I have a patient is suspect to have suffered MDS. His blood type result is anti-A 2+mf;

anti-B 2+s mf, anti-D 3+, Ac neg, Bc neg

He has been transfused 7days before with more than 4 units of AB group red cells .

I can't get the pre-transfusion specimen, and I suspect they have typed him wrong. and I can't eleminate he is antigen decrease.

How can I get the right blood group result? Except waiting...

I have a patient is suspect to have suffered MDS. His blood type result is anti-A 2+mf;

anti-B 2+s mf, anti-D 3+, Ac neg, Bc neg

He has been transfused 7days before with more than 4 units of AB group red cells .

I can't get the pre-transfusion specimen, and I suspect they have typed him wrong. and I can't eleminate he is antigen decrease.

How can I get the right blood group result? Except waiting...

There are two approaches you could use (one cheap, but not necessarily going to give you a definitive answer; one expensive, but more likely to give you a definitive answer).

If he is an Le(a-b+) or an Le(a-b-) Secretor gene positive individual, you could take some of his saliva and test this to see if it is capable of inhibiting anti-A and/or anti-B. This is the cheap way, but may not work.

The other way is to get him genotyped. This is expensive and may not be available to you. It is also not 100% accurate with the ABO Blood Group System, as the genotype does not necessarily reflect the genuine phenotype in very, very rare cases.

:):)

Would a cell separation work with this? Capture the newer, presumably autologous cells and type them? There is a centrifugation method in the Technical Manual.

Would a cell separation work with this? Capture the newer, presumably autologous cells and type them? There is a centrifugation method in the Technical Manual.

I think this is a good way.

Saliva and genotyping can't differ ABO subtype with transfusion error and antigen drcrease, I think.

I have try to seperate cells with anti-E and anti-C which all show mixed field reaction .

The procedure is add anti-serum (anti-E or anti-C) and patient's cells, centrifuge it and then seperate the agglutinated cells with free cells. Add the free cells to two tube then add anti-A and anti-B respecitvely, centrifuge them , then see the result.

I think this can tell me the mix field if comes from two seperatable cells population. It can't differ mosaic with transfusion error.

Then I can do saliva substance to detect the A &B substance, if it exist , the patient maybe mosaic, if not then he is transfusion error.

But I don't know more about mosaic type, whether they produce A &B substance. Would your friends help me with mosaic type knowledge? Thanks in advance!

Edited May 11, 201015 yr by shily

I think this is a good way.

Saliva and genotyping can't differ ABO subtype with transfusion error and antigen drcrease, I think.

Yes they can.

Secretor status and secretor specificity remains the same come what may (including after a BMT), and genotyping will a) show subtypes much more specifically than serological techniques, and these will also always be the patient's DNA.

His blood type result is

• anti-A 2+mf
  
• anti-B 2+s mf
  
• Ac neg
  
• Bc neg
  

He has been transfused 7days before with more than 4 units of AB group red cells ... I suspect they have typed him wrong...

Shily, I am a little perplexed. You suspect that the patient has been mistyped. The reverse (serum) is consistent with an AB (no anti-A or anti-B present in the patient's serum). The forward (cells) show mixed field with both the anti-A and anti-B.

If the patient was mis-typed and was really an A (with missing anti-, then only the anti-B reagent would show mixed field. If the patient was really a B (with missing anti-A), then only the anti-A reagent would show mixed field. The only thing that would explain mixed field with both would be if the patient was an O, but missing both anti-A and anti-B...and probably not doing so well after transfusion with 4 units of type AB cells!

Is it possible that the patient was transfused with O cells? If not at your facility, but at some other facility? That would be a much more probable explanation.

Shily, I am a little perplexed. You suspect that the patient has been mistyped. The reverse (serum) is consistent with an AB (no anti-A or anti-B present in the patient's serum). The forward (cells) show mixed field with both the anti-A and anti-B.

If the patient was mis-typed and was really an A (with missing anti-, then only the anti-B reagent would show mixed field. If the patient was really a B (with missing anti-A), then only the anti-A reagent would show mixed field. The only thing that would explain mixed field with both would be if the patient was an O, but missing both anti-A and anti-B...and probably not doing so well after transfusion with 4 units of type AB cells!

