Malcolm Needs

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.

Our repeat testing was on the CBC tube.  I once had a phlebotomist reuse a tube that had a flash of someone else's blood in it so wanted to make sure more than one tube on the patient reacted the same.

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.

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.

Serious Hazards Of Transfusion (SHOT) have haemolytic transfusion reactions in separate reporting categories.
All of the following can be 'Serious Adverse Reactions';
HTR Acute
HTR Delayed
HTR Hyperhaemolysis
FAHR
 
See SHOT definitions if you want more info.
SHOT Definitions - Serious Hazards of Transfusion

Welcome to this QUITE WONDERFUL site tramnora.  ENJOY!

@Malcolm Needs, I have done as you suggested and await a reply.
Rich

With all due respect (and I KNOW this has NOTHING to do with blood transfusion) I can't see how "birth parent" is more inclusive than "mom/mother".  By definition, it must exclude the dad/father, as they cannot be a "birth parent", but it also excludes other women, who may be related to the baby, such as grandmothers or, indeed, step-mothers.  Surely, only a mom/mother can directly be a birth parent, and, in terms of the need for anti-D immunoglobulin, only her blood group is relevant?

The birth parent  caught my eye more than the bloody type did!!!!  

Haha no.  But it fits!

Did you mean that AuntiS.  I fully confess there were times when I did!!!!!!!!!!!!!!!!!!!!!!!!!!!

I wonder if your providers have ever thought of looking at their patients SYMPTOMS, rather than costing a fortune by using a tick box method for ordering tests?????

Of course, I fully realise that this is a suggestion that can only be put forward to your providers by your Pathologist, as doing so yourself would probably get you into deep trouble.

Did you mean that AuntiS.  I fully confess there were times when I did!!!!!!!!!!!!!!!!!!!!!!!!!!!

🔬 Pre-Transfusion Testing: Is Tube Testing Still Relevant? 🩸
In a world of automation, is there still a place for test tube methods in transfusion medicine? The answer is YES! Here’s why:
🔹 Resolving ABO Discrepancies – When automated methods flag uncertain results, tube testing helps confirm patient blood type.
🔹 Detecting Weak D and Partial D Phenotypes – Some Rh discrepancies can only be resolved using test tubes or additional reagents.
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🔹 Handling Urgent Transfusions – When time is critical, tube testing can provide faster results than automated methods.
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⚠️ Takeaway: While automation enhances efficiency, test tube methods are still vital for accurate pre-transfusion testing and patient safety!
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💬 What’s your lab’s approach? Do you still use tube testing? Share your thoughts! 👇
Options for Pre transfusion Testing – Where Does Tube Testing Fit(Webinar)- Susan T. Johnson

Thanks Lorna.  I'll have a look and see what I can provide but, as I see that you are working in the Isle of Man, may I suggest you get a copy of the BCSH Guideline "Pre-Transfusion Compatibility Procedures in Blood Transfusion Laboratories" from 2012 (which is available free on-line - just put in BCSH Guidelines), and these have a few at the end of the Guideline.

In addition, have a look on this site under "Library" at the top of the page, where you might find more than one thing (probably under "Education", but not only there), that will be of use to you.

I wonder if your providers have ever thought of looking at their patients SYMPTOMS, rather than costing a fortune by using a tick box method for ordering tests?????

Of course, I fully realise that this is a suggestion that can only be put forward to your providers by your Pathologist, as doing so yourself would probably get you into deep trouble.

Thank you for you advise.  Mr. Needs.  I was hoping for something that is built into the system that could manage this.

As someone from the UK (born there, still live there and worked all my professional life there), I concur with jshepherd's post.  I, too, am an aabb individual member.

I think we would all use a serologic centrifuge for this at the usual RPMs for long enough to get all the cells to the bottom, which 30 seconds is probably adequate.

As someone from the UK (born there, still live there and worked all my professional life there), I concur with jshepherd's post.  I, too, am an aabb individual member.

My facility is not AABB accredited, just Joint Commission and FDA, and I have an individual membership. I am the supervisor, and we are a large level 1 metropolitan trauma hospital. I have gained so much from my membership. Everything Cliff mentioned about resources is true, and I can't tell you how many times we've taken advantage of the discount on books for my pathologists (none of whom are transfusion medicine specialists). 
AABB membership also opened up all the subcommittees and sections, and I now sit on 9 subsections and lead one of them. I am also a mentor in the program Cliff mentioned above. 
I would say it's worth it for at least one year, so you can try it out and see what you get from it. Pro tip: if you love it, they do offer a 3 year membership option that knocks some of the cost down.  

We frequently did this in the Reference Laboratory where I was the Manager (but you have to include both a positive and a negative from the "gel" technique into the "tube" technique - or vice versa, to ensure that the "sensitivity" of both techniques, while not being necessarily identical, are reasonably close).

Column agglutination technology is an excellent technique, but does have a tendency to detect antibodies that react at temperatures well below 37oC, even after fairly prolonged incubation at 37oC.  However, the fact that the blood group, including the "reverse grouping" is clear of atypical agglutination suggests that this may not necessarily be the case for this patient.

Just to be on the safe side though, and if you can, I would either treat the plasma from the sample with rabbit erythrocyte stroma (which will adsorb out most "cold" agglutinins), treat the plasma with 0.01M dithiothreitol (which will denature the J-chains of IgM molecules, meaning that, although they can still sensitise the red cells, they are no longer able to agglutinate the red cells) or, and my personal favourite, is to pre-warm the plasma and red cells to 37oC before mixing, perform the IAT at strictly 37oC in glass tubes, wash with saline warmed to 37oC and use monospecific AHG.  If any, or all, of these techniques lead to negative results, the chances are that the antibody is a clinically insignificant "cold" IgM antibody, such as an auto-anti-HI (given that the patient is group A, and the test cells are all group O)..

Failing the above, send a sample to a red cell reference laboratory.

I hope that helps a little bit.

We frequently did this in the Reference Laboratory where I was the Manager (but you have to include both a positive and a negative from the "gel" technique into the "tube" technique - or vice versa, to ensure that the "sensitivity" of both techniques, while not being necessarily identical, are reasonably close).

Can you convert the tube panel cells from 3% to 0.8% and test in gel?  We primarily do that to run selected cells that are not already diluted to 0/8%