ABO Discrepancies Disclosure Objectives Importance Recognition ...

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4/12/2011 Weak front type and weak reverse type resolution: Enhance forward type Incubate patient cells with antisera (per manufacturers directions) Enhance reverse type Incubate reverse type cells with patient serum for 15 to 30 minutes Room temperature or 18°C (per manufacturers directions) 4°C for 15 minutes test concurrently with autologous cells and group O screening cells Enzyme treat reverse type cells with FICIN Case Study #2 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 30’ RT 0 1+ 2+ 1+ 1+ 0 The need is constant. The gratification is instant. Give blood. TM Case Study #2: Patient History Anti-A Anti-B Anti-A,B Anti-D D Control A 1 cells A 2 cells B cells • 33 year old female • Diagnosis: Anemia • Medications: None • Transfusion History: 2 units of packed red blood cells 5 years ago • Lab: Hemoglobin: 9.1 g/dL Patient 0 4+ 4+ 3+ 0 3+ 3+ 1+ Screening Cells DAT IS PEG/IAT I 1+ 0 II 1+ 0 III 1+ 0 Anti-IgG Anti- C3dC3b Saline Control Patient 0 2+ 0 What is the problem? Reverse typing issue Additional antibodies: cold?? Investigation Patient age: 33 years old Diagnosis: Anemia Medications: None Resolution: Additional antibody in reverse type Additional antibody in reverse type resolution: Prewarm Technique Incubate the serum and red cells separately at 37°C before testing Cold Adsorption Incubate equal amounts of red cells (adsorbing cells) and patient serum at 4°C for 30 to 60 minutes Test adsorbed serum against reverse typing cells Case Study #3 Screening Cells IS 4°C Adsorbed Serum I 0 II 0 III 0 A 1 cells A 2 cells B cells Patient 3+ 3+ 1+ 4°C Adsorbed Serum 3+ 3+ 0 The need is constant. The gratification is instant. Give blood. TM 8
4/12/2011 Case Study #3: Patient History Anti-A Anti-B Anti-A,B Anti-D D Control A 1 cells A 2 cells B cells • 45 year old man • Diagnosis: Recurrent GI bleed • Medications: None • Transfusion History: 10 in past year; none in last 3 months • Lab: Hemoglobin: 9.2 g/dL Patient 4+ w+ 4+ 4+ 0 w+ 2+ 3+ Screening Cells DAT IS PEG/IAT I 1+ 0 II 1+ 0 III 1+ 0 Anti-IgG Anti- C3dC3b Saline Control Patient 0 0 0 What is the problem? Forward and Reverse typing issue Investigation Patient age: 45 years old Diagnosis: Recurrent GI bleed Medications: None Resolution: Additional antibody in front type and reverse type Additional antibody in the front and reverse type resolution Forward type: Wash red cells extensively and repeat testing Removes proteins Reverse type Saline replacement technique; Patient cells and serum combined and centrifuged Allows for antigen/antibody reaction (if present) Remove serum and replace with equal volume of saline Mix, centrifuge, and reexamine for agglutination Both macroscopically and microscopically Front Type: Anti-A Anti-B Anti-A,B Patient 4+ w+ 4+ Patient Cells washed X6 with Saline 4+ 0 4+ Reverse Type: A 1 cells A 2 cells B cells Patient w+ 2+ 3+ Saline Replacement 0 1+ 3+ Screening IS PEG/IAT Cells (saline replacement) I w+ 0 II 0 0 III w+ 0 Forward type resolved: Patient forward type: A Reverse type NOT resolved: cold alloantibody?? Anti-M identified at IS 53 54 Reverse grouping cells need to be antigen typed for the M antigen. A 1 cells (original source) A 2 cells (original source) B cells (original source) A 2 cells (second source) B cells (second source) Anti-M 0 2+ 1+ 0 0 •The original source of A 2 and B cells are M antigen positive. Since the patient has anti-M identified at IS, this antigen is interfering with the reverse grouping (causing a discrepancy). •A second source of A 2 and B cells were located that are M antigen negative. These cells will be used to perform reverse grouping on this patient. Anti-A Anti-B Anti-A,B Anti-D D Control A 1 cells A 2 cells B cells Patient 4+ w+ 4+ 4+ 0 w+ 2+ 3+ Washed X6 with normal saline (second source, M antigen negative) Saline replacement 4+ 0 4+ 0 0 3+ 9
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: 4/12/2011 Reverse Grouping Problems
Page 11 and 12: 4/12/2011 61 Anti-A Anti-B Anti-A,B
Page 13: 4/12/2011 73 References • Harmeni

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