Presentation on theme: "ABO Typing Discrepancies"— Presentation transcript:
1 ABO Typing Discrepancies Jayme Heimonen MT(ASCP)SBBBlood Bank Technical SpecialistBorgess Medical CenterKalamazoo, MIASCLS-Michigan 2016
2 ABO Typing Discrepancies Expected reactions are missingAnti-A Anti-B Anti-D Co A1 Cells B Cells
3 ABO Typing Discrepancies Unexpected reactions are present.Anti-A Anti-B Anti-D Co A1 Cells B Cells
4 ABO Typing Discrepancies Reactions are weaker than expected.Anti-A Anti-B Anti-D Co A1 Cells B Cells
5 ABO Typing Discrepancies First Steps;Always repeat the testing in all tubes or microtubes, following your SOPs and the manufacturers product insert.Repeat using washed cells (at least 3 times).Observe tube testing reactions microscopically if possible.Obtain the patient’s history including age, transfusion history and diagnosis.
6 ABO Typing Discrepancies Next steps:Evaluate the reactions in the forward and reverse typing to determine which type is most convincing.Remember: Forward type tests the antigens on the cells. Reverse type test the antibody in the plasma.Determine what ABO group to crossmatch for the patient.
7 ABO Typing Discrepancies What can lead to forward type discrepancies?Transfusions with other ABO typesWeak SubgroupsMixed cell population (HSCT)Certain disease statesRouleaux
8 ABO Typing Discrepancies Example with Transfusions ***Expected reaction is missing Anti-A Anti-B Anti-D Co A1 Cells B Cells 4+ 0*** AB patient massively transfused with Group: A red blood cells.
9 ABO Typing Discrepancies Group: AB patient massively transfused with Group: A red blood cells.Phone call to other hospital where transfusions were administered. Have they typed a pre-transfusion specimen?Observe reactions microscopically(tube testing)-may see weak reactions with patient’s cells and anti-B.Transfuse with Group: AB, A, B or O cells
10 ABO Typing Discrepancies Weak subgroups***Expected reaction is missingAnti-A Anti-B Anti-D Co A1 Cells B Cells0***Weak subgroup of A such as AmAdsorption/elution.Secretor testing.Transfusion with Group: O red blood cells.
11 ABO Typing Discrepancies Mixed cell population ***Expected reaction is weaker Anti-A Anti-B Anti-D Co A1 Cells B Cells 1+*** Group: O patient who received a Group: A HSCT in last 30 days.
12 ABO Typing Discrepancies Group: O patient who received a Group: A HSCT in last 30 days.Call the Blood Bank of the transplant hospital for their transfusion guidelines.Transfuse Group: O red blood cells until there is evidence marrow has engrafted.Transfuse Group: A plasma product to be compatible with newly produced red blood cells.Transfuse irradiated blood products.
13 ABO Typing Discrepancies Disease states such as acute myeloid leukemia and other cancers with chemotherapy.***Expected reaction is weakAnti-A Anti-B Anti-D Co A1 Cells B Cells***Previous typing history.Enhance agglutination.Adsorption/elution.
14 ABO Typing Discrepancies Disease states such as warm autoimmune hemolytic anemia***unexpected reactionAnti-A Anti-B Anti-D Co A1 Cells B Cells*** ***Spontaneous agglutination-cells coated with high concentration of warm autoantibodies.Perform direct antiglobulin test.Always give Group: O blood until discrepancy is resolved.
15 ABO Typing Discrepancies Disease states such as Cold Hemagglutinin diseaseAnti-A Anti-B Anti-D Co A1 Cells B CellsIncubate type at 37oC.Wash cells in 37oC saline.Prewarm reagents and serum/plasma.
16 ABO Typing Discrepancies RouleauxAnti-A Anti-B Anti-D Co A1 Cells B CellsMicroscopically observe cells as a stacked coin retractile appearance:R R R RSaline replacement.
17 ABO Typing Discrepancies What can lead to reverse type discrepancies?Weak or missing antibodies.Extra antibodies.Transfusion.HSCT recipient.Rouleaux.
18 ABO Typing Discrepancies Weak or missing antibodies***Expected reaction missingAnti-A Anti-B Anti-D Co A1 Cells B Cells***Elderly patient with low anti-B titerIncubate all tubes including autocontrol at room temperature for 30 min or 4oC.Increase serum/plasma to cell ratio.Increase incubation time.Transfuse with Group: A red blood cells.
19 ABO Typing Discrepancies Weak or missing antibodies***Expected reaction missingAnti-A Anti-B Anti-D Co A1 Cells B Cells*** 0Increased antibody concentration where antibody exhibits prozoning.Perform isohemagglutinin titer.
20 ABO Typing Discrepancies Atypical antibodies***Unexpected reaction presentAnti-A Anti-B Anti-D Co A1 Cells B Cells***Weak subgroup of A with anti-A1 present.Type patient’s cells with A1 lectin.Test patient’s serum/plasma with cells lacking A1 antigen (such as A2 cells).Perform antibody identification for anti-A1.Transfuse Group: A cells lacking A1 antigen or Group: O cells.
28 ABO Typing Discrepancies Transfusion ***Unexpected reaction Anti-A Anti-B Anti-D Co A1 Cells B Cells *** Group AB patient transfused with Group O cryoprecipitate.
29 ABO Typing Discrepancies Hematopoietic stem cell recipientAnti-A Anti-B Anti-D Co A1 Cells B CellsGroup: A recipient transplanted with Group: B donor at day 56Contact the transplant hospital and get their guidelines for transfusion of packed red cells and plasma products.
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