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ABO Discrepancy case


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New patient, no history, preopped Wednesday for diabetic-related debridement surgery yesterday. Evening shift ran the T/S specimen on ProVue as usual and encountered an ABO discrepancy; patient forwards as A pos, reverses as O (2+ A cells, 4+ B cells). The screen was edited to negative from questionable results in the last two cells. Patient cells are negative with anti-A1 lectin, although the evening shift tech did not run the patient's plasma with A2 cells (I don't think this would have mattered). The reverse was prewarmed for 45 minutes with no resolution, and, unfortunately, everything was left for us on dayshift. :rolleyes:

Long story short, repeat testing ended with us calling the ProVue screen 1+ in all cells. The gel panel produced varied results (1+ to 3+ reactions in 5 of 10 cells, which, I noticed, were all P1 positive, as were all three screening cells) with a negative autocontrol. Immediate spin results are all 3-4+, and all cells of the tube screen and both units we tried were all positive. Prewarming (1 hour) did not help.

The specimen was sent to our reference laboratory and the report sent back today calls this a "cold autoantibody (strong)" but with a negative DAT (both anti-IgG and anti-C3b, C3d, negative autocontrol (gel), a positive gel screen (mixed field) and a prewarmed negative screen using an IAT technique. They recommended using a blood warmer. This is just a preliminary report - I called today and asked if they were actually able to get a clear reverse and was told they did a "settled reading" at 37ºC but that the A cells were still typing 1+. I mentioned the Pand they tentatively indicated they would explore it before sending a final report.

They sent us two units they said were compatible by a prewarmed IAT technique; only one was compatible when we prewarmed and tested with LISS today, so I tested two more from our shelf and got another compatible, per our policy.

Thoughts? I am always wary of prewarm and the reference report we received was very vague and brief. The patient has a decent H/H and should not need units but I am curious what others think.

 

 

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