AN ABO RH TYPING DISCREPANCY AND A NEW BLOOD BANKER · AN ABO RH TYPING DISCREPANCY AND A NEW BLOOD...
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T RUMAN M EDICAL C ENTERS 1 AN ABO RH TYPING DISCREPANCY AND A NEW BLOOD BANKER
Transcript of AN ABO RH TYPING DISCREPANCY AND A NEW BLOOD BANKER · AN ABO RH TYPING DISCREPANCY AND A NEW BLOOD...
T RU MA N M ED ICA L C EN T ERS 1
AN ABO RH TYPING
DISCREPANCY AND A
NEW BLOOD
BANKER
T RU MA N M ED ICA L C EN T ERS 2
Liz Abitz
MLS (ASCP)CM
TRUMAN MEDICAL CENTER
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A 41 YEAR OLD WOMAN
PRESENTED TO THE HOSPITAL
FOR SURGERY INVOLVING A LEFT
COMPLEX ADNEXAL MASS.
The patient had no historical
blood bank records at the testing
facility.
A GEL ANTIBODY
SCREEN WAS STARTED.
While the gel screen was incubating,
the ABO Rh testing was performed.
Initial Testing
Anti-A Anti-B Anti-D A1 Cell B Cell
0 4+ 0 4+ 1+
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A1 Cell B Cell Auto
Control reagent
cell
15’ @4 4+ 3+ 1+ 3+
15’ @ 37 4+ 1+ 0 2+
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Gel Antibody Screen Results
D C E c e K Fya Fyb Jka Jkb Lea Leb S S M N IgG (gel)
SCI + + 0 0 + + 0 + + + + 0 0 + + 0 2+
SC II + 0 + + 0 0 + 0 + 0 0 + + + + + 1+
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After reading through the
AABB technical manual, I
decided to incubate the
reverse type at 37° C for one
hour and doing a “settled”
reading.
ANTIBODY IDENTIFICATION
PANEL RESULTS Cell # D C E c e K Fya Fyb Jka Jkb Lea Leb S s M N
IgG (gel)
1 + + 0 0 + 0 0 + 0 + + 0 + + + + 1+ 2 + + 0 0 + 0 + 0 + 0 + 0 + + 0 + 0 3 + 0 + + 0 0 0 + + + + 0 + 0 + 0 2+ 4 + 0 0 + + 0 0 0 + 0 0 0 0 + 0 + 0 5 0 + 0 + + 0 0 0 + 0 0 0 + + + + 1+ 6 0 0 + + + 0 + + + 0 0 + + + + + 1+ 7 0 0 0 + + + 0 + 0 + 0 + + + + 0 2+ 8 0 0 0 + + 0 + 0 + 0 + 0 0 + 0 + 0 9 0 0 0 + + 0 + + 0 + 0 + + 0 + + 1+
10 0 0 0 + + 0 0 0 + + 0 0 0 + 0 + 0 11 + + 0 0 + + 0 + + 0 0 + + + 0 + 0
auto 0
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ANTIBODY IDENTIFICATION
PANEL RESULTS Cell # D C E c e K Fya Fyb Jka Jkb Lea Leb S s M N
IgG (gel)
1 + + 0 0 + 0 0 + 0 + + 0 + + + + 1+ 2 + + 0 0 + 0 + 0 + 0 + 0 + + 0 + 0 3 + 0 + + 0 0 0 + + + + 0 + 0 + 0 2+ 4 + 0 0 + + 0 0 0 + 0 0 0 0 + 0 + 0 5 0 + 0 + + 0 0 0 + 0 0 0 + + + + 1+ 6 0 0 + + + 0 + + + 0 0 + + + + + 1+ 7 0 0 0 + + + 0 + 0 + 0 + + + + 0 2+ 8 0 0 0 + + 0 + 0 + 0 + 0 0 + 0 + 0 9 0 0 0 + + 0 + + 0 + 0 + + 0 + + 1+
10 0 0 0 + + 0 0 0 + + 0 0 0 + 0 + 0 11 + + 0 0 + + 0 + + 0 0 + + + 0 + 0
auto 0
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ANTIBODY IDENTIFICATION
PANEL RESULTS Cell # D C E c e K Fya Fyb Jka Jkb Lea Leb S s M N
IgG (gel)
1 + + 0 0 + 0 0 + 0 + + 0 + + + + 1+
2 + + 0 0 + 0 + 0 + 0 + 0 + + 0 + 0
3 + 0 + + 0 0 0 + + + + 0 + 0 + 0 2+
4 + 0 0 + + 0 0 0 + 0 0 0 0 + 0 + 0
5 0 + 0 + + 0 0 0 + 0 0 0 + + + + 1+ 6 0 0 + + + 0 + + + 0 0 + + + + + 1+
7 0 0 0 + + + 0 + 0 + 0 + + + + 0 2+
8 0 0 0 + + 0 + 0 + 0 + 0 0 + 0 + 0
9 0 0 0 + + 0 + + 0 + 0 + + 0 + + 1+
10 0 0 0 + + 0 0 0 + + 0 0 0 + 0 + 0
11 + + 0 0 + + 0 + + 0 0 + + + 0 + 0
auto 0
FURTHER TESTING
Cell # D C E c e K Fya Fyb Jka Jkb Lea Leb S s M N IgG
(gel)
19 + + + 0 + 0 0 + 0 + 0 + 0 + 0 + 0
20 + + + 0 + 0 + + + 0 0 + + 0 0 + 0
6 0 0 + + + + 0 + + 0 0 + 0 + 0 + 0
22 + + + + + + 0 + + 0 0 + 0 + 0 + 0
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Anti-M
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1 hour incubation with
“settled” reading A1 cell
B cell
Auto Control
Reagent red cell
1 Hr @ 37°C
(“settled” reading)
4+ 2+ 0 2+
The patient’s prewarmed antibody
screen was negative.
B cell Auto
Control
PW 30’ @ 37 1+ 0
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After some additional
reading, I decided to do a
10 minute prewarm at
37°C then a 1 hour
incubation at 37°C with
“settled” reading.
Adsorption
Patient’s Anti-M
Adsorption
M + reagent cells
Adsorption
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Adsorption
Patient’s plasma (Anti-M) mixed
with the M+ reagent cells
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Adsorption The supernatant fluid is
removed after a centrifugation
and the process is repeated
using fresh reagent cells. The
patient’s adsorbed plasma is
then used for the reverse
typing.
A1 cell B cell IS
(adsorbed plasma)
4+ 0
Adsorption
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B cell M –
reagent cells
M + reagent
cells
10’ PW 1hr @ 37 0 0 0
B negative
Initial Testing
Anti-A Anti-B Anti-D A1 Cell B Cell
0 4+ 0 4+ 1+
Reverse Typing
(using patient’s adsorbed plasma)
A1 cell B cell
4+ 0
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WHY THE EXTRA REACTIVITY?
Anti-A Anti-B Anti-D A1 Cell B Cell
0 4+ 0 4+ 1+
A1 Cell
B Cell
Auto Control
reagent cell
15’ @4 4+ 3+ 1+ 3+ 15’
@ 37 4+ 1+ 0 2+
A1 cell
B cell
Auto Control
Reagent red cell
1 Hr @ 37°C
(“settled” reading)
4+ 2+ 0 2+
WHY THE EXTRA REACTIVITY?
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B cell M -
reagent cells
M + reagent
cells
Pre-W 1 hr @37
0 0 0
A1 cell B cell
IS (adsorbed
plasma) 4+ 0
THANK
YOU
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How is Anti-M
formed?
Clinical Significance
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