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Christian Irizarry Quiones

840063476
10/10/2015
Prof. Wilma Lopez

University of Puerto Rico - Medical Sciences Campus School of Health Professions -


Medical Technology Program
Case Studies for Blood Bank Review
Reproduced from:
Shulman, I.A. (1992). Problem Solving in Immunology. ASCP Press: Wash.

CASE 2 -4 QUESTIONS

A 30-year-old group A, Rh-positive man is being treated at your hospital for a


relapsed of acute leukemia. Leukemia was initially diagnosed 12 months ago, at which time
he received 2 units of packed red blood cells. Three days ago, he was readmitted to your
hospital and required 2 units of red blood cells. His antibody screening test was negative,
both three days and twelve months ago. His hematocrit, which was 0.29 following the
transfusion three days ago, is now only 0.24. The patient has no obvious site of bleeding.
Because of his falling hematocrit level, the patients physician orders 2 more units of red
blood cells to be transfused. After receiving the physicians request, you crossmatch 2 units
of red blood cells using the patients 3-day-old blood specimen. Neither crossmatch shows
hemolysis or agglutination by an immediate spin phase, a 37C phase, or an indirect
antiglobulin phase of testing.
During the transfusion of the first unit, the patient develops fever, chills, and
hemoglobinemia. A transfusion reaction work-up is done, and the posttransfusion blood
sample shows hemolysis, a positive direct antiglobulin test (weakly positive with anti- IgG
and weakly positive with anti-C3), and the presence of anti-Jka. An eluate made from the
red blood cells of the DAT-positive sample, contains anti-Jka. The antibody screening test
and direct antiglobulin test are repeated using the pretransfusion blood sample; these tests
are negative.

1. What is a possible explanation for the drop in the patients hematocrit from 0.29 to 0.24?

La baja en hematocrito se debe a que el paciente esta sufriendo una sensitizacion (DAT+)
en vivo de las clulas rojas positivas para el antgeno Jka, eliminndose esas clulas
sensitizadas.

2. What type of reaction is the patient experiencing when he develops hemoglobinemia


during transfusion?

Una reaccin aguda hemoltica de transfusin.

3. If the patient had anti-Jka at the time of the acute hemolytic transfusion reaction, why
were both crossmatches compatible?
Porque la cantidad de anti-Jka presente en el suero de la muestra tomadas hace 3 das no
tenia la cantidad de anti-Jka para coagular la sangre que se iban a cruzar.

4. What is the risk that 3-day-old blood sample will not accurately reflect the true
immunologic status of a transfusion recipient?

Porque en tres das los ttulos de anti-Jka sern mucho mayores luego de tres das, si
utilizamos una muestra vieja, es posible que la reaccin de aglutinacin no sea visible.

1. What is the patients blood type?

Con la informacin presente es indeterminado, posiblemente sea un subgrupo de A, tal


como A2, porque tiene anticuerpo contra clulas A1. Se debe utilizar Lectin (anti-A1) y
clulas A2 para comprobar que sea correcto.

2. What antibody is present?

El anticuerpo presente es anti-P1

3. What antibodies cannot be ruled out?

Los anticuerpo que no se pudieron descartar con las clulas que no reaccionaron
fueron: Anti-E, Anti-Cw, Anti-P1, Anti-K, Anti-Kpa, Anti-Jka y Anti-Jkb
4. If the patient needs blood before the ABO discrepancy is resolved, what type of blood
should be issued?

Sangre O negativo.

5. Should the donor units be screened for the offending antigen? Why or why not?

No se hace falta, porque el anticuerpo P1 no es de significado clnico (anticuerpo frio).

6. How can the antibody screen be modified to avid detecting clinically insignificant red
blood cell alloantibodies?

Utilizando la tcnica de pre-calentado (pre-warm)

Quien no se pudo descartar con las clulas que no reaccionaron?


Anti-E, Anti-Cw, Anti-P1, Anti-K, Anti-Kpa, Anti-Jka y Anti-Jkb

*Las diferentes faces fueron IS, RT y a 150C , lo cual nos dice que es un anticuerpo frio.

Quin podemos descartar por fase de reaccin?


Anti-E, Anti-Cw, Anti-K, Anti-Kpa, Anti-Jka y Anti-Jkb

Quin tiene un patrn perfecto de reaccin?


Anti-P1

**Se sospecha de un Anti-P1


1. What is the patients blood type?

Es indeterminado, el control Rh es positivo.

2. How would you determine the correct Rh type?

Haciendo un DAT y si es positivo se le realiza una auto-absorcin caliente y con el suero


absorbido hacer un panel de identificacin de anticuerpo.

3. What type of blood should the patient receive?


O Rh negativo

4. Based on these results, what can be said about the initial antibody screen?

Puedo decir que las clulas del paciente estn sensitizadas en vivo, que el anticuerpo es
caliente, de significado clnico y que el prximo paso a realizar una auto-absorcin caliente
para la identificacin de ese anticuerpo que esta sensitizando las clulas rojas del paciente y
realizar un panel de identificacin de anticuerpo.

5. What antibody is present?

Anti-E

6. How should blood be crossmatched for this patient?

Se debe realizar un cruce mayor con clulas O Rh negativo, porque el paciente tiene
anticuerpo en contra del antgeno E que es parte del sistema Rh.

Quien no se pudo descartar con las clulas que no reaccionaron?