Is it possible that the patient was transfused with O cells? If not at your facility, but at some other facility? That would be a much more probable explanation.

Agreed.

Shily, I am a little perplexed. You suspect that the patient has been mistyped. The reverse (serum) is consistent with an AB (no anti-A or anti-B present in the patient's serum). The forward (cells) show mixed field with both the anti-A and anti-B.

If the patient was mis-typed and was really an A (with missing anti-, then only the anti-B reagent would show mixed field. If the patient was really a B (with missing anti-A), then only the anti-A reagent would show mixed field. The only thing that would explain mixed field with both would be if the patient was an O, but missing both anti-A and anti-B...and probably not doing so well after transfusion with 4 units of type AB cells!

Is it possible that the patient was transfused with O cells? If not at your facility, but at some other facility? That would be a much more probable explanation.

Yes , I susperct he is O mistyped with AB and had been transfuised with AB cells.

If the patient has shown autoagglutination in the first time , and he is 72 years old ( sorry, I forget to mention it), antibodies is weaker even in healthy elderly people and he is immuno-deficient because disease.

I have heard 2 or 3 case of ABO type transfusion error , one is 16 years old , they have not show any sign of hemolysis. It is stranger but it exist.

And I agree with your guess, he maybe transfused with O cells and family member's memory is not right.

Edited May 21, 201015 yr by shily

Have you tried to enhance the reactivity with the post-transfusion samples to see the anti-A and anti-B? The reactions may be weakened, but they shouldn't be completely absent unless the patient has agammaglobulinemia. Use 4 drops of serum with 1 drop of typing cells, incubate it at 4 deg C for up to 30 minutes and re-test...if the anti-A and anti-B are there, then that should bring them out. Since you suspect that he is a group O, could you also take the typing to AHG phase? The patient should have IgG anti-A,B as well. I don't know if that is a valid suggestion (Malcom, have you ever heard of such a thing?), but it might be worth a try.

Have you tried to enhance the reactivity with the post-transfusion samples to see the anti-A and anti-B? The reactions may be weakened, but they shouldn't be completely absent unless the patient has agammaglobulinemia. Use 4 drops of serum with 1 drop of typing cells, incubate it at 4 deg C for up to 30 minutes and re-test...if the anti-A and anti-B are there, then that should bring them out. Since you suspect that he is a group O, could you also take the typing to AHG phase? The patient should have IgG anti-A,B as well. I don't know if that is a valid suggestion (Malcom, have you ever heard of such a thing?), but it might be worth a try.

I still rather think that the patient may be an AB who has been transfused with group O blood, however, if it is the other way around, then I would not only try detecting the anti-A and/or anti-B at 4oC (with a group O control, in case the patient has an auto-antiH, auto-anti-HI, etc), but I would also enzyme treat the red cells too, as this will further enhance the reaction.

I can see where you are coming from Heather, but not all group O individuals will have IgG ABO antibodies; it depends on many things, such as an ABO incompatible pregnancy, environmental factors, etc), but it still could be worth a try.

:):)

Have you tried to enhance the reactivity with the post-transfusion samples to see the anti-A and anti-B? The reactions may be weakened, but they shouldn't be completely absent unless the patient has agammaglobulinemia. Use 4 drops of serum with 1 drop of typing cells, incubate it at 4 deg C for up to 30 minutes and re-test...if the anti-A and anti-B are there, then that should bring them out. Since you suspect that he is a group O, could you also take the typing to AHG phase? The patient should have IgG anti-A,B as well. I don't know if that is a valid suggestion (Malcom, have you ever heard of such a thing?), but it might be worth a try.

Thank you. Our reference lab have do the AHG reactivity , but they can't get anything . This patient compatible with AB cells in AHG phese.

As to the 4 degree c and enzyme reaction, I am sorry , I have not do this .

And I think this patient have transfused , what will we get from the post transfused specimen, anti-A, anti-B , this can bond on the transfused cells.