ANTI-A     ANTI-B      ANTI-D      RH CONTROL       A1 CELLS       B CELLS
  0                  0              0                   0                          0                     4+

 

 

Today, we had these results on a labor & delivery patient with history of type A negative, weakly reacting with anti-A.  I am just curious as to your facility's procedures to resolve this discrepancy in comparison.

 

Thanks!

 

 

Any more detail that you can provide on the "weakly reacting with anti-A".  Was it a microscopic reading? Was it mixed-field agglutination?  Were the original results confirmed by a reference laboratory?

 

Assuming these results are from standard tube tests with polyclonal anti-A and anti-B? I would test with monoclonal anti-A,B.  I would incubate the reverse grouping test for 5-15 minutes at room temperature, centrifuge and read.

Before I did anything I would look very carefully into the previous results - then based on that, I would go further.  Also - check if the patient has had a BM transplant or has leukaemia

Any more detail that you can provide on the "weakly reacting with anti-A".  Was it a microscopic reading? Was it mixed-field agglutination?  Were the original results confirmed by a reference laboratory?

 

Assuming these results are from standard tube tests with polyclonal anti-A and anti-B? I would test with monoclonal anti-A,B.  I would incubate the reverse grouping test for 5-15 minutes at room temperature, centrifuge and read.

We use monoclonal reagents in gel.  Then it was tested in tube with monoclonal anti-A and was microscopically positive.  Our supervisor suggested testing it with a type B patient (possesses anti-A).  Do you use this method?  This method didn't seem to change the results, as it was still microscopically positive even after incubating for 10-15 minutes at room temperature. 

Edited September 18, 201410 yr by Mosaics

After confirming the previous result of weak rx with anti-A I would try to absorb and elute anti-A off her red cells (you never have a student when you need one!).  You could also put your front type at 4C for 10 minutes to see what happens (use pt cells in Rh ct as a control). 

To be a devil's advocate, don't your ABO grouping reagents specify in the package insert "tests should not be read microscopically"? 

To be a devil's advocate, don't your ABO grouping reagents specify in the package insert "tests should not be read microscopically"? 

Nope.  I perused them carefully and nowhere did it say that.  Do yours say that?

Then they should!  Simple as that.

 

Grumpy of England.

We do not have monoclonal anti-A,B where I work.   

What is her transfusion history?  Recently transfused with O Neg?  Not enough info given to go on. 

As far as I know she hasn't recently been transfused.  She needs to receive O negative blood if necessary.

Any news about a BMT?

 

I remember one case where a very goof friend of mine had a bit of a shock when a baby's group excluded the mother.  He thought about a baby swap and all sorts of other things, and almost decided that he could no longer do ABO grouping (he was/is a VERY senior member of the blood transfusion fraternity in the UK).

 

It turned out that that the mother had received a BMT earlier in her life, and the baby was the result of an ovum gifted from her sister.

Without the info of the historic type, I would be working to make that reverse type show up.  With that information, I would be looking at weak A subgroups.  You could certainly get a polyclonal antibody from a patient sample, although I would think you would use an O patient (or a pool of them) for the anti-A,B.