trisram Posted December 26, 2009 Share Posted December 26, 2009 A 65 year old man was admitted into the ER with pneumonia. A blood sample was drawn and this is the result of his blood typing: Anti-A = 4+Anti-B = 0Anti-D = 4+a1 cell = 4+b cells = 4+What could be the explanation for this dispcrepancy and what blood should you issue him? Thank you so much for your time. Link to comment Share on other sites More sharing options...
JOANBALONE Posted December 26, 2009 Share Posted December 26, 2009 Hi trisam,Do you have access to A1 lectin and A2 cells. You may have an A2 patient with anti-A1. You can type your patient red cells with A1 lectin and test reagent A2 cells with patient plasma. You may also have a strong cold agglutinin such as anti-M or rouleaux. If you do not have a procedure for resolving ABO discrepancies due to unexpected serum reactions the Technical Manual has a nice section about resolving ABO discrepancies. JB Link to comment Share on other sites More sharing options...
Malcolm Needs ☆ Posted December 26, 2009 Share Posted December 26, 2009 As the patient has pneumonia, I would think that there is a pretty good chance that there is a "cold-reacting" auto-antibody (probably anti-H, anti-HI, anti-i and/or anti-Hi) present. Have you tried performing an auto?As JOANBALONE says though, there is also a good chance that the patient is an A2 with an anti-A1.Either way, unless the antibody reacts strictly at 37oC, and there are no atypical alloantibodies present reacting at 37oC, there is no reason why you should not give group A, D Positive blood that has been found to be compatible at 37oC.:):) Link to comment Share on other sites More sharing options...
JOANBALONE Posted December 26, 2009 Share Posted December 26, 2009 Hi again,I forgot to answer the second part of your question. If time does not allow for resolution of discrepancy our hospital policy is give group O (Rh positive OK in this case) AHG compatible units. If it is an anti-A1 we would give group O or A AHG compatible units. Other hospital policies may be different.JB Link to comment Share on other sites More sharing options...
Malcolm Needs ☆ Posted December 26, 2009 Share Posted December 26, 2009 Hi again,I forgot to answer the second part of your question. If time does not allow for resolution of discrepancy our hospital policy is give group O (Rh positive OK in this case) AHG compatible units. If it is an anti-A1 we would give group O or A AHG compatible units. Other hospital policies may be different.JBI would tend to agree, but would be much happier giving group A, rather than group O blood, because there are a higher number of H antigens exposed on the group O blood.:confused: Link to comment Share on other sites More sharing options...
trisram Posted December 26, 2009 Author Share Posted December 26, 2009 As the patient has pneumonia, I would think that there is a pretty good chance that there is a "cold-reacting" auto-antibody (probably anti-H, anti-HI, anti-i and/or anti-Hi) present. Have you tried performing an auto?As JOANBALONE says though, there is also a good chance that the patient is an A2 with an anti-A1.Either way, unless the antibody reacts strictly at 37oC, and there are no atypical alloantibodies present reacting at 37oC, there is no reason why you should not give group A, D Positive blood that has been found to be compatible at 37oC.:):)Malcome you're amazing! Thanks so much!Thank you too joan. Happy holidays!! Thank you all! Link to comment Share on other sites More sharing options...
Cliff Posted December 27, 2009 Share Posted December 27, 2009 trisram,Please keep in mind that many people use this site, and many more simply visit this site.It sounds like you are posing these questions as if you are working in a lab and need clinical advice, although it has already been alluded to the idea you may be studying for an exam.If you need help with an exam, then say so. Don't ask directly for the answers, but ask for advise on how to learn to find the answers yourself.I suspect if your instructors (and there are many military people who use this site), find out about this, they will not be pleased. Link to comment Share on other sites More sharing options...
trisram Posted December 27, 2009 Author Share Posted December 27, 2009 trisram,Please keep in mind that many people use this site, and many more simply visit this site.It sounds like you are posing these questions as if you are working in a lab and need clinical advice, although it has already been alluded to the idea you may be studying for an exam.If you need help with an exam, then say so. Don't ask directly for the answers, but ask for advise on how to learn to find the answers yourself.I suspect if your instructors (and there are many military people who use this site), find out about this, they will not be pleased.Sorry, yes I am taking a test. I already said I was taking a test in another thread. I have my answers already, I am just double checking. Thank you Link to comment Share on other sites More sharing options...
Yanxia Posted December 28, 2009 Share Posted December 28, 2009 I think trisram should do an O cell with the patients plasma to see if there is any atypical antibody disturb the ABO typing. If it is neg, use anti-A1 to see the cells if A1 and A2 cells to test the antibodies is anti-A or anti-A1.If it is pos, you can incubate it in 37 degree C to see wether it is cliinical significance, and if ,you can run a panel . Link to comment Share on other sites More sharing options...
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