Handouts - Immucor Program Handouts/Weak... · 2017. 1. 11. · 1/11/2017 5 Presentation Objectives • Introduce and explore recent literature related to antibody identification

1/11/2017

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All Content © 2015 Immucor, Inc. All Content © 2015 Immucor, Inc.

Jayanna Slayten, MS, MT(ASCP)SBBCM

Transfusion Medicine Pathology Laboratory

Indiana University Health

Finding Strength In Weak Reactions

All Content © 2015 Immucor, Inc. All Content © 2015 Immucor, Inc. All Content © 2015 Immucor, Inc.

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1/11/2017

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Continuing Education

• PACE, California DHS

– 437-300-17

• Florida BPR

– 20-583504

• 1.0 Contact Hours



• Each attendee must register to receive CE at:

– https://www.surveymonkey.com/r/UserGrpWebinar



• Registration deadline is January 27,

2017

• Certificates will be sent via email only to

those who have registered by February

10, 2017

https://www.surveymonkey.com/r/UserGrpWebinar

1/11/2017

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Other

• Session will be recorded and posted.

– Access information will be sent to each

registrant when the recording becomes

available

• No CE issued for participating in recording


Q&A

• You are all muted

• Q&A following

session

o Type in

questions


• Capture-R®, Ready-Screen®, Ready-ID®, Echo®

and NEO® are registered trademarks of

Immucor, Inc.

• Course content is for information and illustration

purposes only. Immucor makes no

representation or warranties about the accuracy

or reliability of the information presented, and

this information is not to be used for clinical or

maintenance evaluations.

1/11/2017

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• The opinions contained in these case studies

are those of the presenter and do not

necessarily reflect those of Immucor.

All Content © 2015 Immucor, Inc. All Content © 2015 Immucor, Inc.

Jayanna Slayten, MS, MT(ASCP)SBBCM

Transfusion Medicine Pathology Laboratory

Indiana University Health

1/11/2017 12

Immucor User Group Webinar 1/11/17

Finding Strength In Weak Reactions

Jayanna Slayten, MS, MT(ASCP)SBBcm

Indiana University Health Transfusion Services, Med Tech II

and University of Texas Medical Branch SBB Program, Instructor

1/11/2017

5

Presentation Objectives

• Introduce and explore recent

literature related to antibody

identification advantages and

disadvantages

• Explain and evaluate case

studies for weak antibody

reactivity

• Discuss serologic strategies

for addressing weak

reactions in antibody

identification

1/11/2017 13

1/11/2017 14

Outline of Presentation

•Antibody identification

limitations and challenges

•Case A

•Case B

•Case C

1/11/2017 15

Antibody Identification

Pitfalls

Antibodies

DO NOT

follow the

rules!

1/11/2017

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Examples of

Antibody Pitfalls Reference Summary

Immunohematology 2001; 17(1);14-16 SPRCA vs PeG-AHG

Automation compared to tube

Transfusion 2009; 49;505-512 Waxing and Waning of Antibodies

Approximately 2/3 of antibodies

disappear within 5 years after

identification

Transfusion 2010;50;617-621 Evaluations of false negative results and

risk analysis

Immunohematology 2013;29;101-104. SPRCA vs Column Agglutination

Method comparison with assessment of

DHTR or HTR risk analysis

Immunohematology 2011; 27;146-150 Determination of best technique for IRL

Benefits and Challenges

1/11/2017 16

Antibody Pitfalls

• Antibodies are more

reactive in some methods

and not in others

– Anti-Leb

• Transfusion 2015;55-2486-

2488

– Anti-Jka

• Transfusion 2016;56;2973-

2979

– RhIg

• Transfusion 2015;55;1444-

1450

1/11/2017 17

All in balance

1/11/2017 18

1/11/2017

7

Case Studies

Case A

Case B

Case C

1/11/2017 19

Case A

• Patient

– 55 year old female arrives in ED with SOB, joint

and back pain

– No history at your facility

• Current Lab order

– CBC

– PT/PTT

– Chemistry Panel

1/11/2017 20

Case A Lab Results

– CBC

• WBC 6.2 x 109/l Normal with normal WBC morphology

• Hgb 6.6 g/dL Low

• Plt 117 x 109/uL Normal

– PT and PTT • Normal Range Normal

– Chemistry Panel

• Chemistry Panel Creatinine, Calcium and Albumin Normal

• Total Serum Protein 98g/dl Elevated

– Requested additional testing

» Electrophoresis

» Bone Marrow

» X-rays

1/11/2017 21

1/11/2017

8

Capture-R® Ready-Screen® *= presumptive

Rh Kell Duffy Kidd Lewis P MNS Lu Xg

Cell D C c E e f* V Cw K k Kpa Kpb J sa J sb Fya Fyb Jka Jkb Lea Leb P1 M N S s Lua Lub Xga Echo

