ABO Discrepancies Disclosure Objectives Importance Recognition ...

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4/12/2011 Reverse Grouping Problems Weak/Missing Antibodies Newborns Antibodies are not present at birth and only develop after 3 to 6 months of age. Elderly Weakened antibody activity Hypogammaglobulinemia Little or no antibody production (immuno-compromised patient) NO agglutination on reverse grouping Reverse Grouping Problems Resolving Weak/Missing Antibodies Determine patient’s age and diagnosis Incubate serum testing for 15 minutes at room temperature or 18°C to enhance antibody reactions If negative, incubate serum testing at 4°C for 15 minutes Reverse Grouping Problems Extra Antibodies Result of: Cold antibodies (allo- or auto-) Cold antibodies may include anti-I, H, M, N, P, Lewis Rouleaux Anti-A 1 in an A 2 or A 2 B individual Reverse Grouping Problems Resolving Extra Antibodies: Cold Alloantibodies Perform antibody identification at IS and or RT Use the pre-warm technique Incubate the serum and red cells separately at 37°C before testing Perform a cold adsorption Incubating equal amounts of red cells and serum at 4C for 30 to 60 minutes and test adsorbed serum against reverse type cells Antigen type reverse cells for the offending antigen If reverse type cells are antigen positive find reverse type cells that are antigen negative and incubate with serum to resolve discrepancy. Reverse Grouping Problems Extra Antibodies: Rouleaux Result of: Abnormal concentrations of serum proteins Altered serum/protein ratios High-molecular-weight volume expanders Associated with: ‣ Multiple myeloma ‣ Waldenstrom’s macroglobulinemia (WM) ‣ Hydroxyethyl starch (HES), dextran, etc Reverse Grouping Problems Resolution of Extra Antibodies: Rouleaux REMOVE PROTEINS!! If the forward grouping is affected, wash cells to remove protein and repeat test If the reverse grouping is affected, perform saline replacement technique (more common) Reagent cells and patient serum are centrifuged to allow antibody attachment (if present) Serum is removed and replaced by an equal volume of salinewhich disperses cells Tube is mixed, centrifuged, and re-examined for agglutination 6
4/12/2011 Reverse Grouping Problems Result of: Extra Antibodies: Anti-A 1 A 2 (or A 2 B) individuals development of anti-A 1 antibody A 2 (or A 2 B) individuals have less antigen sites than A 1 individuals anti-A 1 is a naturally occurring IgM antibody Antibody reacts with A 1 cells, but not A 2 cells Reverse Grouping Problems Resolution Extra Antibodies: Anti-A 1 Type patient red blood cells with Anti-A 1 lectin Test patient serum with A 1 , A 2 and O cells Case Study #1 The need is constant. The gratification is instant. Give blood. TM Case Study #1: Patient History •88 year old male •Diagnosis: Immunocompromised •Medications: Corticosteroids •Transfusion T f i History: Massive plasma infusion i •Lab: Hemoglobin: 6.5 g/dL Anti-A Anti-B Anti-A,B Anti-D D Control A 1 cells A 2 cells B cells Patient 0 0 0 3+ 0 w+ w+ 0 What is the problem? Both a front AND reverse typing issue Both a front AND reverse typing issue Investigation Patient age: 88 years old Diagnosis: Hypogammaglobulinemia Medications: Immunosuppressive drugs Resolution: weak front type, weak reverse type 7
Page 1 and 2: 4/12/2011 ABO Discrepancies Develop
Page 3 and 4: 4/12/2011 Types of ERRORS Clerical
Page 5: 4/12/2011 Forward Grouping Problems
Page 9 and 10: 4/12/2011 Case Study #3: Patient Hi
Page 11 and 12: 4/12/2011 61 Anti-A Anti-B Anti-A,B
Page 13: 4/12/2011 73 References • Harmeni

ABO Discrepancies Disclosure Objectives Importance Recognition ...

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