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Transfusion requirement for patient of A3 subgroup?


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Hello everyone, 

new to this forum. I work in hospital pathology lab in Australia- would love some advice on whether it’s necessary to transfuse only Group O red cells to patient’s that are probable A3 subgroup? I understand there is a small risk of A3 subgroups developing an allo-anti-A1, if transfused A1 red cells, but if their reverse group shows an absence of reactivity to A1 cells, is it necessary to restrict transfusion to only Group O? 
Has anyone also seen cases of loss of ABO antigen in Acute Lymphoblastic Leukaemia which can render false A1 negative subtype?

Our patient’s forward group has mixed field reactions to 3 different monoclonal Anti-A anti sera. Reverse group matches Group A. 


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There is absolutely no reason to give group O red cells to a recipient who is A3.  Even if the patient does develop an anti-A1, unless that antibody is reactive at strictly 37oC, they can still receive A1 red cells, but, if the anti-A1 does react at 37oC, there is no reason not to transfuse with A2 red cells that are IAT compatible.

Personally, I have never seen loss of A or B antigens through ALL, but I have with AML.  In fact, in one case, we were able to follow whether the patient was in remission or relapse by the strength of the reaction of the A antigen with various anti-A reagents, but this was many years ago, and I honestly can't remember whether these were human-derived polyclonal reagents or early monoclonal reagents.

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thanks for your feedback- my sentiment exactly, I don’t see the point of restricting transfusion with only Group O red cells- it seem unnecessary. Some laboratories here in Oz are too cautious, our standards/guidelines mention exactly what you’ve stated, unless there is an allo-anti-A1 active at 37, the requirement is IAT compatible crossmatch (so A2 transfusions would suffice).

Interesting to hear about your experience with loss of A or B antigen and AML! I’ve only seen cases with AML as well , not ALL. Publications also only mention myeloid leukaemias. You’ve inspired me to follow through with another patient of ours and their progress. 🙂

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If the patient is being treated/transfused in a high level hospital with staff who understand Malcolm's explanation (above), then I would probably not recommend using O cells. However, I suspect that in many smaller hospitals it would be simpler from both administrative and technical understanding points of view to give O cells. This approach may not be ideal if the patient is a chronic or large volume user of red cells (those group O cells are a little more precious and useful in emergencies), and the laboratory now has to deal with an even bigger mixed field scenario.

My experience with loss of ABO antigens is similar to Malcolm's description, but I never had the cool ability to track the patients' health.

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