1 + + 0 + + 0 0 0 + + 0 + 0 + + + + 0 0 + + 0 + + + 0 + + 1+

2 + 0 + + 0 0 0 0 0 + 0 + 0 + + 0 0 + 0 + + + + 0 + 0 + + 1+

3 0 0 + 0 + + 0 0 0 + 0 + 0 + 0 + + + + 0 0 + 0 + 0 0 + + 1+

Pos

Cntrl 4+ Neg

Cntrl 0

1/11/2017 22

Case A

Capture-R ® Ready-ID® Panel *= presumptive

1/11/2017 23



1 + + 0 + + 0 0 0 0 + 0 + 0 + + 0 0 + + w + + + 0 + 0 + + 1+

2 + + 0 0 + 0 0 + 0 + 0 + 0 + + + + 0 + 0 + + + 0 + 0 + 0 1+

3 + 0 + + 0 0 0 0 0 + 0 + 0 + + + 0 + 0 + 0 0 + 0 + 0 + + 1+

4 + 0 + 0 + + 0 0 0 + 0 + 0 + 0 0 + 0 0 + + + + + 0 0 + 0 1+

5 0 + + 0 + + 0 0 0 + 0 + 0 + + 0 0 + 0 + + + 0 + 0 0 + + ?

6 0 0 + + + + 0 0 0 + 0 + 0 + + 0 + 0 0 + + 0 + 0 + 0 + + 1+

7 0 0 + 0 + + 0 0 0 + 0 + 0 + 0 + 0 + + 0 0 + + + + 0 + + 1+

8 0 0 + 0 + + 0 0 + + 0 + 0 + 0 + + + 0 + 0 + + + + + + + 1+

9 0 0 + 0 + + 0 0 0 + 0 + 0 + + 0 + 0 0 + + + 0 + + 0 + + 1+

10 0 0 + 0 + + 0 0 0 + + + 0 + + + + + 0 0 + + 0 + 0 0 + + ?

11 0 0 + 0 + + 0 0 0 + 0 + 0 + 0 + + 0 + 0 0 0 + 0 + 0 + + 1+

12 0 0 + 0 + + 0 0 + + 0 + 0 + + 0 0 + 0 + + 0 + 0 + 0 + + 1+

13 0 0 + 0 + + 0 0 0 + 0 + 0 + + 0 + 0 + 0 + + + 0 + 0 + + 1+

14 + + 0 0 + 0 0 0 + + 0 + 0 + + + + 0 0 0 + 0 + 0 + 0 + 0 ?

Pos

Cntrl 4+ Neg Cntrl 0 Case A

Capture –R ® Ready-ID® Panel *= presumptive

• Any Pattern observed?

• Review all the results

– Do you agree?

• Manual read the result

– Does that change your

next step

1/11/2017 24


Cell D C c E e f* V Cw

K k Kp

a

K

p

b

J

s

a

J

s

b

Fy

a

Fy

b

Jk

a

Jk

b

Le

a

Le

b

P1

M N S s Lu

a

L

u

b

X

g

a

Echo

5 0 + + 0 + + 0 0 0 + 0 + 0 + + 0 0 + 0 + + + 0 + 0 0 + + ?

10 0 0 + 0 + + 0 0 0 + + + 0 + + + + + 0 0 + + 0 + 0 0 + + ?

14 + + 0 0 + 0 0 0 + + 0 + 0 + + + + 0 0 0 + 0 + 0 + 0 + 0 ?

Pos

Cntrl 4+ Neg

Cntrl 0 Case A

1+

1+

1+

1/11/2017

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Case A – Stop and Ponder

•Weak reactions with ABS and

Ready-Id

–Run another Echo Panel

–Run another method/Add DAT

OR

Get more patient information

1/11/2017 25

Capture-R® Ready-ID ® Extend I (D-Positive Panel)

