Pre-workshop

exercises
Transfusion Medicine Workshop
for Haematology Registrars
13–14 March 2021

i Transfusion Medicine Workshop for Haematology Registrars

Pre-workshop
exercises
Thank you for joining us for the Transfusion Medicine Additional resources
Workshop for Haematology Registrars 2021. To make
the most of the workshop, please complete the Please ensure you have listened to both the pre
exercises in this booklet. recorded modules that have been provided:
1. Laboratory Transfusion Techniques
ABO cases
2. Antibody Identification
For each of the ABO cases please ascertain:
• What are the unexpected reactions and possible Reference material
causes? ANZSBT Guidelines: anzsbt.org.au
• What steps would you take to resolve these?
What blood would you cross match?

Serology cases
The case studies provided below will be discussed
and worked through as part of the workshop. They
are based upon clinical examples that may be
encountered in practice. Please review the cases
and bring your answers and comments to be able
to contribute to the discussion and help you gain
the most from the workshop. Additional results and
panels will be provided during the discussion that
will enable you to identify the final antibody/ies.
For each of the antibody panels provided, consider
the questions on the relevant page.

1 Transfusion Medicine Workshop for Haematology Registrars

ABO cases
Patient 1: Ellie
ABO RhD group Antibody screen

Anti-A Anti-B Anti-AB Anti-D Ctrl A1 cells B cells O cells I II III

4 4 4 4 4 4 4 4 4 4 4

Patient 2: Janice
ABO RhD group Antibody screen

Anti-A Anti-B Anti-AB Anti-D Ctrl A1 cells B cells O cells I II III

0 4 4 3 3 4 0 0 0 0 0

Patient 3A: Olivia

ABO RhD group Antibody screen

Anti-A Anti-B Anti-AB Anti-D Ctrl A1 cells B cells O cells I II III

4 4 4 4 0 0 0 0 0 0 0

2 Transfusion Medicine Workshop for Haematology Registrars

ABO cases
Patient 3B: Baby of Olivia, cord blood
ABO RhD group

Anti-A Anti-B Anti-AB Anti-D Ctrl DAT

4 1MF 4 1MF 0 0

Patient 4A: Tim, sample 1

ABO RhD group Antibody screen

Anti-A Anti-B Anti-AB Anti-D Ctrl A1 cells B cells O cells I II III

4 4 4 4 0 0 0 0 0 0 0

Patient 4B: Tim, sample 2, three hours later

ABO RhD group Antibody screen

Anti-A Anti-B Anti-AB Anti-D Ctrl A1 cells B cells O cells I II III

4 0 4 4 0 0 1 0 0 0 0

3 Transfusion Medicine Workshop for Haematology Registrars

ABO cases
Patient 5: Shaba
ABO RhD group Antibody screen

Anti-A Anti-B Anti-AB Anti-D Ctrl A1 cells B cells O cells I II III

w 0 w 4 0 3 3 3 4 4 4

Patient 6: Nick
ABO RhD group Antibody screen

Anti-A Anti-B Anti-AB Anti-D Ctrl A1 cells B cells O cells I II III

0 0 0 0 0 0 0 0 0 0 0

Patient 7: Morgan
ABO RhD group Antibody screen

Anti-A Anti-B Anti-AB Anti-D Ctrl A1 cells B cells O cells I II III

4 0 4 0 0 1 4 1 0 0 0

4 Transfusion Medicine Workshop for Haematology Registrars

Case 1

James Stewart
Case 1.1
Test
Cell Rh Kell Duffy Kidd MNSs P1PK Lewis Lu Cell results
no. no.
D C E c e Cw K k Kpa Fya Fyb Jka Jkb M N S s P1 Lea Leb Lua CAT IAT
1 + + 0 0 + 0 0 + 0 0 + 0 + + + 0 + + 0 + 0 1 3
2 + 0 + + 0 0 0 + 0 + 0 + 0 + + + + + + 0 0 2 0
3 0 0 0 + + 0 + + 0 0 + + + 0 + 0 + + 0 0 0 3 3

Case details
78-year-old male, total hip revision.

5 Transfusion Medicine Workshop for Haematology Registrars

Case 1

James Stewart
Case 1.2
Cell Rh Kell Duffy Kidd MNSs P1 Lewis Lu Co Cell Test results
no. D C E c e Cw K k Kpa Fya Fyb Jka Jkb M N S s P1 Lea Leb Lua Cob no. CAT

1 + + 0 0 + + 0 + 0 + 0 0 + + + + + + 0 + 0 0 1 3
2 + + 0 0 + 0 + + 0 0 + 0 + + 0 + 0 + 0 + 0 0 2 3
3 + + 0 0 + 0 0 + 0 + 0 + 0 0 + 0 + 0 + 0 0 0 3 3
4 + 0 + + 0 0 0 + 0 0 + 0 + 0 + 0 + + 0 + + 0 4 0
5 + 0 + + 0 0 0 + 0 + 0 + + + + 0 + 0 0 + 0 0 5 0
6 0 + 0 + + 0 0 + 0 + 0 0 + + + 0 + + + 0 0 0 6 2
7 0 0 + + + 0 0 + 0 + 0 + 0 0 + + + 0 0 + 0 + 7 0
8 0 0 0 + + 0 + + 0 0 + + 0 + 0 + 0 0 0 + 0 0 8 2
9 0 0 0 + + 0 0 + 0 + + + 0 + 0 0 + 0 0 0 0 0 9 0
10 0 0 0 + + 0 0 + 0 + + 0 + 0 + + + 0 + 0 0 + 10 0
11 0 0 0 + + 0 0 + 0 0 + + 0 + + + + + 0 0 0 0 11 0
D C E c e Cw K k Kpa Fya Fyb Jka Jkb M N S s P1 Lea Leb Lua Cob Auto 0

Patient Anti-A Anti-B Anti-AB Anti-D Ctrl A1 cells A2 cells B cells O cells Ab Sc I 3
JS 0 0 4 0 4 4 Ab Sc II 0
Ab Sc III 3
Cord cells

Direct Antiglobulin Test A1 pos

Poly IgG C3d A 2 pos

B pos

A1 neg

A 2 neg

B neg

Questions
1. Can you identify the probable antibody/antibodies causing these reactions?
2. Is there any antibody/antibodies that cannot be excluded?
3. Do you need to take further steps to exclude these? Why or why not?
4. What type of red cells should be ordered from Lifeblood?

6 Transfusion Medicine Workshop for Haematology Registrars

Case 1

James Stewart
Case 1.3
Cell Rh Kell Duffy Kidd MNSs P1 Lewis Lutheran Co Cell Test results
no. D C E c e Cw K k Kpa Fya Fyb Jka Jkb M N S s P1 Lea Leb Lua Lub Cob no. CAT

1 0 + 0 + + 0 0 + 0 + + + + + + 0 + 0 0 + 0 + 0 1 3
2 + + 0 0 + 0 0 + 0 + 0 0 + + 0 + + 0 0 + 0 + 0 2 3
3 + + 0 0 + 0 0 + 0 0 + 0 + 0 + 0 + + 0 + 0 + 0 3 3
4 + 0 + + 0 0 0 + 0 0 + + 0 + + + + 0 + 0 0 + 0 4 0
5 0 0 + + + 0 0 + 0 + 0 + 0 + + 0 0 + 0 + + + 0 5 0
6 0 0 0 + + 0 + + 0 0 + + + + 0 + + 0 0 + 0 + 0 6 3
7 0 0 + + + 0 0 + 0 + 0 + 0 + 0 + + + 0 + 0 + 0 7 0
8 0 0 0 + + + 0 + 0 0 + 0 + 0 + + + 0 0 + 0 + 0 8 0
9 0 0 0 + + 0 + + + 0 + 0 + + + 0 + + + 0 0 + 0 9 3
10 + 0 0 + + 0 + 0 0 + 0 + 0 0 + + 0 + 0 0 0 + 0 10 3
11 0 0 0 + + 0 0 + 0 + + + 0 + + 0 + 0 0 + 0 + 0 11 0
JS + 0 + + 0 0 0 + 0 0 + 0 + 0 + 0 + + + 0 0 0 0 Auto 0
D C E c e Cw K k Kpa Fya Fyb Jka Jkb M N S s P1 Lea Leb Lua Lub Cob

Patient Anti-A Anti-B Anti-AB Anti-D Ctrl A1 cells A2 cells B cells O cells Ab Sc I 3
JS 0 0 4 0 4 4 Ab Sc II 0
Ab Sc III 3
Cord cells

Direct Antiglobulin Test A1 pos

Poly IgG C3d A 2 pos

B pos

A1 neg

A 2 neg

B neg

Questions
1. Can you identify the probable antibody/antibodies causing these reactions?
2. Is there any antibody/antibodies that cannot be excluded?
3. Do you need to take further steps to exclude these? Why or why not?
4. What type of red cells should be ordered from Lifeblood?

7 Transfusion Medicine Workshop for Haematology Registrars

Case 2

Tom Jones
Case 2.1
Test
Cell Rh Kell Duffy Kidd MNSs P1PK Lewis Lu Cell results
no. no.
D C E c e Cw K k Kpa Fya Fyb Jka Jkb M N S s P1 Lea Leb Lua CAT IAT
1 + + 0 0 + 0 0 + 0 0 + 0 + + + 0 + + 0 + 0 1 0
2 + 0 + + 0 0 0 + 0 + 0 + 0 + + + + + + 0 0 2 3
3 0 0 0 + + 0 + + 0 0 + + + 0 + 0 + + 0 0 0 3 1

Case details
64-year-old male presents with abdominal and radiating back pain: Suspected AAA.
Prior transfusion four months ago during total hip replacement revision.

