The blood bank

The blood bank received a call requesting two units of “Kell-negative” RBCs for a patient with anti-K.

1. Discuss why this request is incorrect.
2. What should the request have stated?

A patient has a history of the following alloantibodies: anti-S, anti-Leb, and anti-Jka.

1. Which of these antibodies are clinically significant?
2. How would you test for compatible RBC units?
3. How would enzyme-treated panel cells react with this mixture of antibodies?  
   A 33-year-old pregnant woman with a high incidence of recurrent miscarriage delivered a baby girl at 36 weeks. Her labor was induced because of evidence of fetal suffering. The laboratory received a neonatal blood sample for blood typing and DAT testing. Here are the test results.
   BABY GIRL SEROLOGIC TESTING
   Patient Red Cells With DAT
   Anti-A Anti-B Anti-D Anti-IgG,-C3d Anti-IgG Anti-C3b,-C3d
   0 0 3+ 3+ 3+ 0
   DAT, Direct antiglobulin test.
4. Interpret the serologic testing results.
   ABO/D Phenotype: _
   DAT: _
5. Why was the serum testing not performed with the ABO typing?
6. What is causing the agglutination in the DAT?
7. What is the next step in this investigation? Further investigation demonstrated an alloantibody reacting with all antibody screen and panel cells at the antiglobulin phase (i.e., a panagglutinin).
8. Based upon these results and the mother’s history, what antibody would you suspect?
9. What further testing is needed for antibody identification?