ABO Discrepancies Disclosure Objectives Importance Recognition ...

4/12/2011
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Case Study #6: Patient History
Anti-A Anti-B Anti-A,B Anti-D
D
Control
A 1 cells A 2 cells B cells
• 73 year old male
• Diagnosis: Lymphoma and severe anemia
• Medications: Aspirin
• Transfusion History: 3 units 6 months ago
• Laboratory: Hemoglobin: 4.5 g/dL
• 4 units requested STAT!!
Patient w+ 4+ 4+ 4+ w+ 4+ 2+ 0
Screening
Cells
IS
PEG/IAT
I 0 0
II 0 0
III 0 0
Auto 1+ 3+
DAT
Anti-IgG
Anti-
C3dC3b
Saline
Control
Patient 3+ 2+ w+
What is the problem?
Forward typing issue
Investigation
Patient age: 73 years old
Diagnosis: Lymphoma
Medications: Aspirin
Resolution:
Weak reactive front type,
positive D control, positive
saline control
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70
Forward type:
Weak Reactivity
Weak ABO subgroup? Malignancy? Spontaneous agglutination?
Anti-A Anti-B Anti-A,B Anti-D
D
Control
Patient w+ 4+ 4+ 4+ w+
Warm washed cells
w+ 4+ 4+ 4+ w+
DAT
Anti-IgG
Anti-
C3dC3b
Saline
Control
Patient 3+ 2+ w+
Warm washed cells
1+ w+ w+
Spontaneous agglutination was not resolved with warm washed cells.
DTT (0.01M) treatment of the red blood cells should be performed to
resolve the ABO/Rh discrepancy and disperse the spontaneous
agglutination.
Anti-A Anti-B Anti-A,B Anti-D
D
Control
A 1 cells A 2 cells B cells
Patient w+ 4+ 4+ 4+ w+ 4+ 2+ 0
Warm washed cells
w+ 4+ 4+ 4+ w+
0.01 M DTT Treated Cells
0 4+ 4+ 4+ 0
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DAT
Anti-IgG
Anti-
C3dC3b
Saline
Control
Patient 3+ 2+ w+
Warm washed cells
1+ w+ w+
0.01 M DTT treated Cells
1+ w+ 0
Resolution:
•Patient is B Positive
•Positive DAT and autocontrol was further investigated by a reference
laboratory, and it was discovered the patient had a warm autoantibody
in his plasma.
ABO discrepancy recognition AND resolution is
imperative in the blood bank.
ABO discrepancies can present themselves as a
front type problem, reverse type problem, or
combination of both.
If ABO discrepancy resolution cannot be performed,
and blood is needed immediately, transfusion of
type O blood may be necessary.
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