8 Transfusion Medicine Workshop for Haematology Registrars

Case 2

Tom Jones
Case 2.2
Cell Rh Kell Duffy Kidd MNSs P1 Lewis Lu Co Cell Test results
no. D C E c e Cw K k Kpa Fya Fyb Jka Jkb M N S s P1 Lea Leb Lua Cob no. CAT
1 + + 0 0 + + 0 + 0 + 0 0 + + + + + + 0 + 0 0 1 3
2 + + 0 0 + 0 + + 0 0 + 0 + + 0 + 0 + 0 + 0 0 2 1
3 + + 0 0 + 0 0 + 0 + 0 + 0 0 + 0 + 0 + 0 0 0 3 3
4 + 0 + + 0 0 0 + 0 0 + 0 + 0 + 0 + + 0 + + 0 4 0
5 + 0 + + 0 0 0 + 0 + 0 + + + + 0 + 0 0 + 0 0 5 3
6 0 + 0 + + 0 0 + 0 + 0 0 + + + 0 + + + 0 0 0 6 3
7 0 0 + + + 0 0 + 0 + 0 + 0 0 + + + 0 0 + 0 + 7 3
8 0 0 0 + + 0 + + 0 0 + + 0 + 0 + 0 0 0 + 0 0 8 1
9 0 0 0 + + 0 0 + 0 + + + 0 + 0 0 + 0 0 0 0 0 9 1
10 0 0 0 + + 0 0 + 0 + + 0 + 0 + + + 0 + 0 0 + 10 1
11 0 0 0 + + 0 0 + 0 0 + + 0 + + + + + 0 0 0 0 11 0
D C E c e Cw K k Kpa Fya Fyb Jka Jkb M N S s P1 Lea Leb Lua Cob Auto 0

Patient Anti-A Anti-B Anti-AB Anti-D Ctrl A1 cells A2 cells B cells O cells Ab Sc I 0
TJ 0 0 4 0 4 4 Ab Sc II 3
Ab Sc III 1
Cord cells

Direct Antiglobulin Test A1 Pos

Poly IgG C3d A2 Pos

B Pos

A1 Neg

A2 Neg

B Neg

Questions
1. Can you identify the probable antibody/antibodies causing these reactions?
2. Is there any antibody/antibodies that cannot be excluded?
3. Do you need to take further further steps to exclude these? Why or why not?

9 Transfusion Medicine Workshop for Haematology Registrars

Case 2

Tom Jones
Case 2.3
Cell Rh Kell Duffy Kidd MNSs P1 Lewis Lutheran Co Cell Test results
no. D C E c e Cw K k Kpa Fya Fyb Jka Jkb M N S s P1 Lea Leb Lua Lub Cob no. CAT D37 IAT ENZ
1 + + 0 0 + 0 0 + + + 0 + 0 + + 0 + + 0 + 0 + 0 1 3 0 0
2 + + 0 0 + + 0 + 0 0 + + + 0 + + + 0 + 0 0 + 0 2 0 0 0
3 + 0 + + 0 0 + + 0 0 + + 0 0 + 0 + + 0 + 0 + 0 3 1 0 1
4 + 0 + + 0 0 0 + 0 + 0 0 + + 0 + + + 0 + 0 + + 4 3 0 0
5 + 0 0 + + 0 0 + 0 0 + + 0 + + + + 0 0 + 0 + 0 5 0 0 0
6 0 + 0 + + 0 0 + 0 + 0 + 0 + + 0 + + + 0 0 + 0 6 3 0 0
7 0 0 + + + 0 0 + 0 0 + + + + + + + 0 0 + 0 + 0 7 0 0 0
8 0 0 0 + + 0 + + 0 0 + + 0 + 0 + + + 0 + 0 + 0 8 1 0 1
9 0 0 0 + + 0 0 + 0 0 + 0 + 0 + 0 + + + 0 0 + 0 9 0 0 0
10 0 0 0 + + 0 0 + 0 + + + + + + + 0 + 0 0 0 + 0 10 1 0 0
11 0 0 0 + + 0 0 + 0 0 + 0 + 0 + 0 + 0 0 + + + 0 11 0 0 0
TJ + + 0 0 + 0 0 + 0 0 + + + + + 0 + 0 0 + 0 + 0 Auto 0 0 0
D C E c e Cw K k Kpa Fya Fyb Jka Jkb M N S s P1 Lea Leb Lua Lub Cob

Patient Anti-A Anti-B Anti-AB Anti-D Ctrl A1 cells A2 cells B cells O cells Ab Sc I 0
TJ 0 0 4 0 4 4 Ab Sc II 3
Ab Sc III 1
Cord cells

Direct Antiglobulin Test A1 Pos

Poly IgG C3d A2 Pos

B Pos

A1 Neg

A2 Neg

B Neg

Questions
5. How do you explain that there are only two positive reactions in the enzyme, six by CAT and none at
D37?
6. What blood would you order from Lifeblood and what would you do when it arrives?

10 Transfusion Medicine Workshop for Haematology Registrars

Case 3

Emily Foote
Case 3.1
Test
Cell Rh Kell Duffy Kidd MNSs P1PK Lewis Lu Cell results
no. no.
D C E c e Cw K k Kpa Fya Fyb Jka Jkb M N S s P1 Lea Leb Lua CAT IAT
1 + + 0 0 + 0 0 + 0 0 + 0 + + + 0 + + 0 + 0 1 w
2 + 0 + + 0 0 0 + 0 + 0 + 0 + + + + + + 0 0 2 w
3 0 0 0 + + 0 + + 0 0 + + + 0 + 0 + + 0 0 0 3 0

Case details
24-year-old female, 16 weeks gestation, P2 G1. Previous pregnancy uneventful.

11 Transfusion Medicine Workshop for Haematology Registrars

Case 3

Emily Foote
Case 3.2
Cell Rh Kell Duffy Kidd MNSs P1 Lewis Lu Co Cell Test results
no. D C E c e Cw K k Kpa Fya Fyb Jka Jkb M N S s P1 Lea Leb Lua Cob no. CAT
1 + + 0 0 + + 0 + 0 + 0 0 + + + + + + 0 + 0 0 1 w
2 + + 0 0 + 0 + + 0 0 + 0 + + 0 + 0 + 0 + 0 0 2 2
3 + + 0 0 + 0 0 + 0 + 0 + 0 0 + 0 + 0 + 0 0 0 3 0
4 + 0 + + 0 0 0 + 0 0 + 0 + 0 + 0 + + 0 + + 0 4 0
5 + 0 + + 0 0 0 + 0 + 0 + + + + 0 + 0 0 + 0 0 5 0
6 0 + 0 + + 0 0 + 0 + 0 0 + + + 0 + + + 0 0 0 6 0
7 0 0 + + + 0 0 + 0 + 0 + 0 0 + + + 0 0 + 0 + 7 0
8 0 0 0 + + 0 + + 0 0 + + 0 + 0 + 0 0 0 + 0 0 8 2
9 0 0 0 + + 0 0 + 0 + + + 0 + 0 0 + 0 0 0 0 0 9 2
10 0 0 0 + + 0 0 + 0 + + 0 + 0 + + + 0 + 0 0 + 10 0
11 0 0 0 + + 0 0 + 0 0 + + 0 + + + + + 0 0 0 0 11 w
D C E c e Cw K k Kpa Fya Fyb Jka Jkb M N S s P1 Lea Leb Lua Cob Auto 0

Patient Anti-A Anti-B Anti-AB Anti-D Ctrl A1 cells A2 cells B cells O cells Ab Sc I w
EF 4 0 4 0 0 4 Ab Sc II w
Ab Sc III 0
Cord cells

Direct Antiglobulin Test A1 Pos

Poly IgG C3d A2 Pos

B Pos

A1 Neg

A2 Neg

B Neg

Questions
1. Can you identify the probable antibody/antibodies causing these reactions?
2. Is there any antibody/antibodies that cannot be excluded?
3. Do you need to take further further steps to exclude these? Why or why not?

12 Transfusion Medicine Workshop for Haematology Registrars

Case 3

Emily Foote
Case 3.3
Cell Rh Kell Duffy Kidd MNSs P1 Lewis Lutheran Co Cell Test results
no. D C E c e Cw K k Kpa Fya Fyb Jka Jkb M N S s P1 Lea Leb Lua Lub Cob no. CAT D22 D37 ENZ DTT

1 + + 0 0 + 0 0 + + + 0 + 0 + + 0 + + 0 + 0 + 0 1 w 1 0 0 0
2 + + 0 0 + + 0 + 0 0 + + + 0 + + + 0 + 0 0 + 0 2 0 0 0 0 0
3 + 0 + + 0 0 + + 0 0 + + 0 0 + 0 + + 0 + 0 + 0 3 0 0 0 0 0
4 + 0 + + 0 0 0 + 0 + 0 0 + + 0 + + + 0 + 0 + + 4 2 3 w 0 0
5 + 0 0 + + 0 0 + 0 0 + + 0 + + + + 0 0 + 0 + 0 5 0 1 0 0 0
6 0 + 0 + + 0 0 + 0 + 0 + 0 + + 0 + + + 0 0 + 0 6 0 1 0 0 0
7 0 0 + + + 0 0 + 0 0 + + + + + + + 0 0 + 0 + 0 7 w 1 0 0 0
8 0 0 0 + + 0 + + 0 0 + + 0 + 0 + + + 0 + 0 + 0 8 2 3 w 0 0
9 0 0 0 + + 0 0 + 0 0 + 0 + 0 + 0 + + + 0 0 + 0 9 0 0 0 0 0
10 0 0 0 + + 0 0 + 0 + + + + + + + 0 + 0 0 0 + 0 10 w 1 0 0 0
11 0 0 0 + + 0 0 + 0 0 + 0 + 0 + 0 + 0 0 + + + 0 11 0 0 0 0 0
EF + + 0 + + 0 0 + 0 + + 0 + 0 + + + + + 0 0 + 0 Auto 0 0 0 w 0
D C E c e Cw K k Kpa Fya Fyb Jka Jkb M N S s P1 Lea Leb Lua Lub Cob

Patient Anti-A Anti-B Anti-AB Anti-D Ctrl A1 cells A2 cells B cells O cells Ab Sc I w
EF 4 0 4 0 0 4 Ab Sc II w
Ab Sc III 0
Cord cells

Direct Antiglobulin Test A1 Pos

Poly IgG C3d A2 Pos

B Pos

A1 Neg

A2 Neg

B Neg

Questions
5. How do you explain the variable reactions?
6. What advice would you give to the obstetrician?

13 Transfusion Medicine Workshop for Haematology Registrars

Case 4

Hilda Almond
Case 4.1
Test
Cell Rh Kell Duffy Kidd MNSs P1PK Lewis Lu Cell results
no. no.
D C E c e Cw K k Kpa Fya Fyb Jka Jkb M N S s P1 Lea Leb Lua CAT IAT
1 + + 0 0 + 0 0 + 0 0 + 0 + + + 0 + + 0 + 0 1 3
2 + 0 + + 0 0 0 + 0 + 0 + 0 + + + + + + 0 0 2 3
3 0 0 0 + + 0 + + 0 0 + + + 0 + 0 + + 0 0 0 3 2

Case details
93-year-old female presents with abdominal pain, cardiac failure, haemorrhage
and haemoglobin 74g/L. Unreliable transfusion history, six pregnancies.
Two red cells units have been requested.

