I need help with this ASAP. It's due by midnight tonight.
Patient LR, 56-year-old white male, group A Rh(D) positive. No history of transfusion.
Pretransfusion sample demonstrated an anti-E. No additional antibodies were detected using LISS. Four E-negative RBC units were crossmatched (at AHG using LISS) and were compatible. During open-heart surgery, LR received the four E-negative RBC units.
Two days following surgery, a sample was submitted to the transfusion service for a potential posttransfusion hemolytic reaction. Pretransfusion hemoglobin was 10.3g/dL and current hemoglobin was 9.8g/dL.
Posttransfusion sample had a microscopic positive DAT and demonstrated the following reactivity with a panel tested with LISS.
The antibody panel is attached.
Questions:
1. What antibody would you suspect?
2. What testing could be performed to confirm your suspicion?
3. What antibody would you expect to find in the eluate?
4. Why is it important to read the DAT microscopically when a transfusion reaction is suspected?