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Abo/Rh Discrepancy

In: Science

Submitted By kgohel
Words 374
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A 37 year old woman was visiting her OB/gynecologist for her 8 weeks prenatal care and during this visit physician ordered prenatal tests that included CBC with differential, Hepatitis B surface antigen, RPR, HIV screening, Rubella titers, ABO Rh type and antibody screening. The CBC and rest of the immunology test were normal. The antibody screening performed on Echo (solid phase) was negative. Immucor Echo (blood bank automated instrument) was not able to determine the ABO type. The following results were obtained from Echo.

|Mono control |Anti-A |Anti-B |Anti-D |Anti-D |A1 cell |B cell |
| | | |Series 4 |Series 5 | | |
|0 |4+ |4+ |3+ |2+ |2+ |2+ |

After looking at initial results from the instrument, technologist repeats the ABO/Rh typing using the tube method. The following results were obtained at immediate spin.

|Anti-A |Anti-B |Anti-D |Mono Control |A1 Cell |B Cell |
| | |Series 4 |(D control) | | |
|4+ |4+ |4+ |0 |2+ |2+ |

An experienced blood bank technologist wanted to rule-out rouleaux, so she performed saline replacement technique. The saline replacement did not correct the discrepancy and the reactions in reverse typing were still present. These findings led the technologist to suspect the cold reacting antibody. She decided to repeat the antibody screening with all three phases and following results were obtained.

| |IS |37 C |AHG |CC |
|SC I |2+ |1+ |0 |2+ |
|SC II |2+ |1+ |0 |2+ |

The technologist called physicians office to obtain patients transfusion history along with number of pregnancies. The patient had never received any blood product and this was her first pregnancy. Technologist performed antibody panel and discovered that strong positive agglutination was seen at immediate spin for some of the cells. These reactions were fading out at 37C and eventually were negative at coombs phase. After completing the antibody panel and ruling out process, technologist ruled in Anti-M reacting at strongly at immediate spin. Anti-M occurs naturally and is considered clinically insignificant when it is reacting at room temperature. The A1 and B cells were positive for M antigen when phenotyped. Technologist had new lot of A1 and B cells that were M negative, in which the ABO/Rh type was confirmed and reported out as AB positive.…...

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