14 Transfusion Medicine Workshop for Haematology Registrars

Case 4

Hilda Almond
Case 4.2
Cell Rh Kell Duffy Kidd MNSs P1 Lewis Lu Co Cell Test results
no. D C E c e Cw K k Kpa Fya Fyb Jka Jkb M N S s P1 Lea Leb Lua Cob no. CAT
1 + + 0 0 + + 0 + 0 + 0 0 + + + + + + 0 + 0 0 1 3
2 + + 0 0 + 0 + + 0 0 + 0 + + 0 + 0 + 0 + 0 0 2 2
3 + + 0 0 + 0 0 + 0 + 0 + 0 0 + 0 + 0 + 0 0 0 3 3
4 + 0 + + 0 0 0 + 0 0 + 0 + 0 + 0 + + 0 + + 0 4 3
5 + 0 + + 0 0 0 + 0 + 0 + + + + 0 + 0 0 + 0 0 5 3
6 0 + 0 + + 0 0 + 0 + 0 0 + + + 0 + + + 0 0 0 6 3
7 0 0 + + + 0 0 + 0 + 0 + 0 0 + + + 0 0 + 0 + 7 3
8 0 0 0 + + 0 + + 0 0 + + 0 + 0 + 0 0 0 + 0 0 8 2
9 0 0 0 + + 0 0 + 0 + + + 0 + 0 0 + 0 0 0 0 0 9 3
10 0 0 0 + + 0 0 + 0 + + 0 + 0 + + + 0 + 0 0 + 10 3
11 0 0 0 + + 0 0 + 0 0 + + 0 + + + + + 0 0 0 0 11 3
D C E c e Cw K k Kpa Fya Fyb Jka Jkb M N S s P1 Lea Leb Lua Cob Auto 0

Patient Anti-A Anti-B Anti-AB Anti-D Ctrl A1 cells A2 cells B cells O cells Ab Sc I 3
HA 0 4 0 0 4 0 Ab Sc II 3
Ab Sc III 2
Cord cells

Direct Antiglobulin Test A1 Pos

Poly IgG C3d A2 Pos

B Pos

A1 Neg

A2 Neg

B Neg

Questions
1. Can you identify the probable antibody/antibodies causing these reactions?
2. Is there any antibody/antibodies that cannot be excluded?
3. Do you need to take further steps to exclude these? Why or why not?
4. What type of red cells should be ordered from Lifeblood?

15 Transfusion Medicine Workshop for Haematology Registrars

Case 4

Hilda Almond
Case 4.3
Cell Rh Kell Duffy Kidd MNSs P1 Lewis Lutheran Co Cell Test results
no. D C E c e Cw K k Kpa Fya Fyb Jka Jkb M N S s P1 Lea Leb Lua Lub Cob no. CAT
1 0 + 0 + + 0 0 + 0 + + + + + + 0 + 0 0 + 0 + 0 1 3
2 + + 0 0 + 0 0 + 0 + 0 0 + + 0 + + 0 0 + 0 + 0 2 3
3 + + 0 0 + 0 0 + 0 0 + 0 + 0 + 0 + + 0 + 0 + 0 3 3
4 + 0 + + 0 0 0 + 0 0 + + 0 + + + + 0 + 0 0 + 0 4 3
5 0 0 + + + 0 0 + 0 + 0 + 0 + + 0 0 + 0 + + + 0 5 3
6 0 0 0 + + 0 + + 0 0 + + + + 0 + + 0 0 + 0 + 0 6 2
7 0 0 + + + 0 0 + 0 + 0 + 0 + 0 + + + 0 + 0 + 0 7 3
8 + 0 0 + + + 0 + 0 0 + 0 + 0 + + + 0 0 + 0 + 0 8 3
9 0 0 0 + + 0 + + + 0 + 0 + + + 0 + + + 0 0 + 0 9 2
10 0 0 0 + + 0 + 0 0 + 0 + 0 0 + + 0 + 0 0 0 + 0 10 0
11 0 0 0 + + 0 0 + 0 + + + 0 + + 0 + 0 0 + 0 + 0 11 3
HA 0 0 0 + + 0 + 0 0 + + + + + + 0 + + + 0 0 + 0 Auto 0
D C E c e Cw K k Kpa Fya Fyb Jka Jkb M N S s P1 Lea Leb Lua Lua Cob

Patient Anti-A Anti-B Anti-AB Anti-D Ctrl A1 cells A2 cells B cells O cells Ab Sc I 3
HA 0 4 0 0 4 0 Ab Sc II 3
Ab Sc III 2
Cord cells

Direct Antiglobulin Test A1 Pos

Poly IgG C3d A2 Pos

B Pos

A1 Neg

A2 Neg

B Neg

Questions
1. Can you identify the probable antibody/antibodies causing these reactions?
2. Is there any antibody/antibodies that cannot be excluded?
3. Do you need to take further steps to exclude these? Why or why not?
4. What type of red cells should be ordered from Lifeblood?

16 Transfusion Medicine Workshop for Haematology Registrars

Case 4

Hilda Almond
Case 4.4
Cell Rh Kell Duffy Kidd MNSs P1 Lewis Lutheran Co Cell Test results
no. D C E c e Cw K k Kpa Fya Fyb Jka Jkb M N S s P1 Lea Leb Lua Lub Cob no. CAT
1 + + 0 1 1
2 + + 0 2 1
3 + + 0 3 1
4 0 + 0 4 0
5 0 + + 5 2
6 + 0 + 6 3
7 + 0 + 7 3
8 0 0 + 8 3
9 0 0 + 9 3
10 0 + 0 10 0
11 0 0 + 11 3
HA 0 0 0 + + 0 + 0 0 + + + + + + 0 + + + 0 0 + 0 Auto 0
D C E c e Cw K k Kpa Fya Fyb Jka Jkb M N S s P1 Lea Leb Lua Lua Cob

Patient Anti-A Anti-B Anti-AB Anti-D Ctrl A1 cells A2 cells B cells O cells Ab Sc I 3
HA 0 4 0 0 4 0 Ab Sc II 3
Ab Sc III 2
Cord cells

Direct Antiglobulin Test A1 Pos

Poly IgG C3d A2 Pos

B Pos

A1 Neg

A2 Neg

B Neg

Questions
5. What is the best source of compatible blood?

17 Transfusion Medicine Workshop for Haematology Registrars

Case 5

William Smith
Case 5.1
Test
Cell Rh Kell Duffy Kidd MNSs P1PK Lewis Lu Cell results
no. no.
D C E c e Cw K k Kpa Fya Fyb Jka Jkb M N S s P1 Lea Leb Lua CAT IAT
1 + + 0 0 + 0 0 + 0 0 + 0 + + + 0 + + 0 + 0 1 0
2 + 0 + + 0 0 0 + 0 + 0 + 0 + + + + + + 0 0 2 0
3 0 0 0 + + 0 + + 0 0 + + + 0 + 0 + + 0 0 0 3 0

Case details
60-year-old male scheduled for radical cystectomy. Prior transfusions two years and four years
ago during cardiac surgery. Patient experienced a delayed transfusion reaction following the last
transfusion and anti-Jka was detected at the time. Four red cell units requested for current surgery.

18 Transfusion Medicine Workshop for Haematology Registrars

Case 5

William Smith
Case 5.2
Cell Rh Kell Duffy Kidd MNSs P1 Lewis Lu Co Cell Test results
no. D C E c e Cw K k Kpa Fya Fyb Jka Jkb M N S s P1 Lea Leb Lua Cob no. CAT
1 + + 0 0 + + 0 + 0 + 0 0 + + + + + + 0 + 0 0 1 0
2 + + 0 0 + 0 + + 0 0 + 0 + + 0 + 0 + 0 + 0 0 2 0
3 + + 0 0 + 0 0 + 0 + 0 + 0 0 + 0 + 0 + 0 0 0 3 0
4 + 0 + + 0 0 0 + 0 0 + 0 + 0 + 0 + + 0 + + 0 4 0
5 + 0 + + 0 0 0 + 0 + 0 + + + + 0 + 0 0 + 0 0 5 0
6 0 + 0 + + 0 0 + 0 + 0 0 + + + 0 + + + 0 0 0 6 0
7 0 0 + + + 0 0 + 0 + 0 + 0 0 + + + 0 0 + 0 + 7 0
8 0 0 0 + + 0 + + 0 0 + + 0 + 0 + 0 0 0 + 0 0 8 0
9 0 0 0 + + 0 0 + 0 + + + 0 + 0 0 + 0 0 0 0 0 9 0
10 0 0 0 + + 0 0 + 0 + + 0 + 0 + + + 0 + 0 0 + 10 0
11 0 0 0 + + 0 0 + 0 0 + + 0 + + + + + 0 0 0 0 11 0
WS + + 0 0 + 0 0 + 0 + 0 0 + + + + + + 0 + 0 0 Auto 0
D C E c e Cw K k Kpa Fya Fyb Jka Jkb M N S s P1 Lea Leb Lua Cob

Patient Anti-A Anti-B Anti-AB Anti-D Ctrl A1 cells A2 cells B cells O cells Ab Sc I 0
WS 0 0 4 0 4 4 Ab Sc II 0
Ab Sc III 0
Cord cells

Direct Antiglobulin Test A1 Pos

Poly IgG C3d A2 Pos

B Pos

A1 Neg

A2 Neg

B Neg

Questions
1. Can you identify the probable antibody/antibodies causing these reactions?
2. Is there any antibody/antibodies that cannot be excluded?
3. Do you need to take further steps to exclude these? Why or why not?
4. What type of red cells should be ordered from Lifeblood?

