ABO Discrepancies

Self-Assessment Quiz

After completing the assignments for “ABO Discrepancies”, complete this GRADED
open book self-assessment quiz. Submit your answers on BlackBoard. This quiz must be
completed before taking Exam 3.

1. When determining the ABO group, both red blood cell and serum/plasma testing are
performed in order to:

a. Confirm RBC and serum results

b. Detect rouleaux
c. Detect weak antibodies
d. Exclude unexpected antibodies

2. If you detect an ABO discrepancy, what is the first step in its resolution?

a. Perform a clerical check and repeat testing

b. Have specimen redrawn
c. Repeat tests with a new lot number of antiserum and/or reagent RBCs
d. Repeat using donor RBCs in place of the reverse grouping cells

3. State how the following conditions would affect ABO grouping results:

a. False positive
b. False negative
c. No affect

_____ Patient with multiple myeloma

_____ Patient with septicemia

_____ Patient with Severe Combined Immunodeficiency Syndrome

_____ Patient receiving chemotherapy for the last 2 weeks

_____ Group A patient who received 20 units of Group AB plasma

_____ Patient whose specimen was drawn from above an IV

_____ Patient with autoanti-I

_____ Patient with anti-Jkb

CLS 422 Clinical Immunohematology I Page 1 of 4

ABO Discrepancies Quiz
4. Mixed field agglutination may be observed in which of the following situations?

a. A1B cells reacting with anti-A1 lectin

b. Acquired B phenomenon
c. Cold autoantibodies
d. Rouleaux

CASE ONE (Questions 5 and 6):

An 83 year old woman was brought to the Emergency Room with a broken hip. She was
immediately schedule for surgery to repair the fracture. Her physician ordered 4 units of
packed RBCs to be prepared for surgery. These are the results of her ABO/Rh:

Reagent: Anti-A Anti-B Anti-D A1 Cells B Cells

Pt results: 0 0 2+ 0 1+

A clerical check was satisfactory. Repeat testing yielded the same results.

5. The next step in resolving this discrepancy would be to:

a. Incubate the anti-A tube and the A1 cell tube at room temperature for 15 minutes.
b. Perform absorption/elution studies using the patient’s RBCs.
c. Place the anti-B and A1 cell tubes in the refrigerator (4C) for 1 hour.
d. Prewarm the patient’s plasma and reverse grouping cells.

6. If transfusion is necessary before the discrepancy can be resolved, the ABO of the
RBCs selected for transfusion should be Group ____.

a. A
b. B
c. AB
d. O

CASE TWO (Question 7):

The results of a first prenatal testing on a 28 year old woman are as follows:
Reagent: Anti-A Anti-B Anti-D BSA A1 Cells B Cells O Cells
Pt results: 3+ 4+ 3+ 0 1+ 0 0

7. What further testing is indicated for the proper workup of this patient?

a. Anti-A,B only
b. Anti-A1 lectin and A2 cells
c. Anti-A1 lectin only
d. An antibody panel

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ABO Discrepancies Quiz
CASE THREE (Questions 8 – 10):

A 40 year old man was admitted to the hospital with a ruptured appendix. After surgery,
he began to experience fever. He was given antibiotics to combat a possible infection
that may have resulted from his condition. His ABO typing revealed the following
results:

Reagent: Anti-A Anti-B Anti-D BSA A1 Cells B Cells

Pt results: 1+ 1+ 4+ 1+ 4+ 4+

8. Where is the discrepancy with these reactions?

a. The 4+ reaction with A1 and B cells

b. The 4+ reaction with anti-B
c. The 1+ reaction with anti-A, anti-B and BSA
d. The 4+ positive reaction with anti-D

Additional typing was performed, yielding the following reactions:

Anti-A1 lectin A2 cells Anti-A,B Screen cells Autocontrol

1+ 3+ 1+ 0 W+

9. What could be a likely explanation for these results?

a. Subgroup of A with anti-A1

b. Group A1 with another cell type, possibly Group B
c. Group AB with weakened antigens and cold autoantibody
d. T activated Group O RBCs

10. This type of reactivity is known as _____________.

a. Cold agglutination
b. Polyagglutination
c. Rouleaux
d. Weak subgroup reactivity

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ABO Discrepancies Quiz
CASE FOUR (Questions 11 – 13):

Three units of RBCs were ordered for a 56 year old white woman scheduled for a
thoracotomy. Results of pre-surgical compatibility testing were as follows:

Anti-A Anti-B Anti-D A1 cells B cells

3+ 0 3+ 2+ 4+

IS 37o AHG CC
Screen cell I 2+ 0 0 2+
Screen cell II 1+ 0 0 2+
Screen cell III 0 0 0 2+
Unit 1, A pos 2+ 0 0 2+
Unit 2, A pos 1+ 0 0 2+
Unit 3, A pos 0 0 0 2+

11. Where is the ABO discrepancy in the patient’s specimen?

a. Forward grouping
b. Reverse grouping
c. No discrepancy

Because the antibody screen was positive, a panel was performed. Anti-P1 was
identified.

12. T F The cause of the ABO discrepancy and positive antibody screen are
most likely the same.

13. Of the following, which additional test should be performed to resolve the ABO
discrepancy?

a. Saline replacement
b. Autoadsorption
c. Repeat reverse grouping with P1 negative RBCs
d. Incubate forward grouping at 4oC

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ABO Discrepancies Quiz