIDE 9

Reference Lab Testing – Plasma

Rh System Kell Duffy Kidd Lewis P MNS

IS

AHG- PeG Cell

D C c E e K k Kpa

Kpb Jsa Jsb Fya Fyb Jka Jkb Lea Leb P1 M N

S s

1

0 0 + 0 + 0 + 0 + 0 + 0 0 + 0 0 + + 0 + 0 0 0

0

2

+ + 0 0 + 0 + 0 + 0 + 0 + + 0 + 0 0 + + 0 + 0

0

3

0 0 + + 0 + 0 0 + 0 + 0 + 0 + + 0 0 0 + 0 + 0

0

4

0 0 + 0 + 0 + 0 + 0 + + 0 + 0 + 0 + + 0 0 + 0

0

5

+ + 0 0 + + + 0 + 0 + + 0 0 + 0 + + 0 + 0 + 0

0

6

0 0 + 0 + 0 + 0 + 0 + + 0 + 0 0 + 0 + 0 + 0 0

0

Auto + + + + + 0 + 0 + 0 + 0 + 0 + + 0 0

0

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SLIDE 10

Reference Lab Testing – Plasma

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Rh System Kell Duffy Kidd Lewis P MNS Lutheran

GEL Cell

D C c E e K k Kpa

Kpb Jsa Jsb Fya Fyb Jka Jkb Lea Leb P1

M N S s

Lua Lub

1

+ + 0 0 + 0 + 0 + 0 + + + + 0 + 0 + + + + + 0 +

1+

2

+ + 0 0 + 0 + 0 + 0 + + + 0 + 0 + + + 0 + 0 0 +

2+

3

+ 0 + + 0 0 + 0 + 0 + 0 0 + 0 0 + + + 0 + + + +

3+

4

+ 0 + 0 + 0 + 0 + 0 + 0 + + 0 0 0 + 0 + + + 0 +

1+

5

0 + + 0 + 0 + 0 + 0 + + + + + + 0 + + + + + 0 +

1+

6

0 0 + + + + + 0 + 0 + + 0 0 + 0 + 0 + 0 + + 0 +

3+

7

0 0 + 0 + + + 0 + 0 + 0 + + + + 0 0 + 0 0 + 0 +

3+

8

0 0 + 0 + 0 + 0 + 0 + 0 + 0 + 0 + + + 0 + + 0 +

2+

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0 0 + 0 + 0 + 0 + 0 + + 0 + + 0 + 0 0 + 0 + 0 +

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0 0 + 0 + 0 + 0 + 0 + 0 + + 0 0 0 + + 0 + 0 0 +

2+

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+ 0 + 0 + + + 0 + 0 + 0 + + + + 0 + + 0 + + 0 +

1+

Auto + + + + + 0

+ 0 + 0 + 0 + 0 + + 0

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SLIDE 11

Reference Lab Testing – Plasma

Rh System Kell Duffy Kidd Lewis P MNS

AHG- PeG GEL Cell

D C c E e K k Kpa

Kpb Jsa Jsb Fya Fyb Jka Jkb Lea Leb P1 M N

S s

1

0 0 + 0 + 0 + 0 + 0 + 0 0 + 0 0 + + 0 + 0 0 0

3+

2

+ + 0 0 + 0 + 0 + 0 + 0 + + 0 + 0 0 + + 0 + 0

3+

3

0 0 + + 0 + 0 0 + 0 + 0 + 0 + + 0 0 0 + 0 + 0

3+

4

0 0 + 0 + 0 + 0 + 0 + + 0 + 0 + 0 + + 0 0 + 0

1+

5

+ + 0 0 + + + 0 + 0 + + 0 0 + 0 + + 0 + 0 + 0

2+

6

0 0 + 0 + 0 + 0 + 0 + + 0 + 0 0 + 0 + 0 + 0 0

3+

Auto + + + + + 0 + 0 + 0 + 0 + 0 + + 0 0

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Additional cells are tested in the gel and range from 1+ to 3+ as well

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  • Let’s look at what we know:
  • Phase of reactivity: AHG
  • Strength/pattern of reactivity: almost all reactive,

different strengths, weak in tube reacts best in gel

  • Patient history: previous history of non-specific gel

reactivity

  • DAT/autocontrol: negative
  • Other info: B+

Serologic Problem Solving

So where do we go at this point?

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SLIDE 13
  • Test phenotypically similar cell - negative for f,

Fyb, Jkb, Leb, M, s Positive

  • Alloadsorption attempted

Unsuccessful

  • Test with ficin treated cells

Negative

  • Test with 0.2M DTT treated cells

Positive

Serologic Problem Solving

So where do we go at this point?

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SLIDE 14

Gerbich antibody Chido/Rodgers antibody

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Testing Results Ficin / papain - Sensitive DTT 0.2M - Resistant Almost all cells reactive Different reaction strengths Does not adsorb out Reacts best in gel, not very well in tube

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SLIDE 15

Pooled Plasma Inhibition

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Pooled Plasma Inhibition

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Original plasma reactivity Control plasma reactivity (6% albumin) Pooled plasma reactivity

1+ 1+ 1+ 1+

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SLIDE 17

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Great!

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SLIDE 18

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Gotcha!

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SLIDE 19

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SLIDE 20

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Anti-Ch

IgG

Class

IAT

Optimal

>90%

Occurrence

FICIN

SENSITIVE

DTT

RESISTANT

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SLIDE 21

Chido/Rodgers

Fun Fact: Named after the first antibody producers, Chido and Rodgers.

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From Human Blood Groups by Geoff Daniels

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SLIDE 22

Chido/Rodgers - “HTLA”

  • Reacts with majority of panel cells
  • Frequently described as “reactive weakly by the

antiglobulin test.”

– Reactions are very weak and will break apart very readily due to the weak attraction between the antigens and antibodies (low avidity). – Repeated reactions may be irreproducible and not give the same strength or reactivity

  • However, reactions of at least 1-2+ have also

been seen using gel technique.

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SLIDE 23

Chido/Rodgers - “HTLA”

  • These antibodies are not clinically significant
  • Weak reactivity with high titers >64 are

characteristic, but titers below 64 have also been seen.

**A high titer does not give us a specificity, but can help the lab determine if they are on the right track with identification**

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SLIDE 24

Chido/Rodgers - “HTLA”

  • Usually negative DAT, but each patient is

different with unique history, diagnosis and treatment plans

  • Reaction pattern suggests an antibody to a

high-frequency antigen, and all or most cells are reactive at IgG.

  • Reactions do not seem to fit a specific

antibody or combination of antibodies pattern

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SLIDE 25

Chido/Rodgers - “HTLA”

  • 1-2 phenotypically similar cells are run and are

reactive

  • Theoretically should not adsorb out of the

plasma because of the low-avidity of the antibody

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SLIDE 26

Transfusions

  • Antibody is not clinically significant
  • Give compatible RBCs if able to but due to

high prevalence of antigen may not be able to find crossmatch compatible

  • May rarely see anaphylactic reactions with

plasma products + platelets

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SLIDE 27

Resources

  • Reid, Marion and Christine Lomas-Francis (2012). The Blood Group

Antigen FactsBook, Elsevier.

  • Daniels, G. (2013) Human Blood Groups, 3rd edition, Wiley-

Blackwell, Oxford, UK. Email me at jensley@kybloodcenter.org

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