19 Transfusion Medicine Workshop for Haematology Registrars

Case 5

William Smith
Case 5.3
Cell Rh Kell Duffy Kidd MNSs P1 Lewis Lu Co Cell Test results
no. D C E c e Cw K k Kpa Fya Fyb Jka Jkb M N S s P1 Lea Leb Lua Cob no. CAT
1 + + 0 0 + + 0 + 0 + 0 0 + + + + + + 0 + 0 0 1 0
2 + + 0 0 + 0 + + 0 0 + 0 + + 0 + 0 + 0 + 0 0 2 0
3 + + 0 0 + 0 0 + 0 + 0 + 0 0 + 0 + 0 + 0 0 0 3 0
4 + 0 + + 0 0 0 + 0 0 + 0 + 0 + 0 + + 0 + + 0 4 0
5 + 0 + + 0 0 0 + 0 + 0 + + + + 0 + 0 0 + 0 0 5 0
6 0 + 0 + + 0 0 + 0 + 0 0 + + + 0 + + + 0 0 0 6 0
7 0 0 + + + 0 0 + 0 + 0 + 0 0 + + + 0 0 + 0 + 7 0
8 0 0 0 + + 0 + + 0 0 + + 0 + 0 + 0 0 0 + 0 0 8 0
9 0 0 0 + + 0 0 + 0 + + + 0 + 0 0 + 0 0 0 0 0 9 0
10 0 0 0 + + 0 0 + 0 + + 0 + 0 + + + 0 + 0 0 + 10 0
11 0 0 0 + + 0 0 + 0 0 + + 0 + + + + + 0 0 0 0 11 0
WS + + 0 0 + 0 0 + 0 + 0 0 + + + + + + 0 + 0 0 Auto 0
D C E c e Cw K k Kpa Fya Fyb Jka Jkb M N S s P1 Lea Leb Lua Cob

Patient Anti-A Anti-B Anti-AB Anti-D Ctrl A1 cells A2 cells B cells O cells Ab Sc I 0
WS 0 0 4 0 4 4 Ab Sc II 0
Ab Sc III 0
Cord cells

Jka CAT
Direct Antiglobulin Test
type XM

Poly IgG C3d Donor 1 0 0

Donor 2 0 0
Donor 3 0 3
Donor 4 0 0

Questions
1. Can you identify the probable antibody/antibodies causing these reactions?
2. Is there any antibody/antibodies that cannot be excluded?
3. Do you need to take further steps to exclude these? Why or why not?

20 Transfusion Medicine Workshop for Haematology Registrars

Case 5

William Smith
Case 5.4
Cell Rh Kell Duffy Kidd MNSs P1 Lewis Lutheran Co Cell Test results
no. D C E c e Cw K k Kpa Fya Fyb Jka Jkb M N S s P1 Lea Leb Lua Lub Cob no. CAT
1 + + 0 0 + 0 0 + + + 0 + 0 + + 0 + + 0 + 0 + 0 1 3
2 + + 0 0 + + 0 + 0 0 + + + 0 + + + 0 + 0 0 + 0 2 0
3 + 0 + + 0 0 + + 0 0 + + 0 0 + 0 + + 0 + 0 + 0 3 0
4 + 0 + + 0 0 0 + 0 + 0 0 + + 0 + + + 0 + 0 + + 4 0
5 + 0 0 + + 0 0 + 0 0 + + 0 + + + + 0 0 + 0 + 0 5 0
6 0 + 0 + + 0 0 + 0 + 0 + 0 + + 0 + + + 0 0 + 0 6 0
7 0 0 + + + 0 0 + 0 0 + + + + + + + 0 0 + 0 + 0 7 0
8 0 0 0 + + 0 + + 0 0 + + 0 + 0 + + + 0 + 0 + 0 8 0
9 0 0 0 + + 0 0 + 0 0 + 0 + 0 + 0 + + + 0 0 + 0 9 0
10 0 0 0 + + 0 0 + 0 + + + + + + + 0 + 0 0 0 + 0 10 0
11 0 0 0 + + 0 0 + 0 0 + 0 + 0 + 0 + 0 0 + + + 0 11 0
WS + + 0 0 + 0 0 + 0 + 0 0 + + + + + + 0 + 0 0 0 Auto 0
D C E c e Cw K k Kpa Fya Fyb Jka Jkb M N S s P1 Lea Leb Lua Lub Cob

Patient Anti-A Anti-B Anti-AB Anti-D Ctrl A1 cells A2 cells B cells O cells Ab Sc I 0
WS 0 0 4 0 4 4 Ab Sc II 0
Ab Sc III 0
Cord cells

Direct Antiglobulin Test A1 Pos

Poly IgG C3d A2 Pos

B Pos

A1 Neg

A2 Neg

B Neg

Questions
1. Can you identify the probable antibody/antibodies causing these reactions?
2. Is there any antibody/antibodies that cannot be excluded?
3. Do you need to take further steps to exclude these? Why or why not?

21 Transfusion Medicine Workshop for Haematology Registrars

Case 6

Hiromi Okata
Case 6.1
Test
Cell Rh Kell Duffy Kidd MNSs P1PK Lewis Lu Cell results
no. no.
D C E c e C w
K k Kp a
Fy a
Fy b
Jk a
Jk b
M N S s P1 Le a
Le b
Lu a
CAT IAT
1 + + 0 0 + 0 0 + 0 0 + 0 + + + 0 + + 0 + 0 1 1
2 + 0 + + 0 0 0 + 0 + 0 + 0 + + + + + + 0 0 2 3
3 0 0 0 + + 0 + + 0 0 + + + 0 + 0 + + 0 0 0 3 2

Case details
38-year-old female G6 P4, in labour.
History of clinically significant antibodies on record in the Blood Bank: Anti-c+S+M.
Previous baby with HDFN.
Induced labour - no current G&S or XM.
Amniotic fluid embolism developed - severe DIC and significant PPH.
Cardiac and respiratory arrest.
Intra-uterine fetal death.
Unmatched blood and blood products required urgently - What is your plan?

1000 1100 1130 1300 1330 1800

Plts 51 80 91 93

INR >14 1.9 1.5 1.4

APTT >120 >120 >120 48.9

Fgn <0.1 0.2 1.4 2.1

D dimer >128

Ca (N: 2.0-2.5) 1.86

Ca++ (1.17-1.31) 0.34 0.54

22 Transfusion Medicine Workshop for Haematology Registrars

Case 6

Hiromi Okata
Case 6.2
Cell Rh Kell Duffy Kidd MNSs P1 Lewis Lu Co Cell Test results
no. D C E c e Cw K k Kpa Fya Fyb Jka Jkb M N S s P1 Lea Leb Lua Cob no. CAT

1 + + 0 0 + + 0 + 0 + 0 0 + + + + + + 0 + 0 0 1 2
2 + + 0 0 + 0 + + 0 0 + 0 + + 0 + 0 + 0 + 0 0 2 3
3 + + 0 0 + 0 0 + 0 + 0 + 0 0 + 0 + 0 + 0 0 0 3 0
4 + 0 + + 0 0 0 + 0 0 + 0 + 0 + 0 + + 0 + + 0 4 3
5 + 0 + + 0 0 0 + 0 + 0 + + + + 0 + 0 0 + 0 0 5 3
6 0 + 0 + + 0 0 + 0 + 0 0 + + + 0 + + + 0 0 0 6 2
7 0 0 + + + 0 0 + 0 + 0 + 0 0 + + + 0 0 + 0 + 7 3
8 0 0 0 + + 0 + + 0 0 + + 0 + 0 + 0 0 0 + 0 0 8 3
9 0 0 0 + + 0 0 + 0 + + + 0 + 0 0 + 0 0 0 0 0 9 3
10 0 0 0 + + 0 0 + 0 + + 0 + 0 + + + 0 + 0 0 + 10 3
11 0 0 0 + + 0 0 + 0 0 + + 0 + + + + + 0 0 0 0 11 3
D C E c e Cw K k Kpa Fya Fyb Jka Jkb M N S s P1 Lea Leb Lua Cob Auto 0

Patient Anti-A Anti-B Anti-AB Anti-D Ctrl A1 cells A2 cells B cells O cells Ab Sc I 1
HO 0 0 4 0 4 4 Ab Sc II 3
Ab Sc III 2
Cord cells

Direct Antiglobulin Test A1 pos

Poly IgG C3d A 2 pos

B pos

A1 neg

A 2 neg

B neg

Questions
1. Can you identify the probable antibody/antibodies causing these reactions?
2. Is there any antibody/antibodies that cannot be excluded?
3. Do you need to take further steps to exclude these? Why or why not?
4. What is your advice to the Blood Bank and Obstetric Team: What red cells should be
transfused?
5. What type of red cells should be ordered from Lifeblood?

23 Transfusion Medicine Workshop for Haematology Registrars

Case 6

Hiromi Okata
Case 6.3
Cell Rh Kell Duffy Kidd MNSs P1 Lewis Lutheran Co Cell Test results
no. D C E c e Cw K k Kpa Fya Fyb Jka Jkb M N S s P1 Lea Leb Lua Lub Cob no. CAT ENZ D22

1 0 + 0 + + 0 0 + 0 + + + + + + 0 + 0 0 + 0 + 0 1 2 3 1
2 + + 0 0 + 0 0 + 0 + 0 0 + + 0 + + 0 0 + 0 + 0 2 2 0 2
3 + + 0 0 + 0 0 + 0 0 + 0 + 0 + 0 + + 0 + 0 + 0 3 0 0 0
4 + 0 + + 0 0 0 + 0 0 + + 0 + + + + 0 + 0 0 + 0 4 3 3 1
5 0 0 + + + 0 0 + 0 + 0 + 0 + + 0 0 + 0 + + + 0 5 3 3 1
6 0 0 0 + + 0 + + 0 0 + + + + 0 + + 0 0 + 0 + 0 6 3 3 2
7 0 0 + + + 0 0 + 0 + 0 + 0 + 0 + + + 0 + 0 + 0 7 3 3 2
8 0 0 0 + + + 0 + 0 0 + 0 + 0 + + + 0 0 + 0 + 0 8 3 3 0
9 0 0 0 + + 0 + + + 0 + 0 + + + 0 + + + 0 0 + 0 9 3 3 1
10 + 0 0 + + 0 + 0 0 + 0 + 0 0 + + 0 + 0 0 0 + 0 10 3 3 0
11 0 0 0 + + 0 0 + 0 + + + 0 + + 0 + 0 0 + 0 + 0 11 3 3 1
HO + + 0 0 + 0 + + 0 0 + 0 + 0 + 0 + + + 0 0 0 0 Auto 0 0 0
D C E c e Cw K k Kpa Fya Fyb Jka Jkb M N S s P1 Lea Leb Lua Lub Cob

Patient Anti-A Anti-B Anti-AB Anti-D Ctrl A1 cells A2 cells B cells O cells Ab Sc I 1
HO 0 0 4 0 4 4 Ab Sc II 3
Ab Sc III 2
Cord cells

Direct Antiglobulin Test A1 pos

Poly IgG C3d A 2 pos

B pos

A1 neg

A 2 neg

B neg

Questions
6. What other sources of red cells should be considered?

