Drylab patients



TECHNICAL CASE STUDIESCase #“ANSWER”COMMENT: Teaching pointsFEATURED CASES#19-01Multiple antibodies, all cells reactiveThe approach to multiple antibody cases; additional strategies when panel cells are limited.#19-02All cells reactive due to anti-kThe approach to panagglutinin cases; strategies for identifying antibodies against high-prevalence antigens.ANTIBODY IDENTIFICATION (ABID); BASIC PROBLEMSABID #1Anti-KStraight-forward single antibody; discuss criteria for proof of antibody specificity; discuss Kell blood group system.ABID #2Anti-EStraight-forward single antibody; discuss criteria for proof of antibody specificity; discuss Rh blood group system.ABID #3Anti-DStraight-forward single antibody; discuss ruling out anti-C and -E in the presence of anti-D, as well as anti-K.ABID #4Anti-cStraight-forward single antibody; discuss criteria for proof of antibody specificity and selection of rule-out cells.ABID #5Anti-FyaSingle antibody specificity with weak reactivity; discuss use of different methodologies; discuss Duffy blood group system.ABID #6Anti-JkaConfusing pattern due to weak antibody; discuss use of different methodologies; discuss Kidd blood group system.ABID #7Anti-SStraight-forward single antibody; discuss selection of rule-out cells and MNSs blood group (BG) system.ABID #8Anti-M cold-reactiveNon-straightforward case due to dosage; use of pre-warmed technique to determine clinical significance; M & N BG discussion.ABID #9Anti-Lea& -LebCase with multiple antibody specificities; use of neutralization to identify BG antibodies; discussion of Lewis BG system.ABID #10Anti-P1Non-straightforward case identification due to antigen variation; use of pre-warmed technique; "P1/Pk/P" blood group system.ABID #11Anti-LuaPresentation of an antibody against a low-prevalence antigen; Lutheran blood group system discussion.ABID #12Anti-KpbPresentation of an antibody against a high-prevalence antigen including differential diagnosis of a pan-agglutinin.ABID #13Anti-E & -KPresentation and investigation of multiple antibodies.ABID #14Cold auto-antibodyCase presenting as a positive immediate spin crossmatch after a negative antibody screen and requiring urgent identification.ANTIBODY IDENTIFICATION (ABID); ADVANCED PROBLEMSABID #15Anti-E, DHTRWeak antibody developing after transfusion and showing dosage effect complicating its interpretation.ABID #16Anti-D and anti-K Non-specific pattern of antibody specificity due to weak antibodies identified by increased gel incubation time. ABID #17Method-dependent antibodyPresentation of a non-specific pattern of antibody reactivity by the gel method and its resolution.ABID #18Gel nonspec ab plus anti-Fya Illustration of the use of different techniques to sort out a complex case including non-specific, method dependent reactivity.ABID #19Anti-Fya & -K & cold-autoApproach to a case with all cells reactive due to multiple antibodies, allo- and auto-, including the usefulness of tube methods.ABID #20Anti-D & -E, D pos pt.Anti-D in a patient with partial D demonstrated by antibody from a similar partial D individual.ABID #21Anti-D, D pos pt.Anti-D in a patient with partial D demonstrated by monoclonal panel.ABID #22Anti-Fya & -SCase with multiple alloantibodies requiring additional investigation.ABID #23Anti-Fya & -VCase with multiple alloantibodies; one common, one against low freq. ag.ABID #24Anti-E, -c, -Jkb & -KComplex multiple antibody case with most cells reactive . ABID #25Anti-c, -Fya, & anti-plex multiple antibody case with all cells reactive. in initial testing.ABO DISCREPANCIESABO-Dsc #1Anti-P1ABO discrepancy due to unexpected, cold-reactive alloantibodyABO-Dsc #2AB with anti-A1ABO discrepancy due to anti-A1 in an A2B patientABO-Dsc #3Cold-reactive autoantibodyABO discrepancy due to unexpected cold-reactive autoantibodyABO-Dsc #4Bruton’s agammaglobulinemiaABO discrepancy due to missing expected antibodiesABO-Dsc #5A3 subgroup of group AABO discrepancy due to weak expression of antigenABO-Dsc #6Group A recipient of group O transplantABO discrepancy due to hematopoietic cell (HPC) transplantationABO-Dsc #7Acquired B antigenABO discrepancy due to unexpected antigen reactivityAUTOANTIBODIESAutoab #1Warm auto-ab. with underlying anti-JkaUse of auto-adsorption to rule out allo-antibody underlying a warm-reactive autoantibodyAutoab #2Warm auto-ab. on the cells only Warm auto-immune hemolytic anemia (WAIHA) without detectable antibody in the plasmaAutoab #3Warm auto-ab. with anti-C specificityWarm-reactive autoantibody with obvious specificity for a blood group on the patient’s cellsAutoab #4Warm auto-ab. mimicking anti-EWarm-reactive autoantibody with obvious specificity for a blood group NOT on the patient’s cellsAutoab #5Warm auto-ab. in Gel; non-reactive in LISS/IAT method.Sensitivity of gel and PEG techniques for warm-autoantibodies; difficulty defining auto- vs. alloantibody in a transfusion-dependent patient; usefulness of multiple techniques.Autoab #6Cold auto-ab. with anti-M specificityCold-reactive autoantibody with specificity for a blood group on the patient’s cellsAutoab #7Cold autoanti-I, non-reactive with patient’s initial specimenThe importance of specimen collection for determining the thermal amplitude of a significant cold-reactive autoantibody.Autoab #8Positive DAT, non-reactive eluateThe differential diagnosis of a positive DAT with a negative eluate and rouleaux phenomenonAutoab #9False negative DATThe importance of testing a DAT performed by tube technique immediately and after 5 min. incubationHDFN (Investigation of antibodies found in pregnant women)HDFN #1Anti-FyaCase illustrating use of father's antigen typing for resolution.HDFN #2Passive anti-D due to RhIGCase showing expected findings at delivery after Rh immune globulin administration.HDFN #3Anti-Jk3Identification of an antibody against a high frequency antigen with discussion of options at delivery.HDFN #4Anti-MIllustration of "prozone" phenomenon in antibody titration, and management of anti-M in pregnancyHDFN #5Anti-GIllustration of recognition and importance of anti-G in pregnancy, including demonstration by adsorption. CLINICAL CASE STUDIESCASE TITLECOMMENT: Teaching pointsAUTOIMMUNE HEMOLYTIC ANEMIA (AIHA)A Patient with a High Reticulocyte CountClassic, severe warm autoimmune hemolytic anemia (WAIHA) with relapse after discontinuing steroidsA Blood Banker's Nightmare Fatal WAIHA with emergency transfusion; auto-anti-SC1A 6 Month Old Girl with Hemolytic Anemia WAIHA in a childAcute Hemolytic Anemia in a 15 year oldCold autoimmune hemolytic anemia (CAIHA) due to autoanti-i associated with EBV infectionA New Panagglutinin in a Transfusion-Dependent PatientAntibody against a high-frequency antigen (AnWj) mimicking a warm autoantibody in a transfusion –dependent patientHEMOLYTIC DISEASE OF THE FETUS AND NEWBORN (HDFN)Everything You Need to Know About HDFN in One Case Study As the title indicates regarding Rh disease.HDFN Due to Anti-D and Anti-CA case of Rh HDFN with sensitization due to the parent’s IV drug useIcterus PraecoxHDN with a negative maternal antibody screen due to an antibody against a low-frequency antigen.Erythroblastosis without an Obvious CauseHDN with a negative maternal antibody screen due to an antibody against a low-frequency antigen.Severe HDN with a Negative Maternal Antibody ScreenSevere ABO HDN.TRANSFUSION REACTION CLINICAL CASE STUDIES:The Worst Pain I've Ever Had A severe ABO immediate hemolytic reaction (IHTR) due to patient misidentification.Fatal IHTR due to an ABO MismatchAn ABO mismatched transfusion with occult but still significant complications in an impaired patient.IHTR in a Patient with a Negative Antibody Detection TestAn IHTR due to an antibody directed against a low-frequency antigen.Fatal IHTR due to Anti-DibFatal hemorrhage in a patient with an antibody against a high frequency antigen that caused an IHTR.A Febrile Reaction in a Woman with Anti-FyaAn IHTR due to a non-ABO antibody caused by clerical error and presenting with fever.Hemolysis after Platelet TransfusionA severe IHTR in a group A woman who received group O single donor platelets.Red Urine in a Recently Transfused WomanA DHTR due to anti-U and other antibodies.Hemoglobinuria in the Operating RoomNon-immune hemolysis of RBCs mimicking an IHTR.Fever after Directed RBCsA woman with a febrile, non-hemolytic reaction (FNHTR) due to transfusion of her son’s RBCsTransfusion Complicated by ShockTransfusion-related anaphylaxis.Jaundice and Rash 24 Days after Cardiac surgeryTransfusion-associated graft-versus-host disease (TA-GVHD) in a NON-immunocompromised patient A Transfusion-Related Respiratory EventFatal transfusion-related acute lung injury (TRALI)Pulmonary Edema after Rapid Transfusion of FFPTransfusion-associated circulatory overload (TACO) after 2 units of FFPDRUG-INDUCED IMMUNE HEMOLYTIC ANEMIA (DIIHA)Hemolysis after ChemotherapyAcute hemolytic reaction due to carboplatin-dependent antibody; initial findings mimicking AIHAFatal Hemolysis in a Woman 13 Days PostpartumFatal hemolysis after repeat administration of drugPATIENTS WITH SICKLE CELL DISEASEPost-op, Post-Transfusion Painful Crisis in a Patient With Sickle Cell DiseaseA DHTR due to anti-C + anti-ERespiratory Failure in a Patient with Sickle Cell DiseaseRBC exchange in a patient with multiple antibodies including anti-Jsb identified with the help of AET treatment of panel RBCs ................
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