ABO TYPING

DISCREPANCIES
RENE JESUS ALFREDO R.
DINGLASAN, RMT
ABO DISCREPANCIES
• Occur when unexpected reactions occur in
the forward and reverse grouping
• When a discrepancy is encountered,
results must be recorded BUT
interpretation of the ABO type must be
delayed until the discrepancy is resolved.
• In emergency cases, it may be necessary
to administer Type O, Rh-compatible
RBCs before the discrepancy is resolved.
(What if there are no Rh-compatible
units?)
• Common Sources of Technical Errors
Resulting in ABO Discrepancies:
• Inadequate identification of blood
specimens, test tubes, or slides
• Cell suspension either too heavy or
too light
• Clerical errors
• Mix-up in samples
• Missed observation of hemolysis
• Failure to add reagents
• Faliure to follow manufacturer’s
instructions
• Uncalibrated centrifuge
• Contaminated reagents
• Warming during centrifugation
CATEGORIES OF ABO
DISCREPANCIES
• GROUP I - unexpected reactions in the
reverse grouping due to weakly reacting or
missing antibodies
• GROUP II – associated with unexpected
reactions in the forward grouping due to
weakly reacting or missing antigens
• GROUP III – discrepancies between
forward and reverse grouping caused by
protein or plasma abnormalities that result
in rouleaux formation
(pseudoagglutination)
• GROUP IV – Miscellaneous problems
Group I – MOST COMMON
• Newborns
• Elderly patients
• Chronic lymphocytic leukemia
• Malignant lymphoma
• Patients using immunosuppresive drugs
• Patients with congenital agammaglobulinemia or
immunodeficiency diseases
• Patients with BM transplantations
• Dilution by plasma transfusion or plasma
exchange
• ABO subgroups
• Chimerism – presence of two cell populations in a
single individual
- reactions from chimerism are typically
MIXED-FIELD
Chimerism
• True chimerism – rarely found; occurs in
twins
• Artificial chimerism:
• Blood transfusions (e.g., type O cells
given to an A or B patient)
• Transplanted bone marrows or
peripheral blood stem cells
• Exchange transfusions
• Fetal-maternal bleeding
GRP. I RESOLUTION
• Best way: incubate patient’s serum with
A1 cells and B cells at room temp. for 15-
30 mins. then centrifuge
• No reaction still?  incubate the tube at
4 C for 15-30 mins.
• An autocontrol and an O cell control must
always be tested at the same time when
resolving Grp. I discrepancy
Group II
• associated with unexpected reactions in
the forward grouping due to weakly
reacting or missing antigens
• Subgroups of A (or B) may be present
• Leukemias
• Hodgkin’s disease
• Acquired B phenomenon – most often
associated with diseases of the
digestive tract (e.g. cancer of colon)
• BGSS – blood group-specific soluble
substances
GRP. II RESOLUTION
• Incubate the test mixture at room temp. for
up to 30 mins.
• If negative still  incubate at 4 C for 15-30
minutes
• Include O cells and AC cells as controls.
Group III
• discrepancies between forward and reverse
grouping caused by protein or plasma
abnormalities that result in rouleaux formation
(pseudoagglutination)
• Multiple myeloma
• Waldenstrom’s macroglobulinemia
• Other plasma cell dyscrasias
• Certain moderately advanced cases of
Hodgkin’s lymphomas
• Elevated levels of fibrinogen
• Plasma expanders, such as dextran and
polyvinylpyrrolidone
• Wharton’s jelly in cord blood samples
GROUP III RESOLUTIONS

• Washing the RBCs several times

with NSS
Group IV
• Miscellaneous problems
• Cold reactive antibodies in which RBCs
are so heavily coated with antibody that
they spontaneously agglutinate,
independent of the specificity of the
reagent antibody
• Patient has circulating RBCs of more
than one ABO group due to RBC
transfusion or marrow transplant
• Unexpected ABO isoagglutinins
• Unexpected non-ABO alloantibodies
Group IV RESOLUTIONS
• Patient’s RBCs could be incubated at 37 C
for a short period then washed with NSS at
37 C three times and retyped.
• If this is not successful, patient’s red cells
can be treated with 0.01 M dithiothreitol
(DTT) to disperse IgM-related
agglutination
• Turn to page
127-128 of
HARMENING,
5TH EDITION