“There’s a resident, do we crossmatch for an A1?” Brian Adkins, M.D. 7/15/16

Story Presented Patient has an A1 antibody Tech is alerted by Soft to perform crossmatch Question comes to resident

Literature review A1 A2 differ in quantity as well as quality Fewer A antigens on A2 A2 allele has single amino acid change most commonly leading to extra residues at COOH end 1-8% of A2 individuals develop A1 antibodies ~30% A2B individuals Anti-A1 does not typically cause hemolytic reactions Hemolysis and organ rejection have been described Crossmatch compatible units of A2 or O should be transfused Shaz et al. 2013

The Whole Story A Rh positive patient DAT positive (IgG 2+, C3d 1+) Anti A1 in the eluate only Plasma screen is negative What’s happening?

Passive Antibody Transfer Patient received out of group platelets at outside institution 2 O Rh positive platelets at Cookeville Regional Medical Center on 6/30/16 History of antibody requires crossmatch compatible blood in Soft

Transfusion of Incompatible Plasma Most often occurs in out of group platelets Most commonly group O to a group A recipient Apheresis platelets contain ~200 ml of plasma Rarely associated with non group O platelets Leads to a positive DAT Rarely associated with overt hemolysis Prevention ABO-compatible products Washed platelets Shaz et al. 2013 Yuan 2011

Bibliography Shaz, Beth, Christopher D. Hillyer, Charles Samuel Abrams, and Mikhail Roshal. Transfusion Medicine and Hemostasis: Clinical and Laboratory Aspects. N.p.: n.p., n.d. Print. Yuan, Shan. "PLATELET PRODUCTS." (n.d.): n. pag.Http://pathology.ucla.edu/workfiles/2-3-Platelet-Products.pdf. 23 Feb. 2011. Web.