Malcolm Needs

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I was thinking of antigens such as M, N, S, s, Fya, Fyb, Jka and Jkb. However, they would only tell you if the patient is likely to be a chimera. As far as what to give the patient, you are right in saying that these results would not help too much, if at all. From what you have described, group A, D Positive cross-match compatible units should be fine.

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Thanks for that Mabel Adams. It may still be worthwhile having a karyotype performed as, in very unusual cases, a twin pregnancy can be completely absorbed into a single foetus, resulting in a single baby. Are any other antigens showing mixed-field reactions?

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Dolichos biflorus (Horse gram) is amongst the best known lectin in the serologist’s tool kit, but beware!. The lectin also agglutinates A, B, AB and O red cells that are Cad+ or Tn+. In addition, as Yanxia so correctly says, it will react with some red cells that are A2 (or, indeed, other subgroups of A) unless the reagent is suitably diluted. By he description of the agglutinates, I would also favour a possible chimera, as my own experience of A3 is that the agglutinates are usually quite small. However, as you yourself say, it could be the result of a stem cell transplant of some kind. I did my project for Fellowship of the Institute of Biomedical Science on blood groups of bone marrow transplant recipients when I was at Westminster Hospital (way back in the last century - well in the 1970's anyway) and found that group A recipients of group O bone marrow transplants, if they were Secretors, sometimes retained a sort of chimera that reacted with both anti-A and anti-A,B as a result of adsorbing soluble A substance onto the group O red cells (with no other apparent mixed-field reactions with other specificities), but did not appear to produce an anti-A post-transplant, or, if they did, it seemed to be adsorbed onto the (apparent) group O red cells coated in soluble group A substance, and had a weakly positive DAT. Having said all that though, the female patients were usually sterile, and required either donated ova, or had their own eggs frozen prior to the transplant treatment.

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