*= presumptive

1/11/2017 26



1 + + 0 0 + 0 0 + 0 + 0 + 0 + 0 + + 0 0 + 0 + + + + 0 + + 1+

2 + + 0 0 + 0 0 0 0 + 0 + 0 + + 0 0 + 0 + 0 0 + 0 + 0 + 0 1+

3 + + 0 0 + 0 0 0 0 + 0 + 0 + 0 + + 0 + 0 + + 0 + 0 0 + + 1+

4 + + 0 0 + 0 0 0 + + 0 + 0 + + 0 0 + 0 + 0 + 0 + + 0 + + 1+

5 + + 0 0 + 0 0 0 0 + 0 + 0 + + 0 + + 0 + + 0 + + + 0 + + 1+

6 + + 0 0 + 0 0 0 + + + + 0 0 0 + + 0 0 0 + + + 0 + 0 + + 1+

7 + + 0 0 + 0 0 0 0 + 0 + 0 + + + + 0 0 + 0 + 0 + 0 0 + + 1+

8 + 0 + + 0 0 0 0 0 + 0 + 0 + + 0 + 0 0 + + + + + + 0 + + 1+

9 + 0 + + 0 0 0 0 0 + 0 + 0 + 0 + + + 0 + + + + + 0 0 + 0 1+

10 + 0 + + 0 0 0 0 + + 0 + 0 + + + + + 0 + + + 0 + + 0 + + 1+

11 + 0 + + 0 0 0 0 0 + 0 + 0 + 0 + 0 + + 0 + + 0 0 + 0 + 0 1+

12 + 0 + + 0 0 0 0 + + 0 + 0 + + 0 0 + 0 + + + 0 + + 0 + + 1+

13 + 0 + + 0 0 0 + 0 + 0 + 0 + 0 0 + 0 + 0 + 0 + 0 + 0 + 0 1+

14 + w + + 0 0 0 0 0 + 0 + 0 + 0 + + 0 0 0 + 0 + 0 + 0 + + 1+

Pos

Cntrl 4+ Neg Cntrl 0 Run Another Echo Panel

Case A - Run another method

• Run PeG-AHG Screen and LISS-AHG Screen

I II III AutoCntrl

– PeG-AHG 1+ 1+ 1+ 0√

– LISS-AHG w+ w+ w+ 0√

• Run IgG DAT

– IgG DAT Negative

– DAT Cntrl Negative

1/11/2017 27

1/11/2017

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Case A – Get More Information

• Call the floor/or computer search of patient record

– Pregnancy Hx? 2 children

– Transfusion Hx? 6 months ago

– Other Hospitals? Being seen at Cancer Center

– Current Diagnosis Multiple Myeloma (MM)

– Recent Drug History

•MM treated 3 lines of therapy/patient refractory

•Started Daratumumab 12 weeks ago

– Schedule: Week 1-8/Weekly dose, Weeks 9-24/

Biweekly dose and Week 25/Monthly

1/11/2017 28

Case A – History is Fastest Solution • Test patient sample with DTT-treated cells

I II III AutoCntrl


– DTT-LISS-AHG 0√ 0√ 0√ 0√

– DTT treatment Control Valid

• Rule out all common alloantibodies

– All excluded except DTT-sensitive blood groups

• Type the patient

– Rh and K

• Provide Antigen Matched Blood

– K negative at minimum

1/11/2017 29

Case A Lab Results after Transfusion

– CBC

• WBC 8.2 x 109/l Normal with normal WBC morphology

• Hgb 7.6 g/dL Low, but increased as expected

• Plt 101 x 109/uL Normal

– PT and PTT • Normal Range Normal

– Chemistry Panel and Confirmation Testing • Electrophoresis Monoclonal IgA protein 1.5g/dL

• Skeletal survey Occult Lytic lesions in skull and spine

• Bone Marrow biopsy 30% abnormal plasma cells confirmed by stain CD138+

Initial diagnosis of symptomatic Multiple Myeloma

suspected by ED physician confirmed with lab results

and patient’s medical history

1/11/2017 30

1/11/2017

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Case A – Take Away Points

• With weak reactions with Solid Phase or Manual

Testing

– Review your results

– Review any question marks, comparing and calling the

results

• Testing options

– Different solutions to the problem

– One may try many options, but then get to the same

conclusion

• Most efficient is to start with the history

1/11/2017 31

Case B

• 65 year old female patient is scheduled for a

cardiovascular procedure in two days.

• The patient’s pre-surgical labs were drawn today.

• Physician has ordered

– T and S

– MSBOS indicates this procedure requires 2 units

to be available for surgery.

