THE ABO AND H BLOOD GROUP • If the person who is blood type A also has a non-

A1 subtype, then they could possibly donate a

SYSTEMS
kidney to a person who is primary blood type B
(or O), depending on other factors.
WHAT IS SUBTYPE?
• WHEN SHOULD WE USE AND NOT USE
• Enzymes that add sugars to form either the type A SUBTYPING RESULTS FOR ALLOCATION?
or the type B antigens determine the blood type
• Individuals who are blood type O lack the enzyme • Subtyping results can only be used when both
to add those sugars and have an H precursor samples were obtained before any RBC
substance that gives them their O blood type. transfusions, and
• You can find blood type antigens on many cells,
including subtype testing results (both initial and
RBCs and cells inside blood vessels of all confirmatory) are clear, valid, and match each
vascular organs that are routinely transplanted otheR
• The reason these blood type antigens are
clinically important in transplantation and blood • You must not use subtype testing if you
transfusion is that question the validity or interrelation of the
individuals have naturally occurring antibodies to
blood type antigens they do not have. Those ABO subtype testing results or if pre-
antibodies transfusion specimens are not available for
are termed isoagglutinins. both initial and confirmatory subtyping
testing
ISOAGGLUTINIS
• antibodies that can react with the blood type ABO DISCREPANCY
antigens on the cells of the organ being • ABO discrepancy exists when the result of an
transplanted ABO RBC typing, or forward type, does not
• For instance, blood type O individuals have A agree with the result of the plasma typing, or
and B isoagglutinins, blood type B reverse type
individuals have A, blood type A individuals • It is extremely important in the clinical
have B, and blood type AB individuals have laboratory to record these initial discrepant
no isoagglutinins results.
• antibodies that can react with the blood type
antigens on the cells of the organ being Type of discrepancy:
transplanted - Causes of ABO discrepancy
• For instance, blood type O individuals have A - Cold-reacting autoantibodies
and B isoagglutinins, - Weak/Low avidity anti-B antibodies
blood type B individuals have A, blood type
A individuals have B, and blood type AB Total N (%)
individuals have no isoagglutinins.
Reverse blood grouping:
WHY DOES IT MATTER? - Alloantibodies(n); anti-M (5), anti-P1 (4),
• An ABO subtype (A1 vs. A, non-A1) allows anti- PP1Pk (1), anti-H (1)
organs to be allocated to additional candidates for
both deceased and living donor transplants - Weak/Low avidity anti-A, B antibodies
• A person who is primary blood type A normally
could not donate 57(43.8)
their organ to a candidate who is blood type B.















 TECHNICAL PROBLEMS 4. Review prior in-house laboratory testing

records.
• should be ruled out with a check of
reagents and equipment and repeating the 5. Contact other healthcare facilities.
testing 6. Verify reagent and equipment performance.
• failure to follow standard
operating procedure or commercial package
inserts, improper
centrifugation, improper preparation of RBC
suspensions, or lack of addition of reagents.

RED BLOOD CELL DISCREPANCY:

EXTRA RBC REACTIVITY

• discrepancy appears when unexpected or

“extra” reactivity is detected in the forward
typiny

• possible causes of an ABO discrepancy

due to extra RBC reactivity include a recent
out-of-group transfusion, stem cell
transplantation, rouleaux, an antibody
to a reagent constituent, acquired B, and cold
or warm autoantibodies

RED BLOOD CELL DISCREPANCY:

MIXED FIELD REACTIVITY

• A RBC typing result that appears to contain

RBCs from more than one ABO group is
known as a “mixed-field reaction.”

• Using a gel method, unagglutinated RBCs

appear at the bottom of the column, while
agglutinated RBCs are detected
at the top of the column.

ABO DISCREPENCY RESOLUTION:

GENERAL APPROACH

1. Repeat the test with the same sample.

2. Repeat the test with a new sample.

3. Review the patient’s medical record.