What are your thoughts on this question? Thank you

[trisram]

25 year old female got admitted into the ER with a knife wound. She was a bone marrow recipient last year. Blood is ordered for her.

I do a ABO/RH and this is a her result:

Anti-A = 0

Anti-B = 0

Anti-D = 4+

a1 cells = 0

b cells = 4+

What could explain the discrepancy here with her ABO typing? And what type of blood should be issued?

Here is my answer:

Patient orginal blood type may have been A+. But she might have been given O+ donor marrow when she had the marrow transfusion last year. I check her medical records to confirm this. If that is the case, then her marrow is making O+ cells but her B antibodies are still in her plasma.

I do an Ab screen, and if that is negative, I issue 37o crossmatched compatible blood for her.

Did I miss anything? Thank you

Edited December 27, 2009 by trisram

[Malcolm Needs ☆]

Not that I can see.

The reason that she is not making an anti-A is that she is probably a secretor, and will still be secreting A substance. Therefore, either her "new" immune system is tollerant of the A antigen, or her A substance is inhibiting any anti-A that is being produced by her "new" immune system.

[Gumby]

At our facility we would give O positive CMV negative ( if patient was CMV negative prior to transplant or if unknown) irradiated units of blood.