LESSON 3: ABO FORWARD/REVERSE TYPING (Manual and Gel Method)
OUTLINE ABO ANTIGEN
I. INTRODUCTION
A. ABO Antigen
B. ABO ANTIBODIES
II. FORWARD TYPING
A. SLIDE METHOD; B.TUBE METHOD
III. REVERSE TYPING
IV. BEDSIDE BLOOD TYPING
V. ABO FORWARD-BACKWARD AND RH-TYPING USING GEL
CARD TECHNOLOGY
A. ABO DISCREPANCIES
B. TECHNICAL ERRORS
C. RESOLVING ABO DISCREPANCIES
INTRODUCTION
− The MAJOR BLOOD GROUP SYSTEMS are the primary
focus of blood banking and transfusion therapy. This
includes the ABO system, which is the most
important of all blood groups in both transfusion and
transplant medicine.
− It is the only blood group system in which individuals
ALREADY HAVE ANTIBODIES in their serum to
antigens that are absent from their red blood cells
(RBCs) without any prior exposure to RBCs through
transfusion or pregnancy (and transplantation).
− Due to the presence of these antibodies, transfusion
of an incompatible ABO type may result in immediate
lysis of donor RBCs. Even today, transfusion of the
wrong ABO group remains a cause of death in
hemolytic transfusion reaction fatalities.
ABO ANTIBODIES
− For this reason, ABO forward and reverse typing is
necessary. Direct or forward typing is DONE FIRST,
but the result must be correlated with the
interpretation of the serum grouping to ensure that
both point to the same ABO group.
o Correlate forward with reverse (must be same)
o Ex. For Blood Type A:
 In forward: reacts in Anti-A;
 In reverse: reacts with Anti-B
− They are SALINE AGGLUTININS with OPTIMAL
− Antigens detected in blood bank testing, including
ABO antigens, are located on the surface of the red
blood cell.
o ABO is known as carbohydrates
o Chromosome 9 gene—encodes for the enzyme.
These enzymes place the carbohydrates for A
and B to the red cells. If none (no
carbohydrate)—O group.
− ABO antigens are also present on lymphocytes,
thrombocytes, organs, endothelial cells, and
epithelial cell.
o ABO is tested in transplant EXCEPT in corneal
transplant because it has low antigen
expression.
− Antigens of the ABO system are well-developed in
ADULTS. They are detectable at 5 to 6 weeks of
gestation.
− however, NEWBORNS demonstrate weaker antigens,
but ABO antigens are fully developed by two to four
years of age.
o ABO antigen or Forward is tested rather than
reverse in children less than2-4y.o.
− A person normally produce antibodies directed
against the A and/or B antigen(s) that is absent from
their erythrocytes.
− These antibodies have been described as NATURALLY
OCCURRING because they are produced without any
exposure to RBCs.
− Mostly these antibodies are IgM.
− ABO antibodies are typically ISOAGGLUTININS.
o Reacts on same species (human to human)
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REACTIVITY at 4°C.
− As previously described,
o ABO antigens are present on the surface of red
cells, (detected in forward typing)
o Antibodies are found in plasma or serum.
(detected in reverse typing)
− ROUTINE TESTING for antigens and antibodies is
performed as a forward and reverse grouping.
FORWARD TYPING (DIRECT)
− Forward typing is done using KNOWN ANTISERA to
detect ABO antigens present on the patient’s red
cells.
o Antisera has antibodies that uses manufactured
polyclonal Ab (more sensitive to Ag as it can
react with different types of epitopes) or
monoclonal Ab (specific epitope only: mostly
weak reaction)
− There are two methods through which this procedure
is performed: Slide (rapid and often used in
emergencies; also used in screening for blood
transfusion) and Tube method (more sensitive & used
more often; uses red cell suspension).
PRINCIPLE
− Red cells from the specimen are reacted with reagent
ANTISERA (anti-A and anti-B). AGGLUTINATION OF
RED CELLS indicates presence of corresponding
antigen (agglutinogen) on red cells.
SPECIMEN :
− Capillary blood from finger prick (often for
emergency cases), or venous blood collected in EDTA
anticoagulant.
− The reagent MANUFACTURER’S PACKAGE INSERT
must be consulted to determine specific specimen
requirements.
1
 LESSON 3: ABO FORWARD/REVERSE TYPING (MANUAL AND GEL METHOD)

o Generally, CLOTTED OR ANTICOAGULATED
BLOOD SAMPLES may be used for ABO testing
(in reverse).
o The RED CELLS may be suspended in
autologous serum, plasma, or saline, or they
may be washed and resuspended in saline.
1. A clean and dry glass slide is divided into two 5. By tilting the slide backwards and forwards (in
sections with a glass marking pencil. The sections rotating motion) examine for agglutination after
are labeled as anti-A, anti-B, and Anti-D to identify exactly two minutes.
the antisera (see Figure 1)

