A zebra with horizontal stripes

[Rh-fan]

Today we found a patient in which the ABO group looks like O.

In the serum we find cold antibodies reactive with all panel cells but not with the patients cells.

The antibodies where pure IgM but are reactive at 30oC (no addition) and 37oC (PEG IAT).

With anti H (Lectine) the patient cells were negative, but the patient was also Lea-b+.

This was pointing to a bombay-like fenotype, where there is no H formation from within the cell but from the plasma (secretor) absorbed on the membrane.

The presence of additional antibodies was excluded with cells lacking the H antigen.

Absorption elution shows no A or B antigen but a small amount of H antigen was detectable.

But now the transfusion advise:

Do we really need to use a rare Bombay donor or are there other possibilities? Is there anybody with experience?

[Malcolm Needs ☆]

I'd give Joyce Poole a ring at the IBGRL in Filton, Bristol, England.

My instincts tell me that it would be okay to give group O, rather than group Oh, but my head and heart say that I'm glad it is not my descision!