Forward and reverse typing discrepancy and crossmatch incompatibility of ABO blood groups: cause analysis and treatment

Figures & data

Figure 1. The flowchart about blood crossmatch incompatibility test. DAT: direct antiglobulin test; IAT: indirect antiglobulin test; BCEIRRS: blood crossmatch by examining the interaction between the recipient’s RBCs and serum.

Table 1. The forward and reverse blood group typing in our study.

	Forward blood group typing			Reverse blood group typing				Blood type
	Anti-A	Anti-B	Anti-AB	Ac	Bc	Oc	Autoantibody
Serotyping weak response or no response.	0	4+	4+	0	0	0	0	B
	0	0	0	0	4+	0	0	O
	0	0	0	4+	0	0	0	O
	4+	0	4+	0	0	0	0	A
	0	4+	4+	0	0	0	0	B
	0	4+	4+	±	0	0	0	B
	0	0	0	4+	0	0	0	O
	0	4+	4+	0	0	0	0	B
	4+	0	4+	0	0	0	0	A
	4+	0	4+	0	0	0	0	A
	4+	0	4+	0	0	0	0	A
Cold agglutinin	4+	4+	4+	4+	4+	4+	4+	O
	0	4+	4+	4+	3+	3+	3+	B
	4+	0	4+	2+	3+	2+	2+	A
	0	4+	4+	3+	3+	3+	3+	B
	4+	0	4+	2+	2+	2+	2+	A
	0	4+	4+	3+	3+	3+	3+	B
MM	0	4+	4+	3+	1+	1+	1+	B
	4+	0	4+	1+	4+	1+	1+/±	A
Bone marrow transplant	0	0	0	3+	0	0	0	Positive O negative B
	0	4+	4+	0	0	0	0	Positive B negative AB
ABO subtype	1+	4+	4+	0	0	0	0	AB subtype
	4+	1+	4+	0	0	0	0	AB subtype

MM, multiple myeloma.

已将部分血型结果0修正为O.

Table 2. Cause analysis and treatment of forward and reverse blood group typing discrepancy.

Cause	Number of cases	Disease	Method
Serotyping weak response or no response.	11 (47.83%)	MM, pancytopenia, leukemia chemotherapy, tumor, etc.	Placement at 4°C for enhancing antigen-antibody reaction, absorption, and diffusion test.
Cold agglutinin	6 (26.09%)	Hemolytic anemia, acute hepatitis E, anal papilla hypertrophy, skin mass	Wash red blood cells with normal saline at 37°C, 2-ME inactivation.
M protein	2 (8.70%)	MM	Saline doubling dilution[3]
Bone marrow transplant	2 (8.70%)	Acute lymphoblastic leukemia, acute myelogenous leukemia	Learn about medical history, etc.
ABO blood group	2 (8.70%)	Atherosclerosis, acute myelogenous leukemia	Add special typing reagent, H substance test and absorption and diffusion test

Table 3. Cause analysis of 57 cases of crossmatch incompatibility.

	n	Percentage (%)
Cold autoantibody combined with warm autoantibody	23	40.35
Alloantibody combined with autoantibody	18	31.58
Alloantibody	6	10.53
Warm autoantibody	6	10.53
Cold autoantibody	3	5.26
Retuzumab combined with autoantibodies	1	1.75
Total	57	100.00

Table 4. Specificity of irregular antibodies in anti-ethmoid positive patients with cross-matched blood.

	Antibody specificity	Percentage (%)
Anti-M antibody	7	29.17
Anti-E antibody	6	25.00
Anti-c, E antibody	5	20.83
Anti-C, e antibody	2	8.33
Anti-c antibody	1	4.17
Anti-S antibody	1	4.17
Anti-M, E antibody	1	4.17
Anti-Lea antibody	1	4.17
Total	24	100

Yudin J, Heddle NM. A 13-question approach to resolving serological discrepancies in the transfusion medicine laboratory. Lab Med. 2014 Summer;45(3):193–206. doi:10.1309/LMEWVSNT2F3O5JDN

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