Question: CASE 2 Jane S. Was Admitted For A Redo Of A Hip Arthroplasty And Had An Order For 2 U Of Packed RBCs. She Received 2 U Of Packed RBCs 1 Year Prior When She Had The Original Hip Surgery. Jane Typed As A Positive, And A Review Of Her Transfusion History Found No Prior History Of Alloantibodies. She Was Transfused With 1 U Of Packed RBCs During Surgery. …

CASE 2 Jane S. was admitted for a redo of a hip arthroplasty and had an order for 2 U of packed RBCs. She received 2 U of packed RBCs 1 year prior when she had the original hip surgery. Jane typed as A positive, and a review of her transfusion history found no prior history of alloantibodies. She was transfused with 1 U of packed RBCs during surgery. Review Figure 1-7, antibody screen 1, done on 11/21/00. QUESTIONS 1. Does the antibody screen indicate the presence of any alloantibodies? 2. On 11/28/00, a type and crossmatch were ordered because the patient’s hemoglobin and hematocrit were dropping. Preop hemoglobin and hematocrit 11.9 g/dL (reference range 12 to 16 g/dL): 35.6% (reference range, 37 to 47%) 11/28/00 hemoglobin and hematocrit 8.0 g/dL; 24.1% What is the most likely explanation for the drop in hemoglobin and hematocrit? 3. Review Figure 1-7, antibody screen 2, done on 11/28/00. Does the postoperative antibody screen indicate the presence of any alloantibodies? 4. What is the significance of the positive autocontrol? 5. A direct antiglobulin panel was performed because of the positive auto-control. IS Polyspecfic AHG 1+ Anti-IgG 1+ Anti-C3 0 AHG CC 1+ 1+ 0 3+ a. Explain the results of the direct antiglobulin panel. b. What would you do next? 6. Review Figure 1-8. “Antibody Panel, Case 1-6.” In this case study, antibodies are excluded only if the patient’s serum does not react with panel cells that are homozygous for the antigen. What antibodies cannot be ruled out by the antibody panel in Figure 1-8? 7. Explain the difference in strength of reaction between cells 1,2, and 8 and cells 3,4,9, and 10. 8. What is the most likely antibody identified by the antibody panel in Figure 1-8? 9. How would you rule out the remaining antibodies? 10. An elution was performed on Jane’s RBCs with the following results on the last wash: AHG CC 0 2+ Screening Cell I Screening Cell II 0 2+ Do the reactions of the eluate confirm the antibody identified in question 6(see last column on Fig 1-8)? 11. What type of transfusion reaction is illustrated by this case? What other antibodies are associated with this type of transfusion reaction? 12. Why is the transfusion history so important in working up any type and cross? 13. What other tests would provide useful information in this case? Explain why, and indicate the probable results. Figure 1-7. ANTIBODY SCREENS Antibody Screen 11/21/00 No. Rh Rhesus Kell Duffy Kidd Sex Linked Lewis MNS P Lutheran Leº Less M N P Luº Lu 37 AHGCC + SCI DC Elcle CW v K K KP” Kp Jsºuse Fy Fyº Jkº Jkº Xgº RIR + + OO + O O O + +0 0 0 0 0 0 + 0 0 + + 0 + + 0 0 + 0 + + + 0 + 0 0 3+ ++ 0 + + 0 + + + 0 + + 0 + + 0 RR + 0 0 SCII | Ас 3+ 3+ 0 0 Antibody Screen 2 11/28/00 Duffy No. Rh Rhesus Kell Kidd Sex Linked Lewis MNS P Lutheran Le Less |M N P Lu|LP D C Ece i CW v K K KP” Kp* Jsº Jse Fy” FyJK JkXg RR + 100+ 0 OTO + +10 RR + 0 0 0 0 + 0 + + 0 + 0 0 + + | + + + 0 SCI SCII + ++ ++ 37 AHGCC 0 2+ 0 0 2+ 0 + + 0 0 0 + + + 0 + + 0 + 0 + 0 AC 0 1+ NT: not tested AC: autocontrol | Figure 1-8. ANTIBODY PANEL No. Rh Rhesus Kell Duffy Kidd MNS P Sex Lewis Link Lutheran LISS 37 AHGCC Elution + + 0 0 0 + + + + + 0 + 0 3+ 1+ قانا + 0 + 0 + PL + + + Olo 0 + 0 0 RR + 0 3+ 1+ | ليبيا + 0 + + 0 + + 0 + 0 w 0 0 4 NIN + + 0 + 0 + 0 lol + + + + + + 0 + 0 w 는 + + + + 0 + + + 0 + 0 + 0 + 0 0 2+ 0 lovu DC Ecle i cWv K K Kp”Kpº jsºus FY Fy® JK JK” xgº Le Les s M N P Luº Luº RR + 0 0 + 0 0 0 + 0 + o + + OO 0 0 O + RR + 0 + + 0 0 0 0 0 0 RS + 0 0 0+ 0 10+ 0 0 0 0 0 + 0 0 0 0 + 0 + 0 10+ 1000 + 0 0 0 0 + 0 + 0 0 100 0 10 0 0 + OTO 0 0 0 + 0 + 0+ + 0 0 0 RiR 0 0 0 + 0 0 0 0 0 0 + + + oOo 0 + OO + + + + + + 0 0 0 + + + + + + 0 + 0 0 2+ 0 7 + 0 + + 0 0 + + + + 0 0 0 2+ 0 ELETE 0 0 + O 00 + + + + + + + 0 + + + 0 3+ 1+ 9 + 이 이 이 이 이 + 이 이 이 + + + O Old + 0 + 0 + + + +0+ 0 W + + + + 2+ 2+ 10 rr 0 0 + + 0 + + + 0 0 0 w 11 + | + + + 0 + 0 + 0 + + 0 + 0 + + + + 0 0 2+ 0 AC 0 1+ w weak