1/11/2017 32

Capture-R ® Ready-Screen ® *= presumptive



1 + + 0 + + 0 0 0 + + 0 + 0 + + + + 0 0 + + 0 + + + 0 + + 1+

2 + 0 + + 0 0 0 0 0 + 0 + 0 + + 0 0 + 0 + + + + 0 + 0 + + 1+

3 0 0 + 0 + + 0 0 0 + 0 + 0 + 0 + + + + 0 0 + 0 + 0 0 + + 1+

Pos

Cntrl 4+ Neg Cntrl 0

1/11/2017 33

Case B

1/11/2017

12

Capture-R® Ready-ID ® *= presumptive



1 + + 0 + + 0 0 0 0 + 0 + 0 + + 0 0 + 0 + + + + 0 + 0 + + 0

2 + + 0 0 + 0 0 + 0 + 0 + 0 + 0 + + 0 + 0 + + + 0 + 0 + 0 0

3 + 0 + + 0 0 0 0 0 + 0 + 0 + + + 0 + 0 + 0 0 + 0 + 0 + + 0

4 + 0 + 0 + + 0 0 0 + 0 + 0 + 0 0 + 0 0 + + + + + 0 0 + 0 1+

5 0 + + 0 + + 0 0 0 + 0 + 0 + + 0 0 + 0 + + + 0 + 0 0 + + 2+

6 0 0 + + + + 0 0 0 + 0 + 0 + + 0 + 0 0 + + 0 + 0 + 0 + + 0

7 0 0 + 0 + + 0 0 0 + 0 + 0 + 0 + 0 + + 0 0 + + + + 0 + + 1+

8 0 0 + 0 + + 0 0 + + 0 + 0 + 0 + + + 0 + 0 + + + + + + + 1+

9 0 0 + 0 + + 0 0 0 + 0 + 0 + + 0 + 0 0 + + + + + + 0 + + 1+

10 0 0 + 0 + + 0 0 0 + + + 0 + + + + + 0 0 + + + + 0 0 + + 1+

11 0 0 + 0 + + 0 0 0 + 0 + 0 + 0 + + 0 + 0 0 0 + 0 + 0 + + 0

12 0 0 + 0 + + 0 0 + + 0 + 0 + + 0 0 + 0 + + 0 + 0 + 0 + + 0

13 0 0 + 0 + + 0 0 0 + 0 + 0 + + 0 + 0 + 0 + + + 0 + 0 + + 0

14 + + 0 0 + 0 0 0 + + 0 + 0 + + + + 0 0 0 + + 0 + 0 0 + 0 0

Pos

Cntrl 4+ Neg Cntrl 0 Case B

1/11/2017 34


1/11/2017 35



K k Kp

a

K

p

b

J

s

a

J

s

b

Fy

a

Fy

b

Jk

a

Jk

b

Le

a

Le

b

P1

M N S s Lu

a

L

u

b

X

g

a

Echo

1 + + 0 + + 0 0 0 0 + 0 + 0 + + 0 0 + 0 + + + + 0 + 0 + + 0

2 + + 0 0 + 0 0 + 0 + 0 + 0 + 0 + + 0 + 0 + + + 0 + 0 + 0 0

3 + 0 + + 0 0 0 0 0 + 0 + 0 + + + 0 + 0 + 0 0 + 0 + 0 + + 0

4 + 0 + 0 + + 0 0 0 + 0 + 0 + 0 0 + 0 0 + + + + + 0 0 + 0 1+

5 0 + + 0 + + 0 0 0 + 0 + 0 + + 0 0 + 0 + + + 0 + 0 0 + + 2+

6 0 0 + + + + 0 0 0 + 0 + 0 + + 0 + 0 0 + + 0 + 0 + 0 + + 0

7 0 0 + 0 + + 0 0 0 + 0 + 0 + 0 + 0 + + 0 0 + + + + 0 + + 1+

8 0 0 + 0 + + 0 0 + + 0 + 0 + 0 + + + 0 + 0 + + + + + + + 1+

9 0 0 + 0 + + 0 0 0 + 0 + 0 + + 0 + 0 0 + + + + + + 0 + + 1+

10 0 0 + 0 + + 0 0 0 + + + 0 + + + + + 0 0 + + + + 0 0 + + 1+

11 0 0 + 0 + + 0 0 0 + 0 + 0 + 0 + + 0 + 0 0 + 0 + 0 0 + + 0

12 0 0 + 0 + + 0 0 + + 0 + 0 + + 0 0 + 0 + + 0 + 0 + 0 + + 0

13 0 0 + 0 + + 0 0 0 + 0 + 0 + + 0 + 0 + 0 + + + 0 + 0 + + 0

14 + + 0 0 + 0 0 0 + + 0 + 0 + + + + 0 0 0 + + 0 + 0 0 + 0 0

Pos

Cntrl 4+ Neg

Cntrl 0 Case B

Case B - Options • All Common alloantibodies are excluded on

non-reactive cells

• What is the reactivity in the ABS and Panel?

– FIRST -- Get more information on the patient

•Learning from last case study!

•Challenge – this is an outpatient sample draw

OR

– Complete IAT Crossmatches and Call Unidentified

OR

– Run another Echo Panel, looking for pattern

OR

– Run another method, add a DAT

1/11/2017 36

1/11/2017

13

Case B – Get More Information


– Pregnancy Hx? 4 children

– Transfusion Hx? Never

– Other Hospitals? None

– Current Diagnosis Mitral Valve Relapse

– Recent Drug History Vitamins, Lipitor, Aspirin

1/11/2017 37

Case B – Crossmatch for Compatibility

• Take Group A units and XM by IS and AHG

– Advantage:

•Find units for procedure scheduled

•If units are incompatible, then the incompatible

crossmatch may aid in the antibody

definition/characteristics

– Disadvantage:

•No clear answer to reactivity detected in the

panel testing

•One may not find compatible units, and this may

have wasted tech time

1/11/2017 38

Case B – XM and Call Unidentified • Calling an antibody unidentified

– Advantage

•All common alloantibodies are excluded on non-

reactive cells

•The AHG-crossmatch may be used as an indicator

of transfusion safety

– Disadvantage

•That unidentified will stay in the patient’s record

going forward

•Always receive AHG crossmatch

•Delay in provision of blood

1/11/2017 39

1/11/2017

14

Case B – Crossmatch for Compatibility

• Example

1/11/2017 40

DIN IS Echo Interpretation Comments

Unit 1 0 0 Compatible

Unit 2 1+ 0 Incompatible

Unit 3 1+ 0 Incompatible

Unit 4 1+ 1+ Incompatible

Unit 5 1+ 1+ Incompatible

Unit 6 0 1+ Incompatible

Capture-R® Ready-ID ® Extend I (D-Positive Panel)