24 Transfusion Medicine Workshop for Haematology Registrars

Case 6

Hiromi Okata
Case 6.4
Cell Rh Kell Duffy Kidd MNSs P1 Lewis Lutheran Co Cell Test results
no. D C E c e Cw K k Kpa Fya Fyb Jka Jkb M N S s P1 Lea Leb Lua Lub Cob no. CAT ENZ Elution

1 0 + 0 + + 0 0 + 0 + + + + + + 0 + 0 0 + 0 + 0 1 2 3 1
2 + + 0 0 + 0 0 + 0 + 0 0 + + 0 + + 0 0 + 0 + 0 2 2 0 2
3 + + 0 0 + 0 0 + 0 0 + 0 + 0 + 0 + + 0 + 0 + 0 3 0 0 0
4 + 0 + + 0 0 0 + 0 0 + + 0 + + + + 0 + 0 0 + 0 4 3 3 1
5 0 0 + + + 0 0 + 0 + 0 + 0 + + 0 0 + 0 + + + 0 5 3 3 1
6 0 0 0 + + 0 + + 0 0 + + + + 0 + + 0 0 + 0 + 0 6 3 3 1
7 0 0 + + + 0 0 + 0 + 0 + 0 + 0 + + + 0 + 0 + 0 7 3 3 1
8 0 0 0 + + + 0 + 0 0 + 0 + 0 + + + 0 0 + 0 + 0 8 3 3 1
9 0 0 0 + + 0 + + + 0 + 0 + + + 0 + + + 0 0 + 0 9 3 3 1
10 + 0 0 + + 0 + 0 0 + 0 + 0 0 + + 0 + 0 0 0 + 0 10 3 3 1
11 0 0 0 + + 0 0 + 0 + + + 0 + + 0 + 0 0 + 0 + 0 11 3 3 1
HO + + 0 0 + 0 + + 0 0 + 0 + 0 + 0 + + + 0 0 0 0 Auto 1 1
D C E c e Cw K k Kpa Fya Fyb Jka Jkb M N S s P1 Lea Leb Lua Lub Cob

Patient Anti-A Anti-B Anti-AB Anti-D Ctrl A1 cells A2 cells B cells O cells Ab Sc I 1
HO 0 0 4 0 4 4 Ab Sc II 3
Ab Sc III 2
Cord cells

Direct Antiglobulin Test A1 pos

Poly IgG C3d A 2 pos
1 1 0 B pos

A1 neg

A 2 neg

B neg

3 days post massive transfusion

Polychromasia, occasional fragmented red cell and spherocyte.

Questions
1. Can you identify the probable antibody/antibodies causing these reactions?
2. Is there any antibody/antibodies that cannot be excluded?
3. Do you need to take further steps to exclude these? Why or why not?
4. What type of red cells should be ordered from Lifeblood?
5. What other sources of red cells should be considered?

25 Transfusion Medicine Workshop for Haematology Registrars

Case 7

Trevor White
Case 7.1
Test
Cell Rh Kell Duffy Kidd MNSs P1PK Lewis Lu Cell results
no. no.
D C E c e C w
K k Kp a
Fy a
Fy b
Jk a
Jk b
M N S s P1 Le a
Le b
Lu a
CAT IAT
1 + + 0 0 + 0 0 + 0 0 + 0 + + + 0 + + 0 + 0 1 4
2 + 0 + + 0 0 0 + 0 + 0 + 0 + + + + + + 0 0 2 4
3 0 0 0 + + 0 + + 0 0 + + + 0 + 0 + + 0 0 0 3 4

Case details
53-year-old male, presents with lethargy, jaundice and a haemoglobin of 45g/L.
Past history of transfusions.

26 Transfusion Medicine Workshop for Haematology Registrars

Case 7

Trevor White
Case 7.2
Cell Rh Kell Duffy Kidd MNSs P1 Lewis Lu Co Cell Test results
no. D C E c e Cw K k Kpa Fya Fyb Jka Jkb M N S s P1 Lea Leb Lua Cob no. CAT
1 + + 0 0 + + 0 + 0 + 0 0 + + + + + + 0 + 0 0 1 4
2 + + 0 0 + 0 + + 0 0 + 0 + + 0 + 0 + 0 + 0 0 2 4
3 + + 0 0 + 0 0 + 0 + 0 + 0 0 + 0 + 0 + 0 0 0 3 4
4 + 0 + + 0 0 0 + 0 0 + 0 + 0 + 0 + + 0 + + 0 4 4
5 + 0 + + 0 0 0 + 0 + 0 + + + + 0 + 0 0 + 0 0 5 4
6 0 + 0 + + 0 0 + 0 + 0 0 + + + 0 + + + 0 0 0 6 4
7 0 0 + + + 0 0 + 0 + 0 + 0 0 + + + 0 0 + 0 + 7 4
8 0 0 0 + + 0 + + 0 0 + + 0 + 0 + 0 0 0 + 0 0 8 4
9 0 0 0 + + 0 0 + 0 + + + 0 + 0 0 + 0 0 0 0 0 9 4
10 0 0 0 + + 0 0 + 0 + + 0 + 0 + + + 0 + 0 0 + 10 4
11 0 0 0 + + 0 0 + 0 0 + + 0 + + + + + 0 0 0 0 11 4
D C E c e Cw K k Kpa Fya Fyb Jka Jkb M N S s P1 Lea Leb Lua Cob Auto 4

Patient Anti-A Anti-B Anti-AB Anti-D Ctrl A1 cells A2 cells B cells O cells Ab Sc I 4
TW 4 4 4 4 0 0 Ab Sc II 4
Ab Sc III 4
Cord cells

Direct Antiglobulin Test A1 Pos

Poly IgG C3d A2 Pos

B Pos

A1 Neg

A2 Neg

B Neg

Questions
1. Can you identify the probable antibody/antibodies causing these reactions?
2. Is there any antibody/antibodies that cannot be excluded?
3. Do you need to take further steps to exclude these? Why or why not?
4. What type of red cells should be ordered from Lifeblood?

27 Transfusion Medicine Workshop for Haematology Registrars

Case 7

Trevor White
Case 7.3
Cell Rh Kell Duffy Kidd MNSs P1 Lewis Lutheran Co Cell Test results
no. D C E c e Cw K k Kpa Fya Fyb Jka Jkb M N S s P1 Lea Leb Lua Lub Cob no. CAT Eluate
1 + + 0 0 + + 0 + 0 + 0 0 + + + + + + 0 + 0 0 0 1 4 4
2 + + 0 0 + 0 + + 0 0 + 0 + + 0 + 0 + 0 + 0 0 0 2 4 4
3 + + 0 0 + 0 0 + 0 + 0 + 0 0 + 0 + 0 + 0 0 0 0 3 4 4
4 + 0 + + 0 0 0 + 0 0 + 0 + 0 + 0 + + 0 + + 0 + 4 4 4
5 + 0 + + 0 0 0 + 0 + 0 + + + + 0 + 0 0 + 0 0 0 5 4 4
6 0 + 0 + + 0 0 + 0 + 0 0 + + + 0 + + + 0 0 0 0 6 4 4
7 0 0 + + + 0 0 + 0 + 0 + 0 0 + + + 0 0 + 0 + 0 7 4 4
8 0 0 0 + + 0 + + 0 0 + + 0 + 0 + 0 0 0 + 0 0 0 8 4 4
9 0 0 0 + + 0 0 + 0 + + + 0 + 0 0 + 0 0 0 0 0 0 9 4 4
10 0 0 0 + + 0 0 + 0 + + 0 + 0 + + + 0 + 0 0 + 0 10 4 4
11 0 0 0 + + 0 0 + 0 0 + + 0 + + + + + 0 0 0 0 0 11 4 4
TW + + 0 + + 0 0 + 0 + 0 + 0 0 + 0 + 0 + 0 0 0 0 Auto 4
D C E c e Cw K k Kpa Fya Fyb Jka Jkb M N S s P1 Lea Leb Lua Lub Cob

Patient Anti-A Anti-B Anti-AB Anti-D Ctrl A1 cells A2 cells B cells O cells Ab Sc I 4
TW (CAT) 4 4 4 4 0 0 Ab Sc II 4
TW (Tube) 4 4 4 0 0 0 Ab Sc III 4
Cord cells

Direct Antiglobulin Test A1 Pos

Poly IgG C3d A2 Pos

4 4 0 B Pos

A1 Neg

A2 Neg

B Neg

Questions
1. Can you identify the probable antibody/antibodies causing these reactions?
2. Is there any antibody/antibodies that cannot be excluded?
3. Do you need to take further steps to exclude these? Why or why not?
4. What type of red cells should be ordered from Lifeblood?

28 Transfusion Medicine Workshop for Haematology Registrars

Case 7

Trevor White
Case 7.4

Cell Rh Kell Duffy Kidd MNSs P1 Lewis Lutheran Co Cell Test results
no. no. Adsorbed
D C E c e Cw K k Kpa Fya Fyb Jka Jkb M N S s P1 Lea Leb Lua Lub Cob CAT plasma
1 0 + 0 + + 0 0 + 0 + + + + + + 0 + 0 0 + 0 + 0 1 4 0
2 + + 0 0 + 0 0 + 0 + 0 0 + + 0 + + 0 0 + 0 + 0 2 4 0
3 + + 0 0 + 0 0 + 0 0 + 0 + 0 + 0 + + 0 + 0 + 0 3 4 0
4 + 0 + + 0 0 0 + 0 0 + + 0 + + + + 0 + 0 0 + 0 4 4 3
5 0 0 + + + 0 0 + 0 + 0 + 0 + + 0 0 + 0 + + + 0 5 4 3
6 0 0 0 + + 0 + + 0 0 + + + + 0 + + 0 0 + 0 + 0 6 4 2
7 0 0 + + + 0 0 + 0 + 0 + 0 + 0 + + + 0 + 0 + 0 7 4 3
8 0 0 0 + + + 0 + 0 0 + 0 + 0 + + + 0 0 + 0 + 0 8 4 0
9 0 0 0 + + 0 + + + 0 + 0 + + + 0 + + + 0 0 + 0 9 4 2
10 + 0 0 + + 0 + 0 0 + 0 + 0 0 + + 0 + 0 0 0 + 0 10 4 3
11 0 0 0 + + 0 0 + 0 + + + 0 + + 0 + 0 0 + 0 + 0 11 4 0
TW + + 0 + + 0 0 + 0 + 0 + 0 0 + 0 + 0 + 0 0 + 0 Auto 4
D C E c e Cw K k Kpa Fya Fyb Jka Jkb M N S s P1 Lea Leb Lua Lub Cob

Patient Anti-A Anti-B Anti-AB Anti-D Ctrl A1 cells A2 cells B cells O cells Ab Sc I 4
TW (CAT) 4 4 4 4 0 0 Ab Sc II 4
TW (Tube) 4 4 4 0 0 0 Ab Sc III 4
Cord cells

Direct Antiglobulin Test A1 Pos

Poly IgG C3d A2 Pos

4 4 0 B Pos

A1 Neg

A2 Neg

B Neg

Questions
1. Can you identify the probable antibody/antibodies causing these reactions?
2. Is there any antibody/antibodies that cannot be excluded?
3. Do you need to take further steps to exclude these? Why or why not?
4. What type of red cells should be ordered from Lifeblood?

