ABO Discrepancies Disclosure Objectives Importance Recognition ...

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4/12/2011 68 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 69 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 71 72 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. 12
4/12/2011 73 References • Harmening, D.M. (2005). Modern Blood Banking and Transfusion Practices (5 th Ed.) • Roback, John et.al. Technical Manual, 16th Edition. City: American Association of Blood Banks (AABB), 2008. • American Red Cross: ABO Discrepancy Standard Operating Procedure • Community Blood Bank: University of Texas at Galveston Specialist in Blood Bank: ABO Discrepancies. 13
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 and 10: 4/12/2011 Case Study #3: Patient Hi
Page 11: 4/12/2011 61 Anti-A Anti-B Anti-A,B

ABO Discrepancies Disclosure Objectives Importance Recognition ...

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