Ricafort, Sean Christopher R.

Blood
Bank
MMLS 3-2

ABO Discrepancies
Group I Discrepancies
- This group of discrepancies are associated with unexpected reaction in reverse typing due
to weak or missing antibody reaction. One of the reasons for the missing or weak
isoagglutinins is that the patient has depressed antibody production or cannot produce the
ABO antibodies.
Common individuals involved in this discrepancy group includes:
 Newborns
 Elderly patients
 Patients with leukemia or lymphoma
 Patients using immunosuppressive drugs
 Patients with congenital or acquired agammaglobulinemia or immunodeficiency disease
 Patients undergone bone marrow or hematopoietic progenitor stem cell (HPC) transplant
 ABO subgroups
Resolution of Common Group I Discrepancies
- Obtaining patient clinical history may immediately resolve this type of discrepancy.
The best way to resolve this discrepancy is to enhance the weak antibody by incubating
the patient serum with reagent A1 and B cells at room temperature for 15 to 30 mins.
If there is still no reaction after centrifugation, the serum-cell mixtures can be incubated
at 4°C for 15 minutes.
Group II Discrepancies
- This group of discrepancies are associated with unexpected reaction in the forward
grouping due to weak or missing antigen. The following are some causes of
discrepancies in this group:
 Subgroups of A (or B) may be present
 Leukemias may yield weakened A or B antigens and Hodgkin’s disease has been
reported in some cases to mimic the depression of antigens found in leukemia.
 Having “Acquired B” phenomenon
Resolution of Common Group II Discrepancies
- The weak antigen with reagent antisera can be enhanced by incubating the test mixture
at room temperature for up to 30 minutes, which will increase the association of the
 antibody with the RBC antigen. If it is still negative, incubate the text mixture at 4°C for
15 to 30 minutes. Include group O and autologous cells as controls. RBCs can also be
retreated with enzymes and retested with reagent antisera.
Group III Discrepancies
- This group of discrepancies occurs between forward and reverse groupings which is
caused by protein or plasma abnormalities and results in rouleaux formation or
pseudoagglutination, attributable to the following:
 Elevated levels of globulin from certain disease states, such as multiple myeloma,
Waldenström’s macroglobulinemia, other plasma cell dyscrasias, and 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
Resolution of Common Group III Discrepancies
- Rouleaux is a stacking of erythrocytes that adhere in a coin- like fashion, giving the
appearance of agglutination. It can be observed on microscopic examination. Cell
grouping can usually be accomplished by washing the patient’s RBCs several times
with saline. Performing a saline replacement technique will free the cells in the case of
rouleaux formation in the reverse type. In this procedure, serum is removed and replaced
by an equal volume of saline. In true agglutination, RBC clumping will still remain after
the addition of saline.
Group IV Discrepancies
- This group of discrepancies are associated between forward and reverse groupings due to
miscellaneous problems that have the following causes:
 Cold reactive autoantibodies 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/stem cell transplant
 Unexpected ABO isoagglutinins
 Unexpected non-ABO alloantibodies
Resolution of Common Group III Discrepancies
- Potent cold autoantibodies can cause spontaneous agglutination of the patient’s cells.
These cells often yield a positive direct Coombs’ or antiglobulin test. To resolve this
discrepancy, the patient’s RBCs could be incubated at 37°C for a short period, then
washed with saline at 37°C three times and retyped. If this is not successful in
resolving the forward type, the patient’s RBCs can be treated with 0.01 M
dithiothreitol (DTT) to disperse IgM-related agglutination. As for the serum, the
reagent RBCs and serum can be warmed to 37°C, then mixed, tested, and read at 37°C.
The test can be converted to the antihuman globulin phase if necessary.