MLAB 2461 CLINICAL II

Immunohematology
ABO Discrepancies - Example 3

A1
Anti-A Anti-B Anti-D D ctrl B cell
cell
4+ 4+ 4+ 0 4+ 4+

In this example the forward type, which detects antigens on red cells, appears to be valid and
the patient appears to be AB pos.  When all tubes in the forward type are positive a D control
must be performed to ensure the cells are not spontaneously aggultinating.  The negative
reaction with the D control validates the forward type.  The problem appears to be in the
reverse type.  AB individuals DO NOT have anti-A or anti-B.  This individual is reverse typing
as a group O.  The discrepancy lies in the reverse group, there is an "unexpected" antibody
present.

There are many blood group antibodies which may be stimulated.  Reverse cell manufacturers
attempt to select A and B individuals with cells that lack antigens which will react with cold
reacting antibodies.  Unfortunately ALL normal adult individuals possess the I antigen.  The
antibody to this antigen reacts preferentially at RT or below, ie, 4C.  This problem will take a bit
longer to resolve.

The first step is to make sure the antibody specificity is against the I antigen.  The key is to test
the patient serum or plasma agains a cell that lacks the I antigen, in this case, cord cells. 
Infants are born I negative or weakly I positive.  By testing the patient sample agains cord cells
additional information will be obtained. All normal adults cells possess the I antigen so
agglutination is expected with all reagent cells tested as well as the patient cells.

Cord Screen Screen Screen Auto-

Cell 1 2 3 control
0 4+ 4+ 4+ 4+

The cord cell is negative which assists in confirming the presence of the cold autoagglutinin,
anti-I.  The auto-control and screen cells are positive which is expected when a cold auto-
agglutinin is present. One could then find A and B cord cells to use as reverse cells to aid in
resolving this problem.

Compatibility testing may have to be performed with a pre-warmed technique, prewarming

patient serum and all cells that the patient will be tested against.  The serum is warmed, added
to the pre-warmed cells and, after appropriate incubation, washed with pre-warmed saline.
THIS TECHNIQUE CAN ONLY BE USED AFTER PROPER IDENTIFICATION OF ANTI-I. The
technique for identifying anti-I will be covered more comprehensively during the
identification of unexpected antibodies unit.

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