Unusual ABO

[MikeB]

Female Orthopedic pre-op patient.  No history of transfusion.

 

Cold reactive antibody identified only reacting at 18C (1+) and 4C (3+) including autocontrol.  No reactivity at IS or 15' RT with panel cells.  DAT (w+) with Poly and C3b/C3d.  No reactivity at 37C or IgG.

 

Anti-A:  1+

Anti-B:  0

Anti-D:  4+

 

A1 Cells:  w+

B cells:     4+

 

Appears to be an A subgroup with an Anti-A1, however.........

 

Anti-A,B:  3+

Anti-A1:  0

 

A2 Cell 'A' :  3+  (Expired 3/29/13)

A2 Cell 'B' :  3+  (Expired 4/26/13)

A2 Cell 'C' :  1+  (In date)

O PoolCells:  0

Autocontrol:   0 

 

Any thoughts on why are the A2 cells reacting so strong at immediate spin compared to the A1 cells?

[David Saikin]

 Maybe anti-IH

[Malcolm Needs ☆]

Agree David, or it could be that there is an anti-M present, and that the A1 cells are M+N+, whilst the A2 cells are all M+N-, or that there is an anti-P1 present and that the A1 cells are P1+, whilst the A2 cells are P14+.

 

You need to do some more work, I'm afraid.

[MikeB]

Alloantiboies (-M, -P1) are a likely possiblity, however we tested two seperate ABID panels and observed no reactivity at IS or 15' RT.  It wasn't until 18C that the cold autoantibody was apparent.

 

 

I origianlly thought IH, but  would have expected the Group O cells to react stronger than the A2.

[Malcolm Needs ☆]

Yes, I would agree MikeB.  Looks like I'll have to have another think!

[Mabel Adams]

In the US all reverse cells are pools aren't they?  They almost always contain some M+ & P1+ cells--although maybe some lots more than others.

[Yanxia]

1.make AB plasma that have no anti-A anfd anti-B and make sure it has not oher antibodies to RBC antigens to react with 2 A2 cells that are out of dated to make sure the reaction with patient plasma is anti-A not other interuption.

2. if there is anti-A in 1, the antibody maybe anti-AH.

[Mabel Adams]

Oh, and remember anti-Leb H?  I can't remember how it works but know that A patients make it.  Maybe someone else can explain why that idea doesn't work or if it might.

[Rh-fan]

anti LebH will be reactive with the pool of O cells.

 

Anti LebH will reactive with cells that have H (group O and A2) and the Leb antigen. Cells that have Leb but lack (a lot of) H (A1) will not be reactive with anti LebH.

 

The differance between anti A and anti A,B makes me think of Ax. In those patients we se sometimes a very strong anti A1 that also is reactive with A2 cells (better to say anti A instead of A1). The problem is in your patient is the weak reaction with A1 cells.

 

Can you test A1 cells in the same way you tested the different A2 cells?

 

Peter