REAGENT :
 Anti-A= Blue (Asul)
 Anti B= Yellow (Banana) 6. Result:
 Anti-D= Clear1 POSITIVE (+): Little clumps of red cells are seen
floating in a clear liquid.
A. SLIDE METHOD NEGATIVE (–): Red cells are floating
2. Using Pasteur pipette/ Applicator stick, place one
− Slide test is quick and needs only simple equipment. homogeneously in a uniform suspension.
drop of the WHOLE BLOOD into the Sections that
− It can be used in blood donation camps and in case of are labeled. (see Figure 1)
an emergency.
− However, it is NOT RECOMMENDED as a routine test
in blood banks since weakly reactive antigens on cells
on forward grouping and low titer anti-A and anti-B
on reverse grouping may be MISSED.

MATERIALS
 Glass slide  Gum label Table 1: Grading of Reaction
 Applicator sticks  Marking pen 3. Place one drop of anti-A serum, one drop of anti-B Record Description of Reaction
 Pasteur pipette  70% Alcohol serum, and one drop of Anti-D in the center of the Macroscopic Readings**
 Cotton  EDTA corresponding section of the slide. (At least 1 is to +4 One solid agglutinate;
 PPE  Syringe (23 or 21 G) 1 ratio). background is clear.
 Blood lancet +3 Several large agglutinates;
background is clear
PROCEDURE +2 Medium sized agglutinates;
background is clear
1 Many small agglutinates;
background is turbid
Microscopic Readings***
4. Mix antiserum and blood by using a separate stick W Barely visible agglutination;
or a separate corner of a slide for each section over turbid background
Figure 1. Slide labelled with Anti-A, Anti-B and Anti-D an area about 1 inch in diameter. (See Figure 2) NEG No agglutination or hemolysis of red cells.
Cells float freely

EXAMPLE (picture):
 Agglutination 4+;
 Yellow= Blood Type B

Figure 2: Mixed slide with blood and Anti-Sera Note:

Ideally, the reaction must be 4+ or 3+
Negative is confirmed under microscope.

