1. Presented by Eric A. Gehrie, MD and prepared by Lorraine N. Blagg, MA, MLS(ASCP)SBB

Clinical Vignette

The patient is an adult with myelodysplastic syndrome (MDS) requiring blood transfusion who is being treated at your hospital. The patient is currently receiving Eltrombopag and Darbepoietin and has received five doses of IVIG over the last two weeks. The patient's target hemoglobin and platelets are 10-12 g/dl and 10,000/cu mm, respectively.

Current hematology labs:

• WBC: 3.96 K/cu mm


• Hemoglobin: 7.7 g/dL


• Hematocrit: 22.9%


• Platelet count: 10 K/cu mm

Transfusion Medicine Lab:

• ABO/Rh type: A Pos


• Antibody Screen: Negative


• Received two irradiated & leukoreduced RBC units and two irradiated & leukoreduced single donor apheresis platelet units

The patient tolerates the transfusions well with no documented incidents and is discharged. The patient returns to the clinic for their routine appointment eighteen days later.

Current hematology labs:

• WBC: 4.87 K/cu mm


• Hemoglobin: 7.6 g/dL


• Hematocrit: 22.5%


• Platelet count: 13 K/cu mm

Transfusion Medicine Lab:

• ABO/Rh type: A Pos


• Antibody Screen: Positive


• Order for one RBC unit and one platelet unit

RBC antibody panel results:



Question:
What is the most likely antibody identification in the plasma?