AB0 grouping

[Nisar]

Hi dear,

We have a 15 year 0ld child gr0uping discrepency ,

anti A = 4+

anti B = 0

with A1cell 4+ and B cells 4 + with negative aut0 c0ntr0l.

Sceening and panel all cells are p0sitive with repeated samples.

please help me 0ut this pr0blem.

[Rh-fan]

Sounds like an antibody to a antigen with a high frequenty. And the antibody is an IgM (also reactive at RT).

My first guess would be; I (could stil be auto), P (with or with out Pk) or Kp( (mostly also IgM fraction).

This will take a lot of further investigation, interesting but difficult case.

Good luck,

Peter

[Nisar]

Sounds like an antibody to a antigen with a high frequenty. And the antibody is an IgM (also reactive at RT).

My first guess would be; I (could stil be auto), P (with or with out Pk) or Kp( (mostly also IgM fraction).

This will take a lot of further investigation, interesting but difficult case.

Good luck,

Peter

we have the panel which is negative for P antigen in some cells,

thank you dear.

[Malcolm Needs ☆]

we have the panel which is negative for P antigen in some cells,

thank you dear.

Are you certain you mean negative for P, and not negative for P1 Nisar? If you are, I want some of that panel!!!!!!!!!

Have you performed a DAT? Is it positive?

Has the patient recently had any infections, such as atypical pneumonia?

If so, have you performed a DL (Donath-Landsteiner) test?

Edited May 31, 2012 by Malcolm Needs

[Nisar]

yes sir that is P1 n0t P.DAT was negative and n0 recent infecti0n.Sir if aut0 c0ntr0l is negative then......I never saw aut0 c0ntr0l negative DAT p0sitive.

Thank y0u Sir

[Rh-fan]

Are you certain you mean negative for P, and not negative for P1 Nisar? If you are, I want some of that panel!!!!!!!!!

Have you performed a DAT? Is it positive?

Has the patient recently had any infections, such as atypical pneumonia?

If so, have you performed a DL (Donath-Landsteiner) test?

Why do you think of DL antibodies when the reactions are so strong. Most DL antibodies I have seen are only weak reactive in normal technics, and mostly neg.

Peter

PS Malcolm, last week our lab found a Kell null patient with anti K5 (or Ktotal or Ku), just on a day that I am not in the lab.

[Malcolm Needs ☆]

Why do you think of DL antibodies when the reactions are so strong. Most DL antibodies I have seen are only weak reactive in normal technics, and mostly neg.

Peter

PS Malcolm, last week our lab found a Kell null patient with anti K5 (or Ktotal or Ku), just on a day that I am not in the lab.

You are correct there Peter - I'm afraid I was chasing zebras and unicorns, rather than looking for horses!

Life is just not fair when they find something as rare as a Ko with anti-Ku on a day when you' re there. IU have immense sympathy with you!

[Malcolm Needs ☆]

I never saw aut0 c0ntr0l negative DAT p0sitive.

Thank y0u Sir

Actually Nisar, this phenomenon is more common than a lot of people think. The thing is that, quite often, if they see that the auto is negative, they don't bother to go on and perform the DAT, and then, of course, they miss it.

[Malcolm Needs ☆]

Coincidentally, we had a sample yesterday that was just the opposite of this. The auto was clearly 3+ positive, but the DAT was clearly negative.

[Rh-fan]

Originally Posted by Nisar

I never saw aut0 c0ntr0l negative DAT p0sitive.

Thank y0u Sir

Actually Nisar, this phenomenon is more common than a lot of people think. The thing is that, quite often, if they see that the auto is negative, they don't bother to go on and perform the DAT, and then, of course, they miss it.

It also depends on the technic used. If you perform a column gel test, then the medium is the same for the DAT and for the auto controle, so when your DAT is pos in that gel, if you add also serum/plasma (auto controle) is must be positive also. Other way around is more common, that with the adition of serum/plasma you have a stronger reaction.

