Case Scenario: Crossmatch Is Positive, What to do?
Case Study: 40 y/o Female with ESRD (Ankita) and on dialysis for 1 month with unknown etiology, with her husband as donor. Rest of her workup is normal. After you rule out her husband as donor, one of her 2 sons come forth as potential donor though Ankita does not want them to donate. Immunological workup is below.
| Sensitization History | 2 Pregnancies | |||||
| HLA Typing | A | B | C | DRB1 | DQB1 | DQA1 |
| Donor | 02:11, 24:07 | 08:01, 52:01 | 03:01, 10:01 | 02:01, 05:01 | 01:01, 01:01/04 | |
| Recipient | 11:01, 24:02 | 35:03, 51:01 | 04:04, 13:01 | 03:02, 06:03 | 01:03, 03:01 | |
| XM | T cells | B Cells | ||||
| CDC XM | Positive | Positive | ||||
| Flow XM | Positive | Positive | ||||
| Single Antigen Bead SAB Report 1 – Click to view |
Class I : Multiple anti HLA Abs | Class II: Multiple Anti HLA Abs. |
Questions & Answers
Q1. What to do if some DQB1*02:01 beads are positive and some are negative and the donor is DQB1*02:01, can we move forward for transplant?
Ans: Need to ascribe the class II antibody as either DQA1 antibody, DQB1 antibody or DQA1 and DQB1 combination antibody. Some times it is not possible to ascribe these and then best is to attribute to both of them and assess with higher risk profile.
Q2. Do I need to get DQA1 typing ? How do I interpret the results with that information?
Ans: If the class II antibody is a DQA1 antibody or a combination antibody then DQA1 typing would be essential for full assessment of immunological risk.