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 LESSON 3: ABO FORWARD/REVERSE TYPING (MANUAL AND GEL METHOD)
B. TUBE METHOD
PRINCIPLE:
− Because of the dire clinical consequences associated
with ABO incompatibilities, ABO typing and ABO
compatibility testing remain the foundation of
pretransfusion testing and an important component
of typing before transplantation.
SPECIMEN:
− Capillary blood from finger prick, or venous blood
collected in EDTA anticoagulant.
− The REAGENT MANUFACTURER’S PACKAGE insert
must be consulted to determine specific specimen
requirements.
o Generally, clotted or anticoagulated blood
samples may be used for ABO testing.
o The red cells may be suspended in autologous
serum, plasma, or saline, or they may be
washed and resuspended in saline.
REAGENT:
 Anti-A= Blue
 Anti B= Yellow
 Anti-D= Clear
 Patients Red cell suspension
PROCEDURE
1. Prepare a 3% suspension of patient’s red cells.
(Includes RC washing)
2. Label three small test tubes with the patient’s name
and identification number and the step 3.
3. Each of these tubes should then be labeled as
follows:
o First tube: “Anti-A”
o Second tube: “Anti-B”
o Third tube: “Anti-D”
 NOTE: Labeling should be done with
care since CLERICAL ERRORS are the
most frequent errors in the blood
bank.
8. Remove each tube and EXAMINE FOR HEMOLYSIS.
o Usually, after centrifuge, “tinataktak ‘yung
bottom” to disturb the cell. If it is true
agglutination: “kahit anong taktak, hindi
mawawala ‘yung aggltsn”
9. Using an AGGLUTINATION VIEWER, gently
resuspend each cell button, and examine for
agglutination.
10. Grade each reaction and record the results.
4. To each of these tubes, add one drop of the
corresponding antisera.
 NOTE: Use a free floating drop. Do
not touch the dropper to the side of
the tube. Always add antisera
BEFORE cells.
5. Using a transfer pipet, add one drop of the well-
mixed 3% cell suspension to each of these three
tubes.
 NOTE: Use a free floating drop. Do
not touch the pipet to the side of the
tube.
6. Gently mix all tubes.
7. SEROFUGE all three test tubes for 15 seconds.
Figure 3.
On the left side, tube with anti A and a drop of 3% red
cell suspension
On the right, tube with anti B and a drop of 3% red cell
suspension.
NOTE: One more tube will be needed for Anti-D.
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(From Cluster 2’s Trans—R.V.Laurezo)
 Test card is already embedded with anti-sera.
PROCEDURE
INTERPRETATION OF RESULT:
1. Agglutination of tested red cells and either hemolysis
or agglutination in tests with serum or plasma
constitute POSITIVE TEST RESULTS.
2. A smooth cell suspension after resuspension of the cell
button is a NEGATIVE TEST RESULT. (Follow the
grading in table 1)
3. Interpretation of serum or plasma and red cell tests
for ABO is given in the table 5.
4. Any discrepancy between the results of the tests with
serum or plasma and red cells should be resolved
before an interpretation is recorded for the patient’s
or donor’s ABO group.
5. Mixed-field agglutination should be investigated for
possible cause. (Mix of agglutinated and
unagglutinated; often in gel method)
NOTE:
 All reagents must be used in accordance with the
manufacturer’s instructions.
 POSITIVE REACTIONS characteristically show 3+ to
4+ agglutination by reagent ABO antibodies;
reactions between test serum and reagent red cells
are often weaker.
 The serum tests may be incubated at room
temperature for 5 to 15 minutes to enhance weak
reactions (used in weak rx on reverse typing).
LESSON 3: ABO FORWARD/REVERSE TYPING (MANUAL AND GEL METHOD)
BEDSIDE BLOOD TYPING
Step 1. Place one drop of isotonic saline solution (NSS)
on each reaction field and auto-control field.
Step 2. Add one drop of the recipient’s blood to each
field in the upper panel of the card and one drop of
donor blood to each field in the lower panel of the card.
Step 3. Stir each field with an applicator stick for
approx. 30 seconds. The reagents must dissolve
completely.
Step 4. Gently rock the card back and forth for approx.
30 to 60 seconds, then check each field for
agglutination.
Step 5. Dry the reaction mixtures and cover with self-
adhesive film before filling the card.
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REVERSE TYPING (INDIRECT)
− Reverse blood grouping is a procedure another way
confirm ABO blood group based on the presence or
absence of anti-A and anti-B in serum using known A
and B red cells. (Usually, known A1 and B cells: can be
manufactured/ manually made in laboratory)
− It is CROSS CHECK for forward typing.
− Performing both forward and reverse grouping
provides a check for accuracy.
− Because of the LACK OF SYNTHESIZED
IMMUNOGLOBULINS, anti-A and Anti-B in newborns
and very young infants, this procedure is NOT
PERFORMED on infants below 4 months of age.
− Reverse grouping is synonymous with backward
typing, indirect typing and serum typing.
PRINCIPLE:
− Because of the dire clinical consequences associated
with ABO incompatibilities, ABO typing and ABO
compatibility testing remain the foundation of
pretransfusion testing and an important component
of typing before transplantation.
SPECIMEN:
− Patients plasma/serum from EDTA tube or red top.
− The REAGENT MANUFACTURER’S PACKAGE INSERT
must be consulted to determine specific specimen
requirements.
o Generally, clotted or anticoagulated blood
samples may be used for ABO testing.
o The RED CELLS may be suspended in
autologous serum, plasma, or saline, or they
may be washed and resuspended in saline.
REAGENT:
− Unkown Sera/serum of patient
− Known A and B (2-5% Red Cell Suspension)
− Normal Saline Solution (0.85-0.95%)
PROCEDURE
1. Prepare 3% Red cell suspension of A and B cells
(After 3 washing)
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 LESSON 3: ABO FORWARD/REVERSE TYPING (MANUAL AND GEL METHOD)

Table 5. Routine ABO Grouping

Reaction Reaction of Interpre Prevalence
of Red Serum with - tation (%) in US
Cells Reagent Population
with Red Cells
Antisera (Serum
(Red Cell Grouping)
Grouping)

2. Label 2 Wasserman test tubes as A and B (see figure

ABO Groups

European
Ethnicity

Ethnicity
A1 Cells

O Cells
B Cells
Anti-A

Anti-B

African
3)
3. Follow the table below.

