an abo rh typing discrepancy and a new blood banker · an abo rh typing discrepancy and a new blood...

T RU MA N M ED ICA L C EN T ERS 1

AN ABO RH TYPING

DISCREPANCY AND A

NEW BLOOD

BANKER

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Liz Abitz

MLS (ASCP)CM

TRUMAN MEDICAL CENTER

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A 41 YEAR OLD WOMAN

PRESENTED TO THE HOSPITAL

FOR SURGERY INVOLVING A LEFT

COMPLEX ADNEXAL MASS.

The patient had no historical

blood bank records at the testing

facility.

A GEL ANTIBODY

SCREEN WAS STARTED.

While the gel screen was incubating,

the ABO Rh testing was performed.

Initial Testing

Anti-A Anti-B Anti-D A1 Cell B Cell

0 4+ 0 4+ 1+

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A1 Cell B Cell Auto

Control reagent

cell

15’ @4 4+ 3+ 1+ 3+

15’ @ 37 4+ 1+ 0 2+

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Gel Antibody Screen Results

D C E c e K Fya Fyb Jka Jkb Lea Leb S S M N IgG (gel)

SCI + + 0 0 + + 0 + + + + 0 0 + + 0 2+

SC II + 0 + + 0 0 + 0 + 0 0 + + + + + 1+

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After reading through the

AABB technical manual, I

decided to incubate the

reverse type at 37° C for one

hour and doing a “settled”

reading.

ANTIBODY IDENTIFICATION

PANEL RESULTS Cell # D C E c e K Fya Fyb Jka Jkb Lea Leb S s M N

IgG (gel)

1 + + 0 0 + 0 0 + 0 + + 0 + + + + 1+ 2 + + 0 0 + 0 + 0 + 0 + 0 + + 0 + 0 3 + 0 + + 0 0 0 + + + + 0 + 0 + 0 2+ 4 + 0 0 + + 0 0 0 + 0 0 0 0 + 0 + 0 5 0 + 0 + + 0 0 0 + 0 0 0 + + + + 1+ 6 0 0 + + + 0 + + + 0 0 + + + + + 1+ 7 0 0 0 + + + 0 + 0 + 0 + + + + 0 2+ 8 0 0 0 + + 0 + 0 + 0 + 0 0 + 0 + 0 9 0 0 0 + + 0 + + 0 + 0 + + 0 + + 1+

10 0 0 0 + + 0 0 0 + + 0 0 0 + 0 + 0 11 + + 0 0 + + 0 + + 0 0 + + + 0 + 0

auto 0

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ANTIBODY IDENTIFICATION

PANEL RESULTS Cell # D C E c e K Fya Fyb Jka Jkb Lea Leb S s M N

IgG (gel)

1 + + 0 0 + 0 0 + 0 + + 0 + + + + 1+ 2 + + 0 0 + 0 + 0 + 0 + 0 + + 0 + 0 3 + 0 + + 0 0 0 + + + + 0 + 0 + 0 2+ 4 + 0 0 + + 0 0 0 + 0 0 0 0 + 0 + 0 5 0 + 0 + + 0 0 0 + 0 0 0 + + + + 1+ 6 0 0 + + + 0 + + + 0 0 + + + + + 1+ 7 0 0 0 + + + 0 + 0 + 0 + + + + 0 2+ 8 0 0 0 + + 0 + 0 + 0 + 0 0 + 0 + 0 9 0 0 0 + + 0 + + 0 + 0 + + 0 + + 1+

10 0 0 0 + + 0 0 0 + + 0 0 0 + 0 + 0 11 + + 0 0 + + 0 + + 0 0 + + + 0 + 0

auto 0

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ANTIBODY IDENTIFICATION

PANEL RESULTS Cell # D C E c e K Fya Fyb Jka Jkb Lea Leb S s M N

IgG (gel)

1 + + 0 0 + 0 0 + 0 + + 0 + + + + 1+

2 + + 0 0 + 0 + 0 + 0 + 0 + + 0 + 0

3 + 0 + + 0 0 0 + + + + 0 + 0 + 0 2+

4 + 0 0 + + 0 0 0 + 0 0 0 0 + 0 + 0

5 0 + 0 + + 0 0 0 + 0 0 0 + + + + 1+ 6 0 0 + + + 0 + + + 0 0 + + + + + 1+

7 0 0 0 + + + 0 + 0 + 0 + + + + 0 2+

8 0 0 0 + + 0 + 0 + 0 + 0 0 + 0 + 0

9 0 0 0 + + 0 + + 0 + 0 + + 0 + + 1+

10 0 0 0 + + 0 0 0 + + 0 0 0 + 0 + 0

11 + + 0 0 + + 0 + + 0 0 + + + 0 + 0

auto 0

FURTHER TESTING

Cell # D C E c e K Fya Fyb Jka Jkb Lea Leb S s M N IgG

(gel)

19 + + + 0 + 0 0 + 0 + 0 + 0 + 0 + 0

20 + + + 0 + 0 + + + 0 0 + + 0 0 + 0

6 0 0 + + + + 0 + + 0 0 + 0 + 0 + 0

22 + + + + + + 0 + + 0 0 + 0 + 0 + 0

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Anti-M

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1 hour incubation with

“settled” reading A1 cell

B cell

Auto Control

Reagent red cell

1 Hr @ 37°C

(“settled” reading)

4+ 2+ 0 2+

The patient’s prewarmed antibody

screen was negative.

B cell Auto

Control

PW 30’ @ 37 1+ 0

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After some additional

reading, I decided to do a

10 minute prewarm at

37°C then a 1 hour

incubation at 37°C with

“settled” reading.

Adsorption

Patient’s Anti-M

Adsorption

M + reagent cells

Adsorption

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Adsorption

Patient’s plasma (Anti-M) mixed

with the M+ reagent cells

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Adsorption The supernatant fluid is

removed after a centrifugation

and the process is repeated

using fresh reagent cells. The

patient’s adsorbed plasma is

then used for the reverse

typing.

A1 cell B cell IS

(adsorbed plasma)

4+ 0

Adsorption

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B cell M –

reagent cells

M + reagent

cells

10’ PW 1hr @ 37 0 0 0

B negative

Initial Testing

Anti-A Anti-B Anti-D A1 Cell B Cell

0 4+ 0 4+ 1+

Reverse Typing

(using patient’s adsorbed plasma)

A1 cell B cell

4+ 0

24 T RU MA N M ED ICA L C EN T ERS

WHY THE EXTRA REACTIVITY?

Anti-A Anti-B Anti-D A1 Cell B Cell

0 4+ 0 4+ 1+

A1 Cell

B Cell

Auto Control

reagent cell

15’ @4 4+ 3+ 1+ 3+ 15’

@ 37 4+ 1+ 0 2+

A1 cell

B cell

Auto Control

Reagent red cell

1 Hr @ 37°C

(“settled” reading)

4+ 2+ 0 2+

WHY THE EXTRA REACTIVITY?

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B cell M -

reagent cells

M + reagent

cells

Pre-W 1 hr @37

0 0 0

A1 cell B cell

IS (adsorbed

plasma) 4+ 0

THANK

YOU

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How is Anti-M

formed?

Clinical Significance

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