Background/Case Studies: A 68-year-old, African American male was submitted for routine pre-op antibody identification and crossmatch compatible red cell units. The patient presented with a current diagnosis of paroxysmal atrial tachycardia and adrenal gland disorder. The patient had no previous history in the reference lab and was not transfused within the last 3 months.
Study
Design/Methods: The serological results from the initial patient testing displayed panreactivity with all panel cells tested at immediate spin and AHG with all enhancements, a negative direct antiglobulin test and negative autocontrol. It was suspected that the patient had developed an antibody against a high incidence antigen. The patient’s red cells were tested against several in-house antisera and submitted for Human Erythrocyte Assay (HEA) BeadChip genotyping to determine if the patient was negative for any high incidence antigens. RHCE and RHD BeadChip testing was also performed on the patient sample.
In addition, the patient sample was tested against several chemically treated phenotype matched red cells, allogeneic adsorptions were also performed. A cold panel was performed as well, including autocontrol and cord cells. A subsequent patient sample had the plasma treated with 0.01 M DTT and autologous cold adsorptions were performed as well to determine clinal significance of the antibody.
Results/Findings: The HEA and serological results did not reveal the patient to be negative for any high incidence antigens. The RHD BeadChip did not reveal any variants however the RHCE BeadChip showed the patient’s genotype to be RHCE*cE/ce(733G) translating to a partial e antigen. The initial allogeneic adsorption which was performed allowed exclusion of all commonly encountered alloantibodies; however, the possibility of a high incidence antibody persisted. The last procedure performed on this sample was the cold panel which showed reactivity with all cells tested; including the autocontrol and cord cells. No units were issued at this time as the patient’s surgery was rescheduled to a later date.
On the subsequent sample, the 0.01M DTT treatment of the plasma removed all reactivity. Additionally, the autologous adsorption also removed all reactivity; allowing all commonly encountered alloantibodies and high incidence antibodies to be excluded.
Conclusions: All initial testing indicated the possibility of a high incidence antibody being present. Several techniques had to be employed in order to determine the nature of the patient’s antibody. The serological testing results revealed that the patient had developed a strong cold auto-antibody.
