INTERESTING CROSSMATCH

• 21/3/2012 Mrs DM-53, presented with history of anaemia.

• Request for crossmatch if Hb <90 and a long list of tests including JAK 2(PCV,ET and myelofibrosis), BCR-ABL(test for CML) & EPG(test for MM).

• Clinical notes – mother died of Myelofibrosis.

• Hb 84

• WCC 4.7

• PLTS 146

• Request for 3 units packed cells

TRANSFUSION HISTORY

• ORh(D)Positive, NAD

• 6 pregnancies, 1 living child

• Received 3 units OPOS 12/2/2012

• Routine crossmatch performed

• Group OPOS

• Antibody screen positive - I/10, II/10, III/10

• ID Panel positive, all cells positive, Auto weaker

• Phenotype mixed field probable Cˉc⁺E⁺e⁺Kˉ

• Total protein 118 increased from 78 in 3months

• Requested warm recollection 22/3/2012

• Antibody screen I/10, II/10, III/5

• Auto +/-

• DAT : C3d specificity

• Panel showed varying strength, cell 9 negative. Reaction appear mixed field or hazy rather than agglutination.

1st

collection(21/3)11

2nd collection(as cold aggs patient – on 22/3)

Sample sent to Red Cross – INITIAL FINDINGS:

• Found to react with most panel cells by Saline LISS and AHG.

• Reacted weakly by 22˚C saline.

• DAT Positive IgM/ 8 C3d/ 5 IgG Negative

• Acid glycine eluate reacted with all panel cells

• No red cell specificity associated with the eluate.

• INITIAL Red Cross report - Given difficulty of crossmatching blood. Recommended the use of phenotype matched : C⁻,K⁻,Jk(b)⁻,S⁻

• We regret we are unable to identify the cause of the reactions of this patients plasma with the panel cells when tested by gel cards. However the reactions were not detected by PEG-IAT.

• The positive DAT and the presence of The The

• The positive DAT and ?antibody in the plasma may be due to the recent transfusion, alternatively it may be due to the patients clinical condition.

• If further transfusion is required, contact the Transfusion Medicine Service at the blood service.

• No blood issued

• THEN….

• Bone marrow aspirate performed 27/03/2012

• EPG results available 28/3/2012:

• Paraprotein detected in beta gamma region

• Monoclonal IgM kappa light chains

• Kappa free LC 54.9 RR(3.3-19.4)

• Further discussion with Red Cross Haematologist

FINAL FINDINGS:

• The results for the DAT may be due to nonspecific uptake of the IgM paraprotein on to the red cells.

• The nonspecific findings in the plasma are likelyalso to be due to the high IgM paraproteinaemia,rather than to specific red cell antigen-antibody reactions.

• The reactions obtained with the eluate are alsoprobably due to elution of adsorbed IgMparaprotein.

• Blood for Transfusion:Blood for transfusion:

• You may consider the use of a tube IATcrossmatch for this patient.Given the further findings outlined above,there is no special requirement for the use ofphenotype matched units for this patient.

• COMMENTS

COMMENTS:It is likely that the positive DAT, the reactionsobtained by card with patient plasma and ineluates are principally due to the interferenceby the IgM paraprotein.

Bone marrow report:

• In conjunction with the presence of an IgM kappa paraprotein, the findings are consistent with a B cell lymphoplasmacytic lymphoma.

• Patient transferred to Melbourne 30/3/2012 without transfusion.

• Patient passed away late November 2012.