*= presumptive

1/11/2017 41



K k Kp

a

K

p

b

J

s

a

J

s

b

Fy

a

Fy

b

Jk

a

Jk

b

Le

a

Le

b

P1

M N S s Lu

a

L

u

b

X

g

a

Echo

1 + + 0 0 + 0 0 + 0 + 0 + 0 + 0 + + 0 0 + 0 + + + + 0 + + 1+

2 + + 0 0 + 0 0 0 + + 0 + 0 + + 0 0 + + 0 0 0 + 0 + 0 + 0 0

3 + + 0 0 + 0 0 0 0 + 0 + 0 + 0 + + 0 + 0 + + 0 + 0 0 + + 1+

4 + + 0 0 + 0 0 0 + + 0 + 0 + + 0 0 + 0 + 0 + 0 + + 0 + + 1+

5 + + 0 0 + 0 0 0 0 + 0 + 0 + + 0 + + 0 + + 0 + + 0 0 + + 0

6 + + 0 0 + 0 0 0 + + + + 0 0 0 + + 0 0 0 + + + 0 + 0 + + 1+

7 + + 0 0 + 0 0 0 0 + 0 + 0 + + + + 0 0 + 0 + 0 + 0 0 + + 1+

8 + 0 + + 0 0 0 0 0 + 0 + 0 + + 0 + 0 0 + + + + + + 0 + + 0

9 + 0 + + 0 0 0 0 0 + 0 + 0 + 0 + + + 0 + + + + + 0 0 + 0 1+

10 + 0 + + 0 0 0 0 + + 0 + 0 + + + + + 0 + + + 0 + + 0 + + 1+

11 + 0 + + 0 0 0 0 0 + 0 + 0 + 0 + 0 + + 0 + + 0 0 + 0 + 0 1+

12 + 0 + + 0 0 0 0 + + 0 + 0 + + 0 0 + 0 + + + 0 + + 0 + + 1+

13 + 0 + + 0 0 0 + 0 + 0 + 0 + 0 0 + 0 + 0 + + 0 0 + 0 + 0 1+

14 + w + + 0 0 0 0 0 + 0 + 0 + 0 + + 0 0 0 + 0 + 0 + 0 + + 0

Pos

Cntrl 4+ Neg

Cntrl 0 Run Another Echo Panel


1/11/2017 42



K k Kp

a

K

p

b

J

s

a

J

s

b

Fy

a

Fy

b

Jk

a

Jk

b

Le

a

Le

b

P1

M N S s Lu

a

L

u

b

X

g

a

Echo

1 + + 0 + + 0 0 0 0 + 0 + 0 + + 0 0 + 0 + + + + 0 + 0 + + 0

2 + + 0 0 + 0 0 + 0 + 0 + 0 + 0 + + 0 + 0 + + + 0 + 0 + 0 0

3 + 0 + + 0 0 0 0 0 + 0 + 0 + + + 0 + 0 + 0 0 + 0 + 0 + + 0

4 + 0 + 0 + + 0 0 0 + 0 + 0 + 0 0 + 0 0 + + + + + 0 0 + 0 1+

5 0 + + 0 + + 0 0 0 + 0 + 0 + + 0 0 + 0 + + + 0 + 0 0 + + 2+

6 0 0 + + + + 0 0 0 + 0 + 0 + + 0 + 0 0 + + 0 + 0 + 0 + + 0

7 0 0 + 0 + + 0 0 0 + 0 + 0 + 0 + 0 + + 0 0 + + + + 0 + + 1+

8 0 0 + 0 + + 0 0 + + 0 + 0 + 0 + + + 0 + 0 + + + + + + + 1+

9 0 0 + 0 + + 0 0 0 + 0 + 0 + + 0 + 0 0 + + + + + + 0 + + 1+

10 0 0 + 0 + + 0 0 0 + + + 0 + + + + + 0 0 + + + + 0 0 + + 1+

11 0 0 + 0 + + 0 0 0 + 0 + 0 + 0 + + 0 + 0 0 0 + 0 + 0 + + 0

12 0 0 + 0 + + 0 0 + + 0 + 0 + + 0 0 + 0 + + 0 + 0 + 0 + + 0

13 0 0 + 0 + + 0 0 0 + 0 + 0 + + 0 + 0 + 0 + + + 0 + 0 + + 0

14 + + 0 0 + 0 0 0 + + 0 + 0 + + + + 0 0 0 + + 0 + 0 0 + 0 0

Pos

Cntrl 4+ Neg

Cntrl 0 Re-evaluate the first panel after the second panel – Is pattern there?

1/11/2017

15

Case B - Run another method

• Run PeG-AHG Screen and LISS-AHG Screen

I II III AutoCntrl

– PeG-AHG 1+ 0√ 0√ 0√


• Run IgG DAT

– IgG DAT Negative

– DAT Cntrl Negative

1/11/2017 43

Panoscreen® *= presumptive


Cell D C c E e f* V Cw K k Kpa Kpb Jsa Jsb Fya Fyb Jka Jkb Lea Leb P1 M N S s Lua Lub Xga IS LISS PEG

1 + + 0 + + 0 0 0 + + 0 + 0 + + + + 0 0 + + + 0 + + 0 + + 0 W 1+

2 + 0 + + 0 0 0 0 0 + 0 + 0 + + 0 0 + 0 + + + + 0 + 0 + + 0 W 0

3 0 0 + 0 + + 0 0 0 + 0 + 0 + 0 + + + + 0 0 + 0 + 0 0 + + 0 W 0

1/11/2017 44

• Anti-M pattern suggested in the Echo

panels verified in tube method

Case B – Take Away Points

• With weak reactions with Solid Phase or Manual

Testing

– Rule out, but look for a pattern

• Testing options

– The history indicated that this would be a naturally

occurring antibody since the patient had no history of

transfusion

– Crossmatching and interpretations when all common

alloantibodies

• Advantages

• Disadvantages

1/11/2017 45

1/11/2017

16

Case B – Take Away Points (cont.)

