1. Case Study: Weird Wonderful Walter
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 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 Completed Crossmatches
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 This is an atypical presentation of an autoantibody………
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