Direct Coomb`s test positive

Hassan was admitted in hospital for antibiotic IV . On the third day after his temperature had normalised the doc signed him for his transfusion. Usually the lab takes 2-4 hours for preparing the blood, but this time the wait was never ending. When asked about the delay they informed us that his direct coombs test was positive, so the cross matching procedure took a longer time. It was a holiday and the resident doc was on call 24hrs. So we did not get any explanation. We have an appointment with the doc on wed after he finishes his antibiotic course.
What does this mean? Is it just a drug induced reaction as in the past 3 months he has had 6 courses of antibiotics other than the IV I mentioned. Or has he developed an auto antibody? What should I do next? What should I ask the doc? Please advise
maha

Dear Maha,

I believe that a positive Coomb's test indicates that an antibody is present.  Do you have a description of the antibody - such as "warm complex" etc.?  This will tell you more.  Some times these antibodies are transient and resolve on their own, other times a pulse of steroids resolves the issue.  How this works determines what course of action should follow.  Certain drugs can also cause hemolysis as you have mentioned - but it would be helpful to see the results that you have obtained.  Also, what is your son's transfusion requirement  (Volume and frequency)?

My son has been dealing with antibodies for the a couple of years now, and there are many courses of action that can be taken in order to deal with them.  In the meantime, it is very important to have genotype matching done for your son in order to limit exposure to antigens that may trigger the antibodies in question. 

Best of luck and feel free to contact me for more information,

Sharmin

Maha, i am sorry to hear about this situation, please keep us updated. Wish Hassan a speedy recovery.
Here are some links describing this test
http://www.answers.com/topic/coomb-s-test

Definition

Coombs' tests are blood tests that identify the causes of anemia.

Description

There are two Coombs' tests. A direct Coombs' test detects the two different antigens that might induce hemolysis in the patient's red blood cells. An indirect Coombs' test looks for antibodies to someone else's red blood cells in the patient's serum (the blood without the cells). Combining the two tests gives clues to the origin of the hemolysis.

—

http://www.nlm.nih.gov/medlineplus/ency/article/003344.htm


manal

Has his transfusion frequency increased recently? Ask the doctor if the positive test might be related to the antibiotic treatment, and if it is an antibody reaction, should treatment begin?

No Sharmin we do not have any description of the antibody. The lab has not prepared any report either as we have the copy of all the tests taken during his admission. The day he had his transfusion was a holiday and the doc had signed his discharge much earlier. Since there are no reports the doc most likely doesn`t know about this test.
Andy his transfusion frequency and volume is the same 200ml every 4 weeks.  (WEIGHT - 13.7 kg)

Maha,

The transfusion requirement is very good news.  I don't think that you have anything to worry about at this time - keep an eye on it and see what the test results say - but the transfusion requirement tells a good story.  Your son is receiving just under 15cc/kg every four weeks - this is ideal.  If an auto antibody were present this would not be the case. 

Sharmin

My husband talked to the lab today. According to them his direct coombs test has been positive from his first trans in that hosp.( He has had 13 transfusions so far in this hosp. His first 4 transfusions were done in 2 diff clinics). They said his indirect coombs test is negative which was a good sign. His direct coombs test was a grade 1 (whatever that means) and is no cause of concern. Is it really not a cause of concern? Had I not asked for the reason for the delay I would never had known about this condition. Now I have something more to worry about Hassan`s feritin. I will post my concern in the chelation corner.
thankyou
maha