Antibodies to hydrocortisone in reagent red cells causing positive antibody screening tests

A rare case of antibody against enhancement media interfering with crossmatching: A case report and review of literature

Detection of clinically significant alloantibodies during pretransfusion testing is essential before any blood transfusion. Sometimes, clinically insignificant antibodies unrelated to blood group antigen may interfere with routine testing. Their interpretation is often made only after tedious immunohematology workup resulting in the exclusion of all possible clinically significant antibodies. We encountered such incidence which interfered with crossmatching. In our case, direct antiglobulin test was negative, indirect antiglobulin test and autocontrol were positive with pan-reactive antibody screening test, and group-specific units were incompatible. After meticulous workup, we could find that these antibodies were directed against the enhancement media, low-ionic strength solution in this case.

Real eyes realizes real lies: A case report and review of nuisance antibodies in immunohematology

Detection of nonspecific antibodies unrelated to blood group antigen that causes nuisance in pretransfusion testing is a rare event. Their interpretation is often made only after the exclusion of all possible clinically significant antibodies and results in the unnecessary expenditure of reagents and human resources. We report one such nuisance antibody detected in an antenatal female that showed pan reaction with antibody screening and identification panel red cells including auto control but was compatible with group-specific donor units. Direct antiglobulin test was positive with no hematological evidence of bleeding. Repeat antibody screening test performed after washing the panel red cells and use of panel cells from different manufacturer showed negative reaction raising the suspicion of antibody specificity against chemical constituents in suspension medium of panel cells. Interpretation of nonspecific antibodies as to what they really are demands extensive immunohematological work-up and causes a delay in issue of blood components to the recipient.

Drug-induced immune hemolytic anemia

Drug-induced immune hemolytic anemia (DIIHA) is rare, and a specialized laboratory is often required to provide the optimal serological tests to confirm the diagnosis. The most common drugs associated with DIIHA and the hypotheses for the mechanisms thought to be involved have changed during the last few decades. The drugs most frequently associated with DIIHA at this time are cefotetan, ceftriaxone, and piperacillin. DIIHA is attributed most commonly to drug-dependent antibodies that can only be detected in the presence of drug (eg, cephalosporin antibodies). DIIHA can also be associated with drug-independent antibodies; such antibodies do not need drug to be present to obtain in vitro reactions (eg, fludarabine). In these latter cases, the drug affects the immune system, causing production of red cell (RBC) autoantibodies; the clinical and laboratory findings are identical to autoimmune hemolytic anemia (AIHA), other than the remission associated with discontinuing the drug. Some of the mechanisms involved in DIIHA are controversial. The most acceptable one involves drugs, like penicillin, that covalently bind to proteins (eg, RBC membrane proteins); RBCs become coated with drug in vivo and, a drug antibody (usually IgG) attaches to the drug-coated RBCs that are subsequently cleared by macrophages. The most controversial is the so-called immune complex mechanism, which has been revised to suggest that most drugs are capable of binding to RBC membrane proteins, but not covalently like penicillins. The combined membrane plus drug can create an immunogen; the antibodies formed can be IgM or IgG and often activate complement, leading to acute intravascular lysis and sometimes renal failure; fatalities are more common in this group. It is still unknown why and how some drugs induce RBC autoantibodies, sometimes causing AIHA.