• Trust your process

– Look to rule out the presence of clinically

significant alloantibodies (per Standards)

– Use the clues in the pattern of positives

•History Naturally occurring since no transfusion

•XM results IgM and IgG detected

•Dosage Antibody demonstrates variability

Circle back to the initial ABS and panels to verify that the

specificity is verified.

1/11/2017 46

1/11/2017 47

“Trust the Test

- the test will tell you what

to do”

Divergent Series, Tris

Case C

• A 30 year old female is currently 20 weeks

pregnant with her second child.

• The patient was in a fender bender, and is

currently in the Emergency Room for evaluation

• Physician has ordered

– Type and Screen

1/11/2017 48

1/11/2017

17

Capture-R® Ready-Screen ® *= presumptive

Sample

Id

Interp Flags Mono

Ctrl

Anti-A Anti-B Anti-D1 Anti-D2 A1 Cells B Cells

17-1 NTD 0 4+ 0 4+ 4+ 1+ 4+

1/11/2017 49



K k Kp

a

K

p

b

J

s

a

J

s

b

Fya

Fyb

Jka

Jkb

Lea

Leb

P1

M N S s Lu

a

L

u

b

X

g

a

Echo

1 + + 0 + + 0 0 0 + + 0 + 0 + + + + 0 0 + + 0 + + + 0 + + 1+

2 + 0 + + 0 0 0 0 0 + 0 + 0 + + 0 0 + 0 + + + + 0 + 0 + + 1+

3 0 0 + 0 + + 0 0 0 + 0 + 0 + 0 + + + + 0 0 + 0 + 0 0 + + 1+

Pos

Cntrl 4+ Neg

Cntrl 0

Case C


1/11/2017 50



K k Kp

a

K

p

b

J

s

a

J

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b

Fy

a

Fy

b

Jk

a

Jk

b

Le

a

Le

b

P1

M N S s Lu

a

L

u

b

X

g

a

Echo

1 + + 0 + + 0 0 0 0 + 0 + 0 + + 0 0 + 0 + + + + 0 + 0 + + 0

2 + + 0 0 + 0 0 + 0 + 0 + 0 + 0 + + 0 + 0 + + + 0 + 0 + 0 0

3 + 0 + + 0 0 0 0 0 + 0 + 0 + + + 0 + 0 + 0 0 + 0 + 0 + + 0

4 + 0 + 0 + + 0 0 0 + 0 + 0 + 0 0 + 0 0 + + + + + 0 0 + 0 1+

5 0 + + 0 + + 0 0 0 + 0 + 0 + + 0 0 + 0 + + + 0 + 0 0 + + 1+

6 0 0 + + + + 0 0 + + 0 + 0 + + 0 + 0 0 + + 0 + 0 + 0 + + 1+

7 0 0 + 0 + + 0 0 0 + 0 + 0 + 0 + 0 + + 0 0 + + + + 0 + + ?

8 0 0 + 0 + + 0 0 + + 0 + 0 + 0 + + + 0 + 0 0 + 0 + + + + 1+

9 0 0 + 0 + + 0 0 0 + 0 + 0 + + 0 + 0 0 + + + + + + 0 + + ?

10 0 0 + 0 + + 0 0 0 + + + 0 + + + + + 0 0 + + + + 0 0 + + 1+

11 0 0 + 0 + + 0 0 0 + 0 + 0 + 0 + + 0 + 0 0 0 + 0 + 0 + + 0

12 0 0 + 0 + + 0 0 + + 0 + 0 + + 0 0 + 0 + + 0 + 0 + 0 + + 0

13 0 0 + 0 + + 0 0 0 + 0 + 0 + + 0 + 0 + 0 + + + 0 + 0 + + ?

14 + + 0 0 + 0 0 0 + + 0 + 0 + + + + 0 0 0 + + 0 + 0 0 + 0 1+

Pos

Cntrl 4+ Neg

Cntrl 0 Case C


1/11/2017 51



K k Kp

a

K

p

b

J

s

a

J

s

b

Fy

a

Fy

b

Jk

a

Jk

b

Le

a

Le

b

P1

M N S s Lu

a

L

u

b

X

g

a

Echo

1 + + 0 + + 0 0 0 0 + 0 + 0 + + 0 0 + 0 + + + + 0 + 0 + + 0

6 0 0 + + + + 0 0 + + 0 + 0 + + 0 + 0 0 + + 0 + 0 + 0 + + 1+

7 0 0 + 0 + + 0 0 0 + 0 + 0 + 0 + 0 + + 0 0 + + + + 0 + + ?

9 0 0 + 0 + + 0 0 0 + 0 + 0 + + 0 + 0 0 + + + + + + 0 + + ?

13 0 0 + 0 + + 0 0 0 + 0 + 0 + + 0 + 0 + 0 + + + 0 + 0 + + ?

14 + + 0 0 + 0 0 0 + + 0 + 0 + + + + 0 0 0 + + 0 + 0 0 + 0 1+

• Any Pattern observed?

