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problems
cls.umc.edu/COURSES/CLS325/Week5/Discrepancies.ppt
1 4+ 1+ 0 4+
2 0 4+ 1+ 0
3 4+ 4+ 1+ 0
4 0 3+ 0 0
What do you do?
• Identify the problem
• Most of the time, the problem is technical
– Mislabeled tube
– Failure to add reagent
• Either repeat test on same sample,
• request a new sample, or
• wash cells
• Other times, there is a real discrepancy due to
problems with the patient’s red cells or serum
Discrepancy ?
• If a real discrepancy is encountered, the
results must be recorded
Red
supernatant
ABO discrepancies
ABO Discrepancies
Problems with RBCs
Weak-reacting/Missing antigens
Extra antigens
Mixed field reactions
Problems with SERUM
Weak-reacting/Missing antibodies
Extra antibodies
Grouping
Forward Reverse
Young Cold
A/B Subgroup Acquired B O Transfusion Elderly
Immunocompromised Autoantibody
Rouleaux Rouleaux
May cause all + reactions
Anti-A1
Forward Grouping Problems
Red Cell Problems
• Affect the forward grouping results
– Missing or weak antigens
– Extra antigens
– Mixed field reactions
Forward Grouping:
Missing or Weak antigens
• ABO Subgroups
• Disease (leukemia, Hodgkin’s disease)
0 0 0 4+
Group O Group A
EXAMPLE
Acquired B Phenotype
• Limited mainly to Group
A1 individuals with:
– Lower GI tract disease
– Cancer of colon/rectum
– Intestinal obstruction
– Gram negative
septicemia (i.e. E. coli)
Problems with The Forward Grouping:
Group A Acquired
individual B
Phenotype
0 2+ mf 4+ 0
Mixed Field Agglutination (Post transfusion)
~ (ABO Testing) Can be seen in A, B and AB individuals who have received O units. The antisera reacts with
the patient’s RBCs, but not with the transfused O cells.
~ (Antibody screen) Can also be seen post transfusion if a person makes an antibody to antigen on donor
cells; antibody agglutinates with donor cell, but not their on cells.
Reverse Grouping Problems
Reverse Grouping
• Affect the reverse grouping results
– Missing or weak antibodies
– Extra antibodies
Reverse Grouping:
Missing or Weak antibodies
• Newborns
– Do not form antibodies until later
• Elderly
– Weakened antibody activity
• Hypogammaglobulinemia
– Little or no antibody production (i.e.
immunocompromised)
• Often shows NO agglutination on reverse
groupings
Resolving Weak or Missing antibodies
• Determine:
– patients age
– diagnosis
• Incubate serum testing for 15 minutes (RT) to
enhance antibody reactions
• If negative, place serum testing at 4°C for 5
minutes with autologous control (a.k.a.
Autocontrol, AC)
• This is called a “mini-cold” panel and should
enhance the reactivity of the antibodies
Reverse Grouping:
Extra Antibodies
Anti-A Anti-B A1 B
Cells Cells
4+ 0 2+ 4+
Others…
• The Bombay phenotype (extremely RARE)
results when hh is inherited
• These individuals do not have any antigens
and naturally produce, anti-A, anti-B, anti-A,B,
and anti-H
• Basically, NO forward reaction and POSITIVE
reverse
• Resolution: test with anti-H lectin (Bombay’s
don’t have H and will not react)
Finding the problem…
• Forward type tests for the
antigen (red cell)
• Reverse type tests for the
antibody (serum)
• Identify what the patient
types as in both Forward &
Reverse Groupings
• Is there a weaker than usual
reaction?
• Is it a missing, weak, or
extra reaction??
Resolving ABO Discrepancies
• Get the patient’s history:
– age
– Recent transplant
– Recent transfusion
– Patient medications
– The list goes on….
Let’s practice !
Example 1
Anti-A Anti-B A1 Cells B Cells
3+ 0 0 1+
Problem:
Causes:
Resolution:
Example 2
Anti-A Anti-B A1 Cells B Cells
3+ 1+ 0 4+
Problem:
Causes:
Resolution:
Example 3
Anti-A Anti-B A1 Cells B Cells
2+ 0+ 1+ 4+
Problem:
Causes:
Resolution:
Example 4
Anti-A Anti-B A1 Cells B Cells
0 0 0 3+
Problem:
Causes:
Resolution:
Example 4
Anti-A,B
Patient RBC 1+
0 2+mf 3+ 0
Problem:
Causes:
Resolution:
Example 6
Anti-A Anti-B A1 Cells B Cells
4+ 4+ 0 1+
Problem:
Causes:
Resolution:
Example 7
Anti-A Anti-B A1 Cells B Cells
0 0 0 0
Problem:
Causes:
Resolution:
Example 6