Typing Discrepancy Case Study

[Mosaics]

I have an interesting case study for y'all that I had at work today. 

 

Patient results:

Anti-A  4+

Anti-B  4+

Anti-D  4+

Rh control 0

A1 cells 3+

B cells 0

 

We have the patient history as a B positive in the computer.

 

What do you think is the cause of these discrepant results and what would you do to resolve?

 

 

 

 

[Malcolm Needs ☆]

Have you changed your anti-A reagent since the patient was typed as B?

[Mosaics]

We did this in gel.  I repeated it in tube and got the same results.  We did not change our anti-A reagent.

[David Saikin]

Is there a way to review the typings that were B+?  Was the pt transfused as a B? I had this happen years ago before monoclonals. We had a donor who typed as B+; in evaluating monoclonal reagents this donor just happened to donate - typed as AB+ with anti-A1.  We had transfused the unit to a group B individual - they got and maintained a good increment from the transfusion.  The A ag was very weak on his rbcs.  Yours is definitely more interesting. 

[Mosaics]

Is there a way to review the typings that were B+?  Was the pt transfused as a B? I had this happen years ago before monoclonals. We had a donor who typed as B+; in evaluating monoclonal reagents this donor just happened to donate - typed as AB+ with anti-A1.  We had transfused the unit to a group B individual - they got and maintained a good increment from the transfusion.  The A ag was very weak on his rbcs.  Yours is definitely more interesting. 

Patient had history of multiple typings as a B positive. 

 

We use monoclonal reagents.

 

Patient is Hematology-Oncology patient.

Edited July 29, 2014 by Mosaics

[pbaker]

Did the patient get a stem cell/bone marrow transplant?

[Mosaics]

Ding, ding, ding!  He had a transplant with AB cord blood

[Malcolm Needs ☆]

Then, presumably, he has a positive DAT due to the anti-A in his own plasma?  If so, you did not supply this information.

[EDibble]

Ding, ding, ding!  He had a transplant with AB cord blood

That was my first thought.

 

Beth

[Mosaics]

Then, presumably, he has a positive DAT due to the anti-A in his own plasma?  If so, you did not supply this information.

I asked the supervisor if a DAT needed to be done.  She said no. 

[Malcolm Needs ☆]

Then the supervisor was WRONG!

 

Thanks Mosaics.

[rravkin@aol.com]

Mosaics, did you request a second specimen for confirmation? Did you check patient history to see when and where the Bone Marrow transplant was done?

[kmmoton]

Bone marrow!