CASE 1: A Patient Was Seen in The Emergency Room and A Crossmatch Was Ordered. The ABO Forward and Reverse Grouping Results Are As Follows

34 MANALO, Rachel Ann
4CMT
CASE 1: A patient was seen in the emergency room and a crossmatch was ordered. The ABO
forward and reverse grouping results are as follows:
Forward Typing Reverse Typing
Anti-A Anti-B Anti-A,B A1 Cells B Cells
0 0 1+ 1+ 4+
1. Are these test results consistent? Why or why not?
These results are not consistent as the results for forward and reverse typing do not match. The
forward typing appears to be of the O phenotype as no agglutination of the patient’s red cells
with Anti-A and Anti-B reagents were observed. However, it is important to note that forward
typing shows a weak reaction with Anti-A,B which would be present only with an A or B antigen in
the patient’s red cells and is inconsistent with the O phenotype. Additionally, reverse typing
shows that the reaction of the patient’s serum with A1 cells is weaker than expected, but the
reaction with B cells is strong, thus the individual is most likely to be of the A phenotype. These
reactions show a possible ABO discrepancy of weak or missing antigen reaction with reagent
Anti-A in forward typing due to a probable subgroup of A.
2. What steps should be taken to resolve any existing discrepancies?
1. First, it is important to identify and rule out the source of discrepancy whether caused by
technical errors or if it is sample-related
○ To exclude technical errors, repeat ABO typing on the same samples and wash red
cells well with saline, if the red cells were suspended in serum or plasma.
○ Testing a new sample can also be done when disagreement occurs between previous
and current test results as possible contamination may be done on the initial sample.
2. If ABO discrepancy still remains, it is important to determine and note the patient’s medical
history such as diagnosis and transfusion history
3. Repeat forward typing with extended incubation times to enhance antigen-antibody reactions.
Include human polyclonal anti-A,B or monoclonal blend anti- A,B.
4. Additional tests such as molecular genotyping of the patient can identify the subgroup of A
present.
3. What blood group should be transfused to the patient?
As the patient is in the emergency room and is most likely in urgent need of transfusion, if there is
no time to do additional molecular genotyping of the patient to determine the subgroup of A, the
safest blood group that should be transfused to the patient is Group O blood because it is absent
of A or B antigens, preventing transfusion-related complications.
CASE 2: An 85 year old cancer patient requires a transfusion. The typing results are as
follows:
Forward Typing Reverse Typing
Anti-A Anti-B Anti-A,B A1 Cells B Cells
4+ 0 4+ 0 0
1. Are these test results consistent? Why or why not?
These results are not consistent as the reactions in forward and reverse typing do not match. The
reaction in forward typing is typical of a A phenotype individual because of strong reactions with
the patient's red cells with Anti-A and Anti-A,B reagents. However, the reverse typing is indicative
of an AB phenotype individual as there is no agglutination observed in the patient’s serum with the
reagent A1 and B cells. These reactions may possibly show an ABO discrepancy of a weak or missing
antibody reaction with reagent B cells in reverse typing.
2. What steps should be taken to resolve any existing discrepancies?
1. First, it is important to identify and rule out the source of discrepancy whether caused by
technical errors or if it is sample-related.
○ To exclude technical errors, repeat ABO typing on the same samples and wash red
cells well with saline, if the red cells were suspended in serum or plasma
○ Testing a new sample can also be done when the discrepancy shows disagreement
between current and previous test results as possible contamination may be done on
the initial sample.
2. If ABO discrepancy still remains, it is important to determine and note the patient’s age,
diagnosis and immunoglobulin levels.
○ As the patient is already 85 years old, the patient may have a decrease in anti-A and
anti-B levels as antibodies decrease with old age.
○ It should also be noted that the patient has been diagnosed with cancer and that
antibody levels decrease in association with several pathologic states.
3. Incubate serum testing for 15 minutes at room temperature to enhance antigen-antibody
reaction, centrifuge, then examine for agglutination.
4. If serum testing is still negative, it should also be repeated and placed at 4° C for 5 minutes
together with an autologous control.
○ The autologous control validates the test result and ensures positive reactions are not
caused by a cold autoantibody. Additionally, Anti-A and Anti-B react best at 4° C.
3. What blood group should be transfused to the patient?
The blood groups that are compatible and can be transfused to this patient should be blood
Group A blood as it only has the A antigen. Blood Group can also be transfused as it is absent of A
and B antigens to avoid any blood transfusion-related complications.
References:
Howard, P. R. (2017). Basic & applied concepts of blood banking and transfusion practices (4th ed.). Elsevier inc.

CASE 1: A Patient Was Seen in The Emergency Room and A Crossmatch Was Ordered. The ABO Forward and Reverse Grouping Results Are As Follows

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34 MANALO, Rachel Ann

Forward Typing Reverse Typing

Anti-A Anti-B Anti-A,B A1 Cells B Cells

1. Are these test results consistent? Why or why not?

2. What steps should be taken to resolve any existing discrepancies?

3. What blood group should be transfused to the patient?

Forward Typing Reverse Typing

Anti-A Anti-B Anti-A,B A1 Cells B Cells

1. Are these test results consistent? Why or why not?

2. What steps should be taken to resolve any existing discrepancies?

3. What blood group should be transfused to the patient?

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