Hello.

 

I am a rootie blood banker... shy...With lots of burning questions.

I am from Richmond, VA. I did most of my blood bank work as a generalist. Since 2008 I have checked with site time to time, and I found this site very helpful and interesting. Thank you all!

 

Can I please ask a question here?

 

Forward is 4+,4+ Rh is 4+ . Reverse 1+, 0. Rh Control is negative.

And patient's red cell is negative with lectin, Anti-A1

So the patient has A subgroup.

Immediate xmatch is compatible.  

My question is... does patiet has anti-A1? I think he still has although it is weak, but my lab think it is cold.

I ran short cold and everything is 1+ or weaker.

To me it is simple text book question, but now I am very confused.

Can someone explain to me?

 

Thank you.

Edited October 4, 201311 yr by richmond

Welcome to this wonderful site richmond.

 

It could be an anti-A1, a "cold" auto-antibody, a "cold" alloantibody, or a mixture of any of these!

 

One way to test if an anti-A1 is present is to test the patient's plasma against about 3 red cell samples known to be A1 and against 3 red cell samples known to be A2.  If the tests are positive with the A1 red cells, but negative with the A2 red cells, you have probably got (at least) an anti-A1 (but, as long as it is not reactive at strictly 37oC, it will not be clinically significant).

 

In the case of an A2B individual, however, there are very few H antigen sites available on the red cells, and the chances are that your patient may well have produced an auto-anti-HI.  There is no easy way of proving this, unless you have access to either group O cord blood red cells or group O adult ii (both of which, to all intents and purposes, will lack the I antigen), and to Oh (Bombay) red cells, which will, of course, lack the H antigen.

 

That having been said, you can almost prove it by testing the patient's plasma against red cells expressing a variety of ABO types.  Those that are A1B will react weakest, and up to group O red cells, which will react the strongest.

Thank you so much Malcom.

 

I was expecting more clear cut answer, but I guess such thing does not exist in BB.

If I can bother you with more questions.

1. Where do you usually get A2 cell? I don't recall if we have one.

2. You indicated that anti-A1 is not considered significant unless it reactivity is observed at 37C.  How do you test at 37C?

3. Suppose you get the same forward and reverse rxn and lectin result how far would you go in terms of testing.ex) Doing  "confirming with Anti-A1 in A subgroup method" what you described.

 

In other word when do you result as Anti-A1 and give A1 negative unit to patient.

No problem richmond.

 

1.  You should be able to discover a few A2 patients within your samples by testing their red cells against Dolichos biflorus, and you can then use those red cells for testing this particular patient's plasma/serum.  Equally, those that you find do react with Dol b can be used as A1 red cells when tested against your patient's plasma/serum.

 

2.  What you do is put the patient's plasma/serum at 37oC and allow it to come to temperature.  At the same time, you put some saline-suspended A1 red cells at 37oC and allow them to come to temperature.  Once both are up to temperature, you mix them as you normally would for any test, incubate at 37oC for the normal time and then look for agglutination or no agglutination.

 

3.  I wouldn't go much further, to be honest, as the results that you get will make very little, if any, clinical didderence.

 

I would only give A1 negative red cells on the very rare occasions when you have an anti-A1 that reacts strictly at 37oC.