• Review all the results

– Do you agree?

• Manual read the result

– Does that change your

next step

Cell #1

Cell #6

= 1+

Cell #7

1+

Cell #9

1+

Cell # 13

0

1/11/2017

18


1/11/2017 52



K k Kp

a

K

p

b

J

s

a

J

s

b

Fya

Fyb

Jka

Jkb

Lea

Leb

P1

M N S s Lu

a

L

u

b

X

g

a

Echo

1 + + 0 + + 0 0 0 0 + 0 + 0 + + 0 0 + 0 + + + + 0 + 0 + + 0

2 + + 0 0 + 0 0 + 0 + 0 + 0 + 0 + + 0 + 0 + + + 0 + 0 + 0 0

3 + 0 + + 0 0 0 0 0 + 0 + 0 + + + 0 + 0 + 0 0 + 0 + 0 + + 0

4 + 0 + 0 + + 0 0 0 + 0 + 0 + 0 0 + 0 0 + + + + + 0 0 + 0 1+

5 0 + + 0 + + 0 0 0 + 0 + 0 + + 0 0 + 0 + + + 0 + 0 0 + + 1+

6 0 0 + + + + 0 0 + + 0 + 0 + + 0 + 0 0 + + 0 + 0 + 0 + + 1+

7 0 0 + 0 + + 0 0 0 + 0 + 0 + 0 + 0 + + 0 0 + + + + 0 + + 1+

8 0 0 + 0 + + 0 0 + + 0 + 0 + 0 + + + 0 + 0 0 + 0 + + + + 1+

9 0 0 + 0 + + 0 0 0 + 0 + 0 + + 0 + 0 0 + + + + + + 0 + + 1+

10 0 0 + 0 + + 0 0 0 + + + 0 + + + + + 0 0 + + + + 0 0 + + 1+

11 0 0 + 0 + + 0 0 0 + 0 + 0 + 0 + + 0 + 0 0 0 + 0 + 0 + + 0

12 0 0 + 0 + + 0 0 0 + 0 + 0 + + 0 0 + 0 + + 0 + 0 + 0 + + 0

13 0 0 + 0 + + 0 0 0 + 0 + 0 + + 0 + 0 + 0 + + + 0 + 0 + + 0

14 + + 0 0 + 0 0 0 + + 0 + 0 + + + + 0 0 0 + + 0 + 0 0 + 0 1+

Pos

Cntrl 4+ Neg

Cntrl 0 Case B


1/11/2017 53



K k Kp

a

K

p

b

J

s

a

J

s

b

Fy

a

Fy

b

Jk

a

Jk

b

Le

a

Le

b

P1

M N S s Lu

a

L

u

b

X

g

a

Echo

1 + + 0 + + 0 0 0 0 + 0 + 0 + + 0 0 + 0 + + + + 0 + 0 + + 0

2 + + 0 0 + 0 0 + 0 + 0 + 0 + 0 + + 0 + 0 + + + 0 + 0 + 0 0

3 + 0 + + 0 0 0 0 0 + 0 + 0 + + + 0 + 0 + 0 0 + 0 + 0 + + 0

4 + 0 + 0 + + 0 0 0 + 0 + 0 + 0 0 + 0 0 + + + + + 0 0 + 0 1+

5 0 + + 0 + + 0 0 0 + 0 + 0 + + 0 0 + 0 + + + 0 + 0 0 + + 1+

6 0 0 + + + + 0 0 + + 0 + 0 + + 0 + 0 0 + + 0 + 0 + 0 + + 1+

7 0 0 + 0 + + 0 0 0 + 0 + 0 + 0 + 0 + + 0 0 + + + + 0 + + 1+

8 0 0 + 0 + + 0 0 + + 0 + 0 + 0 + + + 0 + 0 0 + 0 + + + + 1+

9 0 0 + 0 + + 0 0 0 + 0 + 0 + + 0 + 0 0 + + + + + + 0 + + 1+

10 0 0 + 0 + + 0 0 0 + + + 0 + + + + + 0 0 + + + + 0 0 + + 1+

11 0 0 + 0 + + 0 0 0 + 0 + 0 + 0 + + 0 + 0 0 0 + 0 + 0 + + 0

12 0 0 + 0 + + 0 0 + + 0 + 0 + + 0 0 + 0 + + 0 + 0 + 0 + + 0

13 0 0 + 0 + + 0 0 0 + 0 + 0 + + 0 + 0 + 0 + + + 0 + 0 + + 0

14 + + 0 0 + 0 0 0 + + 0 + 0 + + + + 0 0 0 + + 0 + 0 0 + 0 1+

Case C – Evaluate Pattern Anti-K, Anti-M, Anti-S

Case C - Options

• All common alloantibodies are excluded on

non-reactive cells except –K, -M and –S

–Get more patient information

–Run additional panels to verify or exclude

•Run a second Echo Panel

–Stay with the same method whenever

possible

–Follow the trail

1/11/2017 54

1/11/2017

19

Case B – Get More Information


– Pregnancy Hx? 1 child, no complications

– Transfusion Hx? 16 years old after MVA

– Other Hospitals? None

– Current Diagnosis Pregnancy

– Recent Drug History Vitamins and Iron

1/11/2017 55

Capture-R® Ready-ID ® Extend I (D-Positive Panel) *= presumptive

1/11/2017 56


Cell D C c E e f* V Cw K k Kpa Kpb Jsa Jsb Fya Fyb Jka Jkb Lea Leb P1 M N S s Lua Lub Xga Echo