[Nisar]

DAT is negative

thanks sir

[Nisar]

yes sir such cases i have als0 seen but vice versa n0t seen still my five years 0f j0b when DAT is p0sitive and Aut0 c0ntr0l is neg.when DAT is p0sitive Aut0 c0ntr0l is als0 p0sitive

[Mabel Adams]

Can't an anti-Vel look like this? Of, course, I think that is a bit of a zebra compared to a strong anti-I. Maybe the patient is i making anti-I??? Malcolm, what's statistically most likely? Allo anti-I, anti-P,P1,Pk? Can't be Bombay cuz the patient types as A.

[Nisar]

thank y0u dear it can be anti vel 0r any 0ther l0w incidence antib0dy with high thermal amplitude t0wards high incidence antigen.regarding anti I,the patient serum is c0mpatible with father red cells,the 0nly c0mpatibility seen.we als0 did screening 0n strict pre warm technique but the same result.at 37 degree C it is lysing the cell.0ne interesting thing that we seen is, the father gr0up is just the same as the child.b0th bl00d is cmpatible with each 0ther.

0ne 0f the bl00d bank give him para b0mbay but that is n0t p0ssible as the A antigen is sr0ngly expressed 0n patient red cell.

thanks a l0t dear

[Rh-fan]

Can't an anti-Vel look like this? Of, course, I think that is a bit of a zebra compared to a strong anti-I. Maybe the patient is i making anti-I??? Malcolm, what's statistically most likely? Allo anti-I, anti-P,P1,Pk? Can't be Bombay cuz the patient types as A.

I have seen a lot of anti Vel antibodies and those where never this strong (but in serology everything is possible). These kind of reactions more fit I or P, and then is anti P (+Pk) more common than anti I (in my experience).

[Malcolm Needs ☆]

I agree Peter, BUT, the haemolysis at 37oC is a bit of a worry (as is the fact that Dad's blood is compatible).

The fact that Dad is compatible certainly points to an alloantibody directed against a high incidence antigen.

Those that commonly (and I use the term "commonly" here in its loosest sense, as such antibodies are not common) are anti-P+Pk+P1 (the old "anti-Tja), anti-Vel, anti-H (from an Oh, rather than the much more common auto-anti-H) and anti-I (from an ii adult, rather than the much more common auto-anti-I). Just occassionally, an anti-Lea can be haemolytic, but not often. This is NOT to say that other antibodies cannot be haemolytic - not by a long way - but those four specificities tend to demonstrate strong haemolysis.

We can rule out the anti-H, but it could be any of the other three.

Trouble is, in a situation like this, it doesn't matter which antibody is more common than the other two, it could still be the rarest!

[Mabel Adams]

Has this child ever been transfused? Can all of the likely culprits above be naturally occurring?

[Nisar]

the child has never transfused but the chil and father has the same gr0up,same antibdy screening and panel result.

[Malcolm Needs ☆]

In that case , it is less likely to be an anti-Vel. It is more likely to be an anti-I in an adult ii or an anti-P+Pk+P1 in a pp.

It is VERY unusual, however, for either of these to appear in two immediate generations.

[Mabel Adams]

Maybe the parents are genetically related?

[Eagle Eye]

Maybe the parents are genetically related?

Yes..it is a possibility in the country Nisar is from....

[Barbarakym]

Actually Nisar, this phenomenon is more common than a lot of people think. The thing is that, quite often, if they see that the auto is negative, they don't bother to go on and perform the DAT, and then, of course, they miss it.

For transfusion purposes I don't think it matters for the average transfusion. Many healthy people in any given population have Positive DAT. So we do not worry about DAT in our workups. If it goes to Reference Lab because we do not have clear cut answer (lots of positive, Warm auto messing up reactions, Positive Auto at 37 or AHG, etc) then Reference lab does do the DAT.

Our worry is if something is coating our cells in our panels (Auto Pos) then Since our transfusion service does not do eluate, I want workup done at Ref lab to be sure there is nothing hiding on the cells.