29 Transfusion Medicine Workshop for Haematology Registrars

Case 8

Peter Isaacs
Case 8.1
Test
Cell Rh Kell Duffy Kidd MNSs P1PK Lewis Lu Cell results
no. no.
D C E c e Cw K k Kpa Fya Fyb Jka Jkb M N S s P1 Lea Leb Lua CAT IAT
1 + + 0 0 + 0 0 + 0 0 + 0 + + + 0 + + 0 + 0 1 0
2 + 0 + + 0 0 0 + 0 + 0 + 0 + + + + + + 0 0 2 0
3 0 0 0 + + 0 + + 0 0 + + + 0 + 0 + + 0 0 0 3 0

Case details
61-year-old male with autoimmune hepatitis.
Pre-op liver transplant: Multiple red cell and albumin transfusions.
Liver transplant (30/12): Four red cell units transfused during surgery and intra-op scavenged red
cells.
Subsequent red cell transfusions:
• Day 1 post op: 1 red cell unit
• Day 6 post op: 1 red cell unit
• Day 8 post op: 1 red cell unit
• Day 9 post op: 1 red cell unit
Post op Day 12: Signs and symtoms of acute intravascular haemolytic transfusion reaction.

Laboratory results

30/12 31/12 1/1 3/1 5/1 7/1 8/1 10/1 12/1 13/1 25/1

Hb 108 107 118 99 96 88 77 86 74 63 97

Plt 182 184 265 152 134 113 125 134 164 218 116

LDH 1144 496 270

SBR 345 301 179 150 102 84 77 73 71

Morphology
• Moderate polychromasia
• Few spherocytes
• Autoagglutination

30 Transfusion Medicine Workshop for Haematology Registrars

Case 8

Peter Isaacs
Case 8.2: Post-op day 1
Cell Rh Kell Duffy Kidd MNSs P1 Lewis Lu Co Cell Test results
no. D C E c e Cw K k Kpa Fya Fyb Jka Jkb M N S s P1 Lea Leb Lua Cob no. CAT
1 + + 0 0 + + 0 + 0 + 0 0 + + + + + + 0 + 0 0 1 0
2 + + 0 0 + 0 + + 0 0 + 0 + + 0 + 0 + 0 + 0 0 2 0
3 + + 0 0 + 0 0 + 0 + 0 + 0 0 + 0 + 0 + 0 0 0 3 0
4 + 0 + + 0 0 0 + 0 0 + 0 + 0 + 0 + + 0 + + 0 4 0
5 + 0 + + 0 0 0 + 0 + 0 + + + + 0 + 0 0 + 0 0 5 0
6 0 + 0 + + 0 0 + 0 + 0 0 + + + 0 + + + 0 0 0 6 0
7 0 0 + + + 0 0 + 0 + 0 + 0 0 + + + 0 0 + 0 + 7 0
8 0 0 0 + + 0 + + 0 0 + + 0 + 0 + 0 0 0 + 0 0 8 0
9 0 0 0 + + 0 0 + 0 + + + 0 + 0 0 + 0 0 0 0 0 9 0
10 0 0 0 + + 0 0 + 0 + + 0 + 0 + + + 0 + 0 0 + 10 0
11 0 0 0 + + 0 0 + 0 0 + + 0 + + + + + 0 0 0 0 11 0
D C E c e Cw K k Kpa Fya Fyb Jka Jkb M N S s P1 Lea Leb Lua Cob Auto 0

Patient Anti-A Anti-B Anti-AB Anti-D Ctrl A1 cells A2 cells B cells O cells Ab Sc I 0
PI Ab Sc II 0
Post-op 4 0 4 0 0 3
D1 Ab Sc III 0
Cord cells

Direct Antiglobulin Test A1 Pos

Poly IgG C3d A2 Pos

B Pos

A1 Neg

A2 Neg

B Neg

Questions
1. Can you identify the probable antibody/antibodies causing these reactions?
2. Is there any antibody/antibodies that cannot be excluded?
3. Do you need to take further steps to exclude these? Why or why not?
4. What type of red cells should be ordered from Lifeblood?

31 Transfusion Medicine Workshop for Haematology Registrars

Case 8

Peter Isaacs
Case 8.3: Post-op day 6
Cell Rh Kell Duffy Kidd MNSs P1 Lewis Lu Co Cell Test results
no. D C E c e Cw K k Kpa Fya Fyb Jka Jkb M N S s P1 Lea Leb Lua Cob no. CAT
1 + + 0 0 + + 0 + 0 + 0 0 + + + + + + 0 + 0 0 1 0
2 + + 0 0 + 0 + + 0 0 + 0 + + 0 + 0 + 0 + 0 0 2 0
3 + + 0 0 + 0 0 + 0 + 0 + 0 0 + 0 + 0 + 0 0 0 3 0
4 + 0 + + 0 0 0 + 0 0 + 0 + 0 + 0 + + 0 + + 0 4 0
5 + 0 + + 0 0 0 + 0 + 0 + + + + 0 + 0 0 + 0 0 5 0
6 0 + 0 + + 0 0 + 0 + 0 0 + + + 0 + + + 0 0 0 6 0
7 0 0 + + + 0 0 + 0 + 0 + 0 0 + + + 0 0 + 0 + 7 0
8 0 0 0 + + 0 + + 0 0 + + 0 + 0 + 0 0 0 + 0 0 8 0
9 0 0 0 + + 0 0 + 0 + + + 0 + 0 0 + 0 0 0 0 0 9 0
10 0 0 0 + + 0 0 + 0 + + 0 + 0 + + + 0 + 0 0 + 10 0
11 0 0 0 + + 0 0 + 0 0 + + 0 + + + + + 0 0 0 0 11 0
D C E c e Cw K k Kpa Fya Fyb Jka Jkb M N S s P1 Lea Leb Lua Cob Auto 0

Patient Anti-A Anti-B Anti-AB Anti-D Ctrl A1 cells A2 cells B cells O cells Ab Sc I 0
PI Post-op D1 4 0 4 0 0 3 Ab Sc II 0
PI Post-op D6 4 0 4 0 0 3 Ab Sc III 0
Cord cells

CAT
Direct Antiglobulin Test Group
XM

Poly IgG C3d Donor 1 0 A pos

0 0 0

Questions
1. Can you identify the probable antibody/antibodies causing these reactions?
2. Is there any antibody/antibodies that cannot be excluded?
3. Do you need to take further steps to exclude these? Why or why not?
4. What type of red cells should be ordered from Lifeblood?

32 Transfusion Medicine Workshop for Haematology Registrars

Case 8

Peter Isaacs
Case 8.4: Post-op day 12
Cell Rh Kell Duffy Kidd MNSs P1 Lewis Lu Co Cell Test results
no. D C E c e Cw K k Kpa Fya Fyb Jka Jkb M N S s P1 Lea Leb Lua Cob no. CAT
1 + + 0 0 + + 0 + 0 + 0 0 + + + + + + 0 + 0 0 1 0
2 + + 0 0 + 0 + + 0 0 + 0 + + 0 + 0 + 0 + 0 0 2 0
3 + + 0 0 + 0 0 + 0 + 0 + 0 0 + 0 + 0 + 0 0 0 3 0
4 + 0 + + 0 0 0 + 0 0 + 0 + 0 + 0 + + 0 + + 0 4 0
5 + 0 + + 0 0 0 + 0 + 0 + + + + 0 + 0 0 + 0 0 5 0
6 0 + 0 + + 0 0 + 0 + 0 0 + + + 0 + + + 0 0 0 6 0
7 0 0 + + + 0 0 + 0 + 0 + 0 0 + + + 0 0 + 0 + 7 0
8 0 0 0 + + 0 + + 0 0 + + 0 + 0 + 0 0 0 + 0 0 8 0
9 0 0 0 + + 0 0 + 0 + + + 0 + 0 0 + 0 0 0 0 0 9 0
10 0 0 0 + + 0 0 + 0 + + 0 + 0 + + + 0 + 0 0 + 10 0
11 0 0 0 + + 0 0 + 0 0 + + 0 + + + + + 0 0 0 0 11 0
D C E c e Cw K k Kpa Fya Fyb Jka Jkb M N S s P1 Lea Leb Lua Cob Auto 2

Patient Anti-A Anti-B Anti-AB Anti-D Ctrl A1 cells A2 cells B cells O cells Ab Sc I 0
PI Post-op D1 4 0 4 0 0 3 Ab Sc II 0
PI Post-op D6 4 0 4 0 0 3 Ab Sc III 0
PI Post-op D12 4 0 4 4 2 2 2 3 Cord cells

Post-op Day 12

CAT Tube
Direct Antiglobulin Test Group
XM XM

Poly IgG C3d Donor 1 2 2 A pos

2 2 0 Donor 2 2 2 A pos
Donor 3 2 2 A pos
Donor 4 2 2 A pos
Auto 2 2 Apos

Questions
1. Can you identify the probable antibody/antibodies causing these reactions?
2. Is there any antibody/antibodies that cannot be excluded?
3. Do you need to take further steps to exclude these? Why or why not?
4. What type of red cells should be ordered from Lifeblood?

