ABO Discrepancies Disclosure Objectives Importance Recognition ...

4/12/2011
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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+
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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 ABO resolution
Absorb the anti-Jk a out of the patient sample and re-test the
serum with the reverse type cells to resolve the ABO.
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)
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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
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