Hello everyone..................

 

I hate anti-a1 to be honest with you... I never liked it.. 

 

Patient's history 

blood type: A pos. no discrepancy noted on the other hospital.. One hospital reported inconclusive antibody result.  Received 2 prbc within 30 days. 

Patient is at my facility. Now has back type discrepancy. ABID- Anti-M and inconclusive.

Before getting the absc result.. my tech decided to work on the extra reaction backtype discrepancy thinking that it's a subgroup.. anti-A1 lectin was negative and RT tube screen was positive at IS. A2 cell was negative at IS, but when I let it sit for 15 min.. it was 1+w positive.

So I'm thinking it's not a real subgroup. 

 

Vision Gel ABORH : Anti A- 4+ Anti-B- 0 Anti-D - 4+ DC 0 A1C: 2+ and BC: 4+

ABSC: Positive and Auto control: Negative. 

I tested for M antigen for both affirmagen 0.8% and 3% and both are positive for M... so I am guessing it's reacting to that.. 
However, I ran extra cells for 3 positive and 3 negatives. Extra cells were strongly positive and some cells were HLA +.

 

Is this patient a subgroup? Or is it the Anti-M reacting? Or is it the cold? Help

 

Thank you!



 

 

I CANNOT tell from the information you have given (not least because the phenotype of the reverse typing cells and the panel cells are unknown to me).

I would very strongly suggest that you send samples to a Red Cell Reference Laboratory to get this sorted out, BEFORE the patient needs a transfusion in an emergency.

From what you do tell us, I think the antibody/antibodies are unlikely to be fatally clinically significant, but it depends on the true specificity/specificities and the underlying pathology.

I would not trust those A1 lectin results with recent transfusion of 2 RBCs; really doesn't matter if they were group O or A red cells, they could be giving you false testing results.

 

DAT?

I would do a panel, IS, RT incubation, 4C incubation......in tube.  I say this because this is where the discrepancy is happening.   I see you use Vision - have you done a regular panel on the instrument?  Curious if it shows clear cut reactivity - or junkie, up the side-like reactivity?

I would also do an ag type on the patient - even though they've been transfused......its' only 2 units, so, IF the pt is M neg, you should see MF if the units were M pos. ( we do this but don't report......it just give you an "idea" of what may or may not be going on......)  If they type 3-4+ M pos with no MF, - you can - with a decent amount of certainty - eliminate M as a possibility.

Remember...........M isn't the only trouble maker in the "cold".   Could be one or both Lewis's, P1,  I've actually seen a K react at RT - so, ya never know!

Edited October 2, 2024Oct 2 by Bet'naSBB

Sounds like ABO discrepancy due to a cold agglutinin which may or may not have specificity.   I would run 3 M+ cells and 3 M neg cells at IS, RT and 4'C along with an autocontrol.  IF only the M+ cells react at IS or RT, then I would ficin treat the A1 and B cells and repeat the reverse grouping using ficin treated cells.   Just a suggestion.  

So we ended up sending it out to ARC. 

 

Patient is subgroup A2 and Anti-M identified.