33 Transfusion Medicine Workshop for Haematology Registrars

Case 8

Peter Isaacs
Case 8.5: Post-op day 12
Cell Rh Kell Duffy Kidd MNSs P1 Lewis Lu Co Cell Test results
no. D C E c e Cw K k Kpa Fya Fyb Jka Jkb M N S s P1 Lea Leb Lua Cob no. CAT Eluate
1 + + 0 0 + + 0 + 0 + 0 0 + + + + + + 0 + 0 0 1 0 0
2 + + 0 0 + 0 + + 0 0 + 0 + + 0 + 0 + 0 + 0 0 2 0 0
3 + + 0 0 + 0 0 + 0 + 0 + 0 0 + 0 + 0 + 0 0 0 3 0 0
4 + 0 + + 0 0 0 + 0 0 + 0 + 0 + 0 + + 0 + + 0 4 0 0
5 + 0 + + 0 0 0 + 0 + 0 + + + + 0 + 0 0 + 0 0 5 0 0
6 0 + 0 + + 0 0 + 0 + 0 0 + + + 0 + + + 0 0 0 6 0 0
7 0 0 + + + 0 0 + 0 + 0 + 0 0 + + + 0 0 + 0 + 7 0 0
8 0 0 0 + + 0 + + 0 0 + + 0 + 0 + 0 0 0 + 0 0 8 0 0
9 0 0 0 + + 0 0 + 0 + + + 0 + 0 0 + 0 0 0 0 0 9 0 0
10 0 0 0 + + 0 0 + 0 + + 0 + 0 + + + 0 + 0 0 + 10 0 0
11 0 0 0 + + 0 0 + 0 0 + + 0 + + + + + 0 0 0 0 11 0 0
D C E c e Cw K k Kpa Fya Fyb Jka Jkb M N S s P1 Lea Leb Lua Cob Auto 2

Patient Anti-A Anti-B Anti-AB Anti-D Ctrl A1 cells A2 cells B cells O cells Ab Sc I 0
PI Post-op D1 4 0 4 0 0 3 Ab Sc II 0
PI Post-op D6 4 0 4 0 0 3 Ab Sc III 0
PI Post-op D12 4 0 4 4 2 2 2 3 Cord cells

Direct Antiglobulin Test A1 pos 4

Poly IgG C3d A 2 pos 4
2 2 0 B pos 0

A1 neg 4
A 2 neg 4
B neg 0

Questions
1. Can you identify the probable antibody/antibodies causing these reactions?
2. Is there any antibody/antibodies that cannot be excluded?
3. Do you need to take further steps to exclude these? Why or why not?
4. What type of red cells should be ordered from Lifeblood?

34 Transfusion Medicine Workshop for Haematology Registrars

Case 9

Julie Thomas
Case 9.1
Test
Cell Rh Kell Duffy Kidd MNSs P1PK Lewis Lu Cell results
no. no.
D C E c e Cw K k Kpa Fya Fyb Jka Jkb M N S s P1 Lea Leb Lua CAT IAT
1 + + 0 0 + 0 0 + 0 0 + 0 + + + 0 + + 0 + 0 1 3
2 + 0 + + 0 0 0 + 0 + 0 + 0 + + + + + + 0 0 2 3
3 0 0 0 + + 0 + + 0 0 + + + 0 + 0 + + 0 0 0 3 1

Case details
25-year-old female in her third pregnancy. Previous pregnancy had a mild history of HDFN.
No antenatal care this pregnancy. Emergency LSCS.

35 Transfusion Medicine Workshop for Haematology Registrars

Case 9

Julie Thomas
Case 9.2
Cell Rh Kell Duffy Kidd MNSs P1 Lewis Lutheran Co Cell Test results
no. D C E c e Cw K k Kpa Fya Fyb Jka Jkb M N S s P1 Lea Leb Lua Lub Cob no. CAT

1 + + 0 0 + + 0 + 0 + 0 0 + + + + + + 0 + 0 0 0 1 3
2 + + 0 0 + 0 + + 0 0 + 0 + + 0 + 0 + 0 + 0 0 0 2 3
3 + + 0 0 + 0 0 + 0 + 0 + 0 0 + 0 + 0 + 0 0 0 0 3 3
4 + 0 + + 0 0 0 + 0 0 + 0 + 0 + 0 + + 0 + + 0 0 4 3
5 + 0 + + 0 0 0 + 0 + 0 + + + + 0 + 0 0 + 0 0 0 5 3
6 0 + 0 + + 0 0 + 0 + 0 0 + + + 0 + + + 0 0 0 0 6 2
7 0 0 + + + 0 0 + 0 + 0 + 0 0 + + + 0 0 + 0 + 0 7 3
8 0 0 0 + + 0 + + 0 0 + + 0 + 0 + 0 0 0 + 0 0 0 8 3
9 0 0 0 + + 0 0 + 0 + + + 0 + 0 0 + 0 0 0 0 0 0 9 3
10 0 0 0 + + 0 0 + 0 + + 0 + 0 + + + 0 + 0 0 + 0 10 0
11 0 0 0 + + 0 0 + 0 0 + + 0 + + + + + 0 0 0 0 0 11 3
D C E c e Cw K k Kpa Fya Fyb Jka Jkb M N S s P1 Lea Leb Lua Lub Cob Auto 0

Patient Anti-A Anti-B Anti-AB Anti-D Ctrl A1 cells A2 cells B cells O cells Ab Sc I 3
JT 0 0 0 0 4 4 Ab Sc II 3
Ab Sc III 1
Cord cells

Direct Antiglobulin Test A1 pos

Poly IgG C3d A 2 pos

B pos

A1 neg

A 2 neg

B neg

Questions
1. Can you identify the probable antibody/antibodies causing these reactions?
2. Is there any antibody/antibodies that cannot be excluded?
3. Do you need to take further steps to exclude these? Why or why not?
4. What type of red cells should be ordered from Lifeblood?

36 Transfusion Medicine Workshop for Haematology Registrars

Case 9

Julie Thomas
Case 9.3
Cell Rh Kell Duffy Kidd MNSs P1 Lewis Lu Co Cell Test results
no. D C E c e Cw K k Kpa Fya Fyb Jka Jkb M N S s P1 Lea Leb Lua Cob no. CAT D37 ENZ

1 + + 0 0 + + 0 + 0 + 0 0 + + + + + + 0 + 0 0 1 3 3 3
2 + + 0 0 + 0 + + 0 0 + 0 + + 0 + 0 + 0 + 0 0 2 3 3 3
3 + + 0 0 + 0 0 + 0 + 0 + 0 0 + 0 + 0 + 0 0 0 3 3 3 3
4 + 0 + + 0 0 0 + 0 0 + 0 + 0 + 0 + + 0 + + 0 4 3 3 3
5 + 0 + + 0 0 0 + 0 + 0 + + + + 0 + 0 0 + 0 0 5 3 3 3
6 0 + 0 + + 0 0 + 0 + 0 0 + + + 0 + + + 0 0 0 6 2 0 2
7 0 0 + + + 0 0 + 0 + 0 + 0 0 + + + 0 0 + 0 + 7 3 0 3
8 0 0 0 + + 0 + + 0 0 + + 0 + 0 + 0 0 0 + 0 0 8 3 0 3
9 0 0 0 + + 0 0 + 0 + + + 0 + 0 0 + 0 0 0 0 0 9 3 0 3
10 0 0 0 + + 0 0 + 0 + + 0 + 0 + + + 0 + 0 0 + 10 0 0 0
11 0 0 0 + + 0 0 + 0 0 + + 0 + + + + + 0 0 0 0 11 3 0 3
JT 0 0 0 + + 0 + + 0 + + 0 + + + 0 + + + 0 0 0 Auto 0 0 0  
D C E c e Cw K k Kpa Fya Fyb Jka Jkb M N S s P1 Lea Leb Lua Cob

Patient Anti-A Anti-B Anti-AB Anti-D Ctrl A1 cells A2 cells B cells O cells Ab Sc I 3
JT 0 0 0 0 4 4 Ab Sc II 3
Ab Sc III 1
Cord cells

Direct Antiglobulin Test A1 pos

Poly IgG C3d A 2 pos

B pos

A1 neg

A 2 neg

B neg

Questions
1. Can you identify the probable antibody/antibodies causing these reactions?
2. Is there any antibody/antibodies that cannot be excluded?
3. Do you need to take further steps to exclude these? Why or why not?
4. What type of red cells should be ordered from Lifeblood?

37 Transfusion Medicine Workshop for Haematology Registrars

Case 9

Julie Thomas
Case 9.4
Cell Rh Kell Duffy Kidd MNSs P1 Lewis Lu Co Cell Test results
no. D C E c e Cw K k Kpa Fya Fyb Jka Jkb M N S s P1 Lea Leb Lua Cob no. CAT Titre
1 0 + 0 + + 0 0 + 0 + + + + + + 0 + 0 0 + 0 + 0 1 Neat 3
2 + + 0 0 + 0 0 + 0 + 0 0 + + 0 + + 0 0 + 0 + 0 3 1:2 3
3 + + 0 0 + 0 0 + 0 0 + 0 + 0 + 0 + + 0 + 0 + 0 3 1:4 3
4 + 0 + + 0 0 0 + 0 0 + + 0 + + + + 0 + 0 0 + 0 3 1:8 3
5 0 0 + + + 0 0 + 0 + 0 + 0 + + 0 0 + 0 + + + 0 2 1:16 3
6 0 0 0 + + 0 + + 0 0 + + + + 0 + + 0 0 + 0 + 0 1 1:32 2
7 0 0 + + + 0 0 + 0 + 0 + 0 + 0 + + + 0 + 0 + 0 2 1:64 2
8 0 0 0 + + + 0 + 0 0 + 0 + 0 + + + 0 0 + 0 + 0 0 1:128 1
9 0 0 0 + + 0 + + + 0 + 0 + + + 0 + + + 0 0 + 0 0 1:256 +/-
10 + 0 0 + + 0 + 0 0 + 0 + 0 0 + + 0 + 0 0 0 + 0 3 1:512 0
11 0 0 0 + + 0 0 + 0 + + + 0 + + 0 + 0 0 + 0 + 0 2 1:1024 0
JT 0 0 0 + + 0 + + 0 + + 0 + + + 0 + + + 0 0 0 0 0  
D C E c e Cw K k Kpa Fya Fyb Jka Jkb M N S s P1 Lea Leb Lua Cob

Patient Anti-A Anti-B Anti-AB Anti-D Ctrl A1 cells A2 cells B cells O cells Ab Sc I 3
JT 0 0 0 0 4 4 Ab Sc II 3
Ab Sc III 1
Cord cells

Direct Antiglobulin Test A1 pos

Poly IgG C3d A 2 pos

B pos

A1 neg

A 2 neg

B neg

Questions
1. Can you identify the probable antibody/antibodies causing these reactions?
2. Is there any antibody/antibodies that cannot be excluded?
3. Do you need to take further steps to exclude these? Why or why not?
4. What type of red cells should be ordered from Lifeblood?

