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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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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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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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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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