Sisi Posted October 27, 2012 Share Posted October 27, 2012 (edited) I encountered an ABO discrepancy as follow:[TABLE=width: 409][TR][TD=class: xl22, width: 58, bgcolor: transparent]Anti-A[/TD][TD=class: xl22, width: 57, bgcolor: transparent]AntiAB[/TD][TD=class: xl22, width: 51, bgcolor: transparent]Anti-B[/TD][TD=class: xl22, width: 45, bgcolor: transparent]A cell[/TD][TD=class: xl22, width: 50, bgcolor: transparent]B cell [/TD][TD=class: xl22, width: 49, bgcolor: transparent]O cell[/TD][TD=class: xl22, width: 48, bgcolor: transparent]Anti-D[/TD][TD=class: xl22, width: 72, bgcolor: transparent]Auto ctrl[/TD][TD=class: xl22, width: 60, bgcolor: transparent]Rh Ctrl[/TD][TD=class: xl22, width: 53, bgcolor: transparent]anti-H[/TD][/TR][TR][TD=class: xl22, bgcolor: transparent]w[/TD][TD=class: xl22, bgcolor: transparent]4+[/TD][TD=class: xl22, bgcolor: transparent]4+[/TD][TD=class: xl22, bgcolor: transparent]3+[/TD][TD=class: xl22, bgcolor: transparent, align: right]0[/TD][TD=class: xl22, bgcolor: transparent, align: right]0[/TD][TD=class: xl22, bgcolor: transparent]4+[/TD][TD=class: xl22, bgcolor: transparent, align: right]0[/TD][TD=class: xl22, bgcolor: transparent, align: right]0[/TD][TD=class: xl22, bgcolor: transparent]3+[/TD][/TR][/TABLE]After washing with warm saline, the anti-A reaction become weaker. Antibody screen is negative. The patient have rouleaux reaction with his auto control. Patient: No trasnsfusion, no leukemia or bone marrow transplant, it it similar to what have mention as B(A) type that will react with the MHO4 clone of Anti-A reagent or AxB? What further test should I do in order to confirm it?It that the anti-H have a 3+ strong reaction already suggest that it is a subgroup? Thank you for your help! Edited October 27, 2012 by Sisi Add new information Link to comment Share on other sites More sharing options...
Yanxia Posted October 27, 2012 Share Posted October 27, 2012 Sisi, in my lab , we do the anti-H parallel with 2 tube of B cells and 2 tube of O cells to see if the patient's H antigen is stronger or weaker.I don't know if you see the anti-A reaction under microscope to confirm it is nor rouleaux. If the anti-B give 4+ reaction ,we will not do anti-AB test, because it can give 4+ ,too.I will do adsorption and elution test to see if A antigen is here, and test the saliva blood group substance. Link to comment Share on other sites More sharing options...
Sisi Posted October 27, 2012 Author Share Posted October 27, 2012 Thank you Shily,The reaction with anti-H of 2 other B cells are weaker reaction, just weak positive and O-cell are 4+. So, I suspect it is subgroup. The reaction with anti-A is not rouleaux but very weak after washing with saline. Our lab does not perform neither the adsorption and elution test or saliva blood group. We usually send our cases to reference lab, but I want to ensure I have not miss any important step before that. Thanks a lot. Link to comment Share on other sites More sharing options...
Yanxia Posted October 27, 2012 Share Posted October 27, 2012 Sisi, why you washing the anti-A reaction tube, DO you wash the cells before add anti-A? Link to comment Share on other sites More sharing options...
Sisi Posted October 27, 2012 Author Share Posted October 27, 2012 We do not washed the cells before typing. But since the auto control have rouleaux and anti-A reaction is weak positive. Therefore, further testing, I washed the cell three times with 37 saline to eliminate rouleaux formation and other non-specific cold antibodies. Would you perform this, washed with 37C saline or just saline for further confirmation? Moreover, I used 2 random group B patient serum to react with the patient cells, the results were negative. ? reactivity against the blue dye/ base of anti-A? But how to explain the much stronger reaction with anti-H than other normal group B? Thank you ! Link to comment Share on other sites More sharing options...
Yanxia Posted October 28, 2012 Share Posted October 28, 2012 Sisi,I will wash the cells with saline 3 times before test, if there is auto-agglutination caused by cold antibody, I will wash it with 37 degree C saline to wash the cold antibody off.If you wash the cells before test, I think free antibody such as anti-dye will be washed off, so I don't think it is anti-dye.I prefer it is a subgroup. You select 2 random group B patient serum , because we don't know its titer, it will be weaker than our anti-A reagent, so the reaction with subgroup will be too weak to see.It is my pleasure. Link to comment Share on other sites More sharing options...
Sisi Posted October 30, 2012 Author Share Posted October 30, 2012 Thanks a lot!! Link to comment Share on other sites More sharing options...
David Saikin Posted October 30, 2012 Share Posted October 30, 2012 Sounds to me like your pt is a(weak subgroup of A)B with anti-A1. Did you run the serum/plasma against A2 cells? did you rule out cold reacting abs? Link to comment Share on other sites More sharing options...
Sisi Posted October 31, 2012 Author Share Posted October 31, 2012 Cold ab had been rule out by washing cells with 37 saline. Since our lab do not have A2 cell. I haven's done this. Thanks. Link to comment Share on other sites More sharing options...
Rh-fan Posted October 31, 2012 Share Posted October 31, 2012 The H antigen of the patient is weaker then that of normal B cells, correct?If that is the case it is strange, because until now you only have a problem with the A antigen but when the H antigen is weaker then normal B, there can be a problem with the B antigen. Did you test group O cells (screening panel) at low temp to exclude other cold antibodies (maybe the reaction with the A cells is not due to anti A/A1 )?Peter Link to comment Share on other sites More sharing options...
rravkin@aol.com Posted October 31, 2012 Share Posted October 31, 2012 Is it posible to incubate the reaction volume of Anti A/patient cells at 37C for a given period to see if the reaction will persist; also have you considered a DAT and follow-up testing if positive? Link to comment Share on other sites More sharing options...
Sisi Posted November 1, 2012 Author Share Posted November 1, 2012 Dear Peter,The H antigen of the case is stronger than normal B. Cold ab had been rule out by washing cells with 37 saline. Thanks. Link to comment Share on other sites More sharing options...
Sisi Posted November 1, 2012 Author Share Posted November 1, 2012 DAT of the case is negative. Thanks. Link to comment Share on other sites More sharing options...
aafrin Posted November 1, 2012 Share Posted November 1, 2012 Cold ab had been rule out by washing cells with 37 saline. Since our lab do not have A2 cell. I haven's done this. Thanks.If you have A1 Lectin use it on your A group donor/ patient's cells. those that don't react are A2 cells. Use 3 A1 cells and 3 A2 cells to check the specificity of the anti-A antibody. Link to comment Share on other sites More sharing options...
Rh-fan Posted November 1, 2012 Share Posted November 1, 2012 those that don't react are A2 cells. Or A3, Ax, Ael, Aend, or something else. There is more that A1 and A2 Link to comment Share on other sites More sharing options...
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