38 Transfusion Medicine Workshop for Haematology Registrars

Case 9

Julie Thomas
Case 9.5: Baby of Julie Thomas
Cell Rh Kell Duffy Kidd MNSs P1 Lewis Lutheran Co Cell Test results
no. D C E c e Cw K k Kpa Fya Fyb Jka Jkb M N S s P1 Lea Leb Lua Lub Cob no. Eluate

1 0 + 0 + + 0 0 + 0 + + + + + + 0 + 0 0 + 0 + 0 1 1
2 + + 0 0 + 0 0 + 0 + 0 0 + + 0 + + 0 0 + 0 + 0 2 3
3 + + 0 0 + 0 0 + 0 0 + 0 + 0 + 0 + + 0 + 0 + 0 3 3
4 + 0 + + 0 0 0 + 0 0 + + 0 + + + + 0 + 0 0 + 0 4 3
5 0 0 + + + 0 0 + 0 + 0 + 0 + + 0 0 + 0 + + + 0 5 0
6 0 0 0 + + 0 + + 0 0 + + + + 0 + + 0 0 + 0 + 0 6 0
7 0 0 + + + 0 0 + 0 + 0 + 0 + 0 + + + 0 + 0 + 0 7 0
8 0 0 0 + + + 0 + 0 0 + 0 + 0 + + + 0 0 + 0 + 0 8 0
9 0 0 0 + + 0 + + + 0 + 0 + + + 0 + + + 0 0 + 0 9 0
10 + 0 0 + + 0 + 0 0 + 0 + 0 0 + + 0 + 0 0 0 + 0 10 3
11 0 0 0 + + 0 0 + 0 + + + 0 + + 0 + 0 0 + 0 + 0 11 0
JT + + 0 + + 0 0 + 0 0 + + + 0 + + + 0 0 0 0 Auto
D C E c e Cw K k Kpa Fya Fyb Jka Jkb M N S s P1 Lea Leb Lua Lub Cob

Patient Anti-A Anti-B Anti-AB Anti-D Ctrl A1 cells A2 cells B cells O cells Ab Sc I 3
Baby of JT 0 0 4 0 Ab Sc II 3
Ab Sc III 1
Cord cells

Direct Antiglobulin Test Cord blood A1 pos

Poly IgG C3d A 2 pos

4 B pos

A1 neg

A 2 neg

B neg

Questions
1. Can you identify the probable antibody/antibodies causing these reactions?
2. Is there any antibody/antibodies that cannot be excluded?
3. Do you need to take further steps to exclude these? Why or why not?
4. What type of red cells should be ordered from Lifeblood?

39 Transfusion Medicine Workshop for Haematology Registrars

Case 10

Morgan Childs
Case 10.1
Test
Cell Rh Kell Duffy Kidd MNSs P1PK Lewis Lu Cell results
no. no.
D C E c e Cw K k Kpa Fya Fyb Jka Jkb M N S s P1 Lea Leb Lua CAT IAT
1 + + 0 0 + 0 0 + 0 0 + 0 + + + 0 + + 0 + 0 1 0
2 + 0 + + 0 0 0 + 0 + 0 + 0 + + + + + + 0 0 2 3
3 0 0 0 + + 0 + + 0 0 + + + 0 + 0 + + 0 0 0 3 2

Case details
27-year-old pregnant postpartum female - second pregnancy. Baby has neonatal jaundice and
mild anaemia. MCA doppler during pregnancy indicates no abnormalities

40 Transfusion Medicine Workshop for Haematology Registrars

Case 10

Morgan Childs
Case 10.2
Cell Rh Kell Duffy Kidd MNSs P1 Lewis Lu Co Cell Test results
no. D C E c e Cw K k Kpa Fya Fyb Jka Jkb M N S s P1 Lea Leb Lua Cob no. CAT

1 + + 0 0 + + 0 + 0 + 0 0 + + + + + + 0 + 0 0 1 0
2 + + 0 0 + 0 + + 0 0 + 0 + + 0 + 0 + 0 + 0 0 2 0
3 + + 0 0 + 0 0 + 0 + 0 + 0 0 + 0 + 0 + 0 0 0 3 0
4 + 0 + + 0 0 0 + 0 0 + 0 + 0 + 0 + + 0 + + 0 4 3
5 + 0 + + 0 0 0 + 0 + 0 + + + + 0 + 0 0 + 0 0 5 3
6 0 + 0 + + 0 0 + 0 + 0 0 + + + 0 + + + 0 0 0 6 2
7 0 0 + + + 0 0 + 0 + 0 + 0 0 + + + 0 0 + 0 + 7 3
8 0 0 0 + + 0 + + 0 0 + + 0 + 0 + 0 0 0 + 0 0 8 2
9 0 0 0 + + 0 0 + 0 + + + 0 + 0 0 + 0 0 0 0 0 9 2
10 0 0 0 + + 0 0 + 0 + + 0 + 0 + + + 0 + 0 0 + 10 2
11 0 0 0 + + 0 0 + 0 0 + + 0 + + + + + 0 0 0 0 11 2
D C E c e Cw K k Kpa Fya Fyb Jka Jkb M N S s P1 Lea Leb Lua Cob Auto 0

Patient Anti-A Anti-B Anti-AB Anti-D Ctrl A1 cells A2 cells B cells O cells Ab Sc I 0
MC 0 0 4 0 3 3 Ab Sc II 3
Baby of MC 0 3 3 4 0 Ab Sc III 2
Cord cells

Direct Antiglobulin Test A1 pos

Cord Blood DAT IgG C3d A 2 pos

2 B pos

A1 neg

A 2 neg

B neg

Questions
1. Can you identify the probable antibody/antibodies causing these reactions?
2. Is there any antibody/antibodies that cannot be excluded?
3. Do you need to take further steps to exclude these? Why or why not?
4. What type of red cells should be ordered from Lifeblood?

41 Transfusion Medicine Workshop for Haematology Registrars

Case 10

Morgan Childs
Case 10.3
Cell Rh Kell Duffy Kidd MNSs P1 Lewis Lutheran Co Cell Test results
no. D C E c e Cw K k Kpa Fya Fyb Jka Jkb M N S s P1 Lea Leb Lua Lub Cob no. CAT

1 0 + 0 + + 0 0 + 0 + + + + + + 0 + 0 0 + 0 + 0 1 2
2 + + 0 0 + 0 0 + 0 + 0 0 + + 0 + + 0 0 + 0 + 0 2 0
3 + + 0 0 + 0 0 + 0 0 + 0 + 0 + 0 + + 0 + 0 + 0 3 0
4 + 0 + + 0 0 0 + 0 0 + + 0 + + + + 0 + 0 0 + 0 4 3
5 0 0 + + + 0 0 + 0 + 0 + 0 + + 0 0 + 0 + + + 0 5 3
6 0 0 0 + + 0 + + 0 0 + + + + 0 + + 0 0 + 0 + 0 6 2
7 0 0 + + + 0 0 + 0 + 0 + 0 + 0 + + + 0 + 0 + 0 7 3
8 0 0 0 + + + 0 + 0 0 + 0 + 0 + + + 0 0 + 0 + 0 8 2
9 0 0 0 + + 0 + + + 0 + 0 + + + 0 + + + 0 0 + 0 9 2
10 + 0 0 + + 0 + 0 0 + 0 + 0 0 + + 0 + 0 0 0 + 0 10 2
11 0 0 0 + + 0 0 + 0 + + + 0 + + 0 + 0 0 + 0 + 0 11 2
MC + + 0 0 + 0 + + 0 0 + 0 + + + 0 + + + 0 0 0 0 Auto 0
D C E c e Cw K k Kpa Fya Fyb Jka Jkb M N S s P1 Lea Leb Lua Lua Cob

Patient Anti-A Anti-B Anti-AB Anti-D Ctrl A1 cells A2 cells B cells O cells Ab Sc I 0
MC 0 0 4 0 3 3 Ab Sc II 3
Ab Sc III 2
Cord cells

Direct Antiglobulin Test A1 pos

Poly IgG C3d A 2 pos

B pos

A1 neg

A 2 neg

B neg

Questions
1. Can you identify the probable antibody/antibodies causing these reactions?
2. Is there any antibody/antibodies that cannot be excluded?
3. Do you need to take further steps to exclude these? Why or why not?
4. What type of red cells should be ordered from Lifeblood?

42 Transfusion Medicine Workshop for Haematology Registrars

Case 10

Morgan Childs
Case 10.4 Cord Blood
Cell Rh Kell Duffy Kidd MNSs P1 Lewis Lutheran Co Cell Test results
no. D C E c e Cw K k Kpa Fya Fyb Jka Jkb M N S s P1 Lea Leb Lua Lub Cob no. ELUATE
1 0 + 0 + + 0 0 + 0 + + + + + + 0 + 0 0 + 0 + 0 1 0
2 + + 0 0 + 0 0 + 0 + 0 0 + + 0 + + 0 0 + 0 + 0 2 0
3 + + 0 0 + 0 0 + 0 0 + 0 + 0 + 0 + + 0 + 0 + 0 3 0
4 + 0 + + 0 0 0 + 0 0 + + 0 + + + + 0 + 0 0 + 0 4 0
5 0 0 + + + 0 0 + 0 + 0 + 0 + + 0 0 + 0 + + + 0 5 0
6 0 0 0 + + 0 + + 0 0 + + + + 0 + + 0 0 + 0 + 0 6 0
7 0 0 + + + 0 0 + 0 + 0 + 0 + 0 + + + 0 + 0 + 0 7 0
8 0 0 0 + + + 0 + 0 0 + 0 + 0 + + + 0 0 + 0 + 0 8 0
9 0 0 0 + + 0 + + + 0 + 0 + + + 0 + + + 0 0 + 0 9 0
10 + 0 0 + + 0 + 0 0 + 0 + 0 0 + + 0 + 0 0 0 + 0 10 0
11 0 0 0 + + 0 0 + 0 + + + 0 + + 0 + 0 0 + 0 + 0 11 0
Baby
+ + 0 0 + 0 0 + 0 + + + + 0 + Auto 0
of MC
D C E c e Cw K k Kpa Fya Fyb Jka Jkb M N S s P1 Lea Leb Lua Lua Cob

Patient Anti-A Anti-B Anti-AB Anti-D Ctrl A1 cells A2 cells B cells O cells Ab Sc I

Baby of MC 0 3 3 4 0 Ab Sc II

Ab Sc III

Cord cells

Direct Antiglobulin Test Cord blood A1 pos 0 CCDee 0

Poly IgG C3d A 2 pos 0 CCDee 0
2 B pos 2 CCDee 2

A1 neg 0
A 2 neg 0
B neg 2

Questions
5. What are the options for control of jaundice and rising bilirubin levels?

43 Transfusion Medicine Workshop for Haematology Registrars