Table 3. Guide in the interpretation of Backward Blood o o + + o O 45 49

Groupings
+ o o + o A 40 27
Patients Known 3% Red Known 3% Red cell
serum type cell suspension suspension of B o + + o o B 11 20
of A cells cells + + o o o AB 4 4
A o + o o + + + Bombay Rare Rare
B + o
AB o o  No reaction with O cells since they do not produce
O + + anti-H; all has H precursor (O has the greatest H);
Table 2
Type A has H cells, “natatbunan lang ng A
CONTENT TUBE 1 (A) TUBE 2 (B) cells”but can still be detected
Unkown serum/ serum 2 drops 2 drops Table 4. Reverse Typing Interpretation  BOMBAY: has no A, B and H antigen—sometimes
of patient Blood INTERPRETATION is masks as O cells (False O cells); but since it has
Known 3% Red cell 1 drop - type no/ weak H antigen: it produces Anti-H causing
Suspension of A cells A Agglutination in B cells with no agglutination reaction with O cells that is filled with H antigen.
Known 3% Red cell - 1 drop in A cells demonstrate that the serum do (Simply, it produces antibodies against O cells)
Suspension of B cells have antibodies for B cells, thus indication
that the individual is Blood type A.
B Agglutination in A cells with no agglutination
4.Cover the tubes with Nescofilm. in B cells demonstrate that the serum do ABO FORWARD-BACKWARD AND RH-TYPING USING
5.Mix gently and centrifuge all the tubes for 15 have antibodies for A cells, thus indication GEL CARD TECHNOLOGY
seconds at 3,400 rpm that the individual is Blood type B. − The GEL TECHNOLOGY METHOD was developed by
6. Gently dislodge the cell bottom and examine for AB Agglutination is not present in both A and B DR. YVES LAPIERRE in 1985.
hemolysis or agglutination. cells, demonstrate that the serum do not − This technology uses DEXTRAN ACRYLAMIDE GEL
have antibodies for either A or B cells, thus particles to trap agglutinated red cells. This method
indicating that the individual is Blood type was developed to standardized traditional tube
AB. testing methods.
O Agglutination is present in both A and B cells, − Because of this new technology, it was found that the
demonstrate that the serum do have gel particles are IDEAL MATERIAL FOR TRAPPING THE
antibodies for both A and B cells, thus AGGLUTINATE.
indicating that the individual is Blood Type
O. − Compared with the traditional tube testing, the GEL
TEST provides a more stable and well defined
endpoints of the agglutination reaction.

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 LESSON 3: ABO FORWARD/REVERSE TYPING (MANUAL AND GEL METHOD)

− It can be used to PERFORM DIFFERENT TESTS such as: PROCEDURES Figure 2: Sample grade reaction
o ABO forward and reverse grouping, A. PREPARATION OF RED CELL SUSPENSION Negative 0  Well-defined pellet of non-
o Rh typing, agglutinated red blood cells at
1. Prepare tube containing 0.1 ml washed packed RBC
o Direct antiglobulin test, the bottom of the gel column and
and 4.9 mL NSS. This will produce a 2% RED CELL
o antibody screening,
SUSPENSION  no visible agglutinated cells in the
o identificaton of antibodies, and rest of gel column.
2.Transfer 2.5 mL of 2% red cell suspension to a separate
o compatability testing.  Barely visible small-sized clumps
tube containing 2.5 mL NSS. This dilution will produce
1% RED CELL SUSPENSION. w+ of agglutinated cells in the lower
− For FORWARD ABO BLOOD GROUPINGS, card has part of the gel column and
3. Set this cell suspension aside.
gels that contain anti-A and anti-B and Anti-AB.  a pellet of unagglutinated cells at
− MICROTUBES WITH BUFFERED GEL are used for ABO the bottom.
B. ABO FORWARD AND RH TYPING USING THE GEL
reverse grouping. 1+  Some small-sized clumps of
− The Rh typing card contain anti-D, anti-C, anti-E, anti- CARD
agglutinated cells most
c, anti-e and a control. (reactions in the gel method 1. Flip the cover foil
frequently in the lower half of the
are graded from +1 to +4, including mixed filled) 2. Dispense 50 uL of 1% red cell suspension using an
gel column.
− automatic pipettor on each well labeled A, B, and D
 A small pellet may also be
of the gel card. Avoid hitting the gel as you deliver the Positive observed at the bottom of the gel
red cells.
column.
3. Cover the well with the foil again. You may secure the
2+  Small or medium-sized clumps of
cover using a Nescofilm.
4. Centrifuge for 15 seconds at 3,400 rpm using a specially agglutinated cells throughout the
gel column.
designed gel card centrifuge.
5. Observe and interpret the results  A few unagglutinated cells may
be visible at the bottom of the gel
column.
C. ABO BACKWARD TYPING USING THE GEL CARD
3+  Medium-sized clumps of
1. Flip the cover foil agglutinated cells in the upper
2. Dispense 50 uL of the unknown plasma sample using half of the gel column.
an automatic pipettor on each well labeled CTL, A1, 4+  A well-defined band of
and B of the gel card. Avoid hitting the gel as you
agglutinated red blood cells in
deliver you your sample.
the top part gel column.
3. Cover the well with the foil again. You may secure the