1 + + 0 0 + 0 0 + 0 + 0 + 0 + 0 + + 0 0 + 0 + + + + 0 + + 1+

2 + + 0 0 + 0 0 0 0 + 0 + 0 + + 0 0 + 0 + 0 0 + 0 + 0 + 0 0

3 + + 0 0 + 0 0 0 0 + 0 + 0 + 0 + + 0 + 0 + + 0 + 0 0 + + 1+

4 + + 0 0 + 0 0 0 + + 0 + 0 + + 0 0 + 0 + 0 + 0 0 + 0 + + 1+

5 + + 0 0 + 0 0 0 0 + 0 + 0 + + 0 + + 0 + + 0 + + + 0 + + 1+

6 + + 0 0 + 0 0 0 + + + + 0 0 0 + + 0 0 0 + + + 0 + 0 + + 1+

7 + + 0 0 + 0 0 0 0 + 0 + 0 + + + + 0 0 + 0 + 0 + 0 0 + + 1+

8 + 0 + + 0 0 0 0 0 + 0 + 0 + + 0 + 0 0 + + + + + + 0 + + 1+

9 + 0 + + 0 0 0 0 0 + 0 + 0 + 0 + + + 0 + + + + + 0 0 + 0 1+

10 + 0 + + 0 0 0 0 + + 0 + 0 + + + + + 0 + + + 0 + + 0 + + 1+

11 + 0 + + 0 0 0 0 0 + 0 + 0 + 0 + 0 + + 0 + + 0 + + 0 + 0 1+

12 + 0 + + 0 0 0 0 + + 0 + 0 + + 0 0 + 0 + + + 0 0 + 0 + + 0

13 + 0 + + 0 0 0 + 0 + 0 + 0 + 0 0 + 0 + 0 + 0 + + + 0 + 0 1+

14 + w + + 0 0 0 0 0 + 0 + 0 + 0 + + 0 0 0 + + 0 0 + 0 + + 0

Pos

Cntrl 4+ Neg Cntrl 0 Run Another Echo Panel == Anti-M ruled out on cell 12 and 14

Case C - Options

• All common alloantibodies are excluded on non-

reactive cells except –K, -M and –S

–Get more patient information

–Run additional panels to verify or exclude

•Run a second Echo Panel

–Stay with the same method whenever

possible

–Follow the trail == to Antibody Definition

1/11/2017 57

Next – what is the patient’s ABO?

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20

Case C – ABO Discrepancy Resolution

• Repeat with manual ABO method

Anti-A Anti-B Anti-D A1C BC

4+ 0 4+ 2+ 4+

• Options

– Subtype of A

– Cold Reactive antibody

•Cold Auto

•Anti-M, Anti-Lea, Anti-P1, etc.

1/11/2017 58

Case C – ABO Discrepancy Resolution

• Options

– Subtype of A

•Type with anti-A1 Anti-A1 Interpretation

4+ A1

Not Subtype

– Cold Reactive antibody

•Test Antibody Screen IS 37 LISS

SC1 2+ 0 1+

SC2 2+ 0 1+

Auto 2+ 0 0√

1/11/2017 59

Case C – Resolve ABO

• Cold reactive antibody confirmation

– If negative at IS, not a cold reactive antibody

– If positive at IS, likely cold reactive antibody

Repeat with manual ABO with pre-warm method

Anti-A Anti-B Anti-D A1C BC

Pre-warm 4+ 0 4+ 0 4+ Resolved Gp A

1/11/2017 60

Go to pre-warm technique

1/11/2017

21

Case C – Take Away Points

• No antibody history previously, does not mean weak

reactions in the current sample are “false”

– With history verification, this patient had two different red

cell exposures (pregnancy and txn.)

– Look back at previous investigations to add to the current

investigation

• Weak reactions may be observed in both ABS, Panel

and ABO testing

– Use what is learned in ABS/panel testing to help resolve the

ABO discrepancy

– This patient is a responder…. IgM and IgG

1/11/2017 61

Closing

1/11/2017 62

Believe the reactions and

look for a pattern

Q and A

1/11/2017 63

Making all the Pieces fit to

make a beautiful picture

Blood Bank

Interpretation

Making all the reactions

make sense…. To find

the blood faster for the

patient !!

1/11/2017

22


Questions?



• Each attendee must register at

– https://www.surveymonkey.com/r/UserGrpWebinar

• Registration deadline is January 27, 2017

• Certificates will be sent via email only to those

who have registered by February 10, 2017

Thank you!
https://www.surveymonkey.com/r/UserGrpWebinar

Documents

Handouts - Immucor Program Handouts/Weak... · 2017. 1. 11. · 1/11/2017 5 Presentation Objectives • Introduce and explore recent literature related to antibody identification