An immunohematology teaching case with questions. For use or adaption with teaching/examination resources for transfusion medicine, immunohematology, and blood banking.
Only around 0.2-2.0% of the patient population will have detectable RBC antibodies -- fewer still will have multiplePatients more frequently exposed to RBC antigens are more likely to have antibodies (multiply transfused sickle cell adult patients ~47%)So you've mastered the type & screen and antibody panels... but what do you do if an antibody panel is inconclusive?Selected Cell Panels - select cells with minimal overlap of antigens; helpful for patients with a known history of an antibodyEnzyme-treated panels - destroy certain antigens and enhance expression of others; modify RBC surface by removing sialic acid residues and by denaturing or removing glycoproteinsExamples: ficin, papain, bromelin, trypsinOne-step enzyme method: enzymes utilized in place of enhancement media (instead of LISS or PEG)Two-step enzyme method: panel RBCs are treated with an enzyme first, then the antibody ID panel is done with treated cells; should compare reactivity to antibody ID panel of same cells without enzyme treatmentA special case seen in blood banking: Daratumumab ("Dara") patientsDaratumumab is a drug used in treatment of Multiple MyelomaPlasmacytoma or plasma cell cancer - plasma cells express CD 38~30k new cases, ~12.5k deaths per yearAnemia is a key symptom (with calcium levels, renal insufficiency, bone lesions)CD 38 is a cyclic ADP ribose hydrolase - with roles in calcium signalling & NAD metabolismExpressed on all cell types: notably Plasma cells and RBCsOne option for treating Multiple Myeloma is the drug Daratumumab: a monoclonal antibody IgG1K anti-CD 38; kills myeloma cells through patient's own immune responseWhat does this have to do with blood bank?CD38 is found on RBCs -- including screen and panel cells, in crossmatchesDara patients show PANAGGLUTINATION in all AHG testing - positive screen, panel, crossmatch, variable/weak positive DAT (at IgG)Multiple myeloma patients need frequent transfusions - increased chance of developing alloAbEnzyme treated panel case studyDara patient case study
This excel file is an antibody ID panel template free of copyright restrictions for use in teaching and creation of immunohematology educational materials.
A mini series of choose your own adventure cases for students to explore blood bank workflow and decision making. Topics covered:Hemolytic Disease of the NewbornABO DiscrepancyCrossmatchingAuto Antibodies