ABO Discrepancies Disclosure Objectives Importance Recognition ...

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4/12/2011 Case Study #4: Patient History Case Study #4 • 36 year old female • Diagnosis: Pregnancy #3 • Medications: Pre-natal vitamins • Transfusion History: No transfusions The need is constant. The gratification is instant. Give blood. TM 57 58 Anti-A Anti-B Anti-A,B Anti-D D Control A 1 cells A 2 cells B cells Patient 4+ 0 4+ 4+ 0 2+ 0 3+ Screening Cells IS PEG/IAT I 0 0 II 0 0 III 0 0 What is the problem? Reverse typing issue Investigation Patient age: 36 years old Diagnosis: Pregnant Medications: vitamins Resolution: Additional antibody in reverse type •Test the patient’s serum against different A 1 and A 2 cells Patient Serum A 1 cells 3+ A 1 cells 3+ A 1 cells 3+ A 2 cells 0 A 2 cells 0 A 2 cells 0 •Test the patient’s red blood cells against anti-A 1 lectin (Dolichos biflorus) Anti-A 1 Lectin (Dolichous biflorus) Patient 0 Resolution: Patient is (probable) type A 2 with anti-A 1 in her serum Case Study #5: Patient History Case Study #5 • 50 year old female • Diagnosis: COPD • Medications: Morphine • Transfusion History: No known transfusion per blood bank records • Lab: Hemoglobin: 7.5 g/dL The need is constant. The gratification is instant. Give blood. TM 10
4/12/2011 61 Anti-A Anti-B Anti-A,B Anti-D D Control A 1 cells A 2 cells B cells Patient 4+ mf 0 4+ mf 4+ 0 1+ w+ 4+ Screening Cells IS PEG/IAT Investigation I 1+ 2+ II 0 0 III 1+ 2+ What is the problem? Forward and Reverse typing issue Patient age: 50 years old Diagnosis: COPD Medications: Morphine Resolution: Mixed field in front type and extra antibody(ies) in reverse type Additional antibody in the front and reverse type resolution Forward type: Mixed field What is causing mixed field—has this patient been transfused? Harvest reticulocytes (that aren’t coated with antibody) and re-test front type Upon further investigation, patient was transfused with 4 group O Positive units last week at a different facility (explaining the mixed field reactivity identified in the front type). The antibody screen was negative at that time. Anti-A Anti-B Anti-A,B Reticulocyte Separation Cells Patient 4+ 0 4+ A 2 cells 2+ 64 63 Reverse type Antibody identification What antibody is in the screen? Could it be interfering with the reverse type? An elution of the patient’s red blood cells should be performed to Reverse type resolution: Antigen type the reverse group RBCs for Jk a to determine if the antibody is interfering with <strong>ABO</strong> resolution Absorb the anti-Jk a out of the patient sample and re-test the serum with the reverse type cells to resolve the <strong>ABO</strong>. identify the antibody that is coating the red blood cells (positive auto- control) Anti-Jk a Elution of the patient’s red blood cells identifies anti-Jk a is coating the cells. Antibody identification in the serum identifies anti-Jk a A 1 cells (original source) 2+ (original source) B cells 2+ (original source) 65 Since the patient has been recently transfused, differential adsorptions are performed at a cold temperature to fully remove the anti-Jk a from the patient serum. A 1 cells A 2 cells B cells Patient 1+ w+ 4+ Adsorbed serum 0 0 4+ Case Study #6 Anti-A Anti-B Anti-A,B Anti-D D Control A 1 cells A 2 cells B cells Patient 4+ mf 0 4+ mf 4+ 0 1+ w+ 4+ Reticulocyte Separation Cells Adsorbed serum 4+ 0 4+ 0 0 4+ The need is constant. The gratification is instant. Give blood. TM 11
Page 1 and 2: 4/12/2011 ABO Discrepancies Develop
Page 3 and 4: 4/12/2011 Types of ERRORS Clerical
Page 5 and 6: 4/12/2011 Forward Grouping Problems
Page 7 and 8: 4/12/2011 Reverse Grouping Problems
Page 9: 4/12/2011 Case Study #3: Patient Hi
Page 13: 4/12/2011 73 References • Harmeni

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