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KTUCK

ABO TYPING DISCREPANY WITH MTS GEL

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2 weeks Post partum G2P2 female in ER with vaginal bleeding.

Patient HX includes B POS patient receiving blood from first pregnancy from 2 years prior. Upon initial OB work up, Anti-E and Anti-c(little) identified. Patient induced early due to antibody titers being high. Baby girl delivered and found to be group B rh POS with a 4+ DAT.

at ER visit, Patient taken to OR and TSC ordered. In MTS gel, type displays Anti-A-0, Anti-B-4+, Anti-D-4+, patient plasma with a reverse cells- 4+, patient plasma with B reverse cells- 3+mf. Plasma warmed, still getting same results. No rouleaux  found. Tube typing demonstrates Anti-A-0, Anti-B-4+, Anti-D-4+, patient plasma with a reverse cells- 4+, patient plasma with B reverse cells- 0.

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Just as a matter of interest, was the sample hard centrifuged, because if not, it could be white cells that are causing the phenomenon on your machine.  I'm not saying that is what it is,; just that it could be.

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Yes, I centrifuged in my specific centrifuge just for BB. I have found that our core lab centrifuge does not spin the specimens down very well, so I have to spin again in mine.

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Posted (edited)
1 hour ago, KTUCK said:

Yes, I centrifuged in my specific centrifuge just for BB. I have found that our core lab centrifuge does not spin the specimens down very well, so I have to spin again in mine.

To confirm you are getting an equivalent of a "hard spin", you should verify that your blood samples have platelet-poor plasma after the two centrifugations.  We use the StatSpin Express 3 centrifuges that spin at 7200rpm and produce 4400rcf for 3 minutes.  These are the same centrifuges that Coagulation Section uses to prepare platelet-poor plasma for coagulation testing.

As part of our protocol for investigating ABO discrepancies in gel and even weakly positive antibody screens, we routinely centrifuge a blood sample 3x for a total of 9 minutes and then retest.  This is surprisingly effective.

Edited by Dansket
added new paragraph

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Posted (edited)

Your reverse cells are probably Rh- and may react with anti c.   Using gel will only enhance this reaction since the plasma/cells are in contact for 10+ minutes or more especially if using automation.   You probably ran your reverse tube without delay so you did not pick up the anti c.  If you incubated your tube reverse B cell at 37 you would probably pick up some reactivity.   I have seen this many times especially with anti c. 

 

Edited by R1R2

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I have the Statspin express 4. Love these centrifuges, But I also do the platelet poor too.

I was thinking it may possibly be the reverse cell situation like R1R2 stated, but don't run into too many problems like this (we are a smaller facility), so I wasn't for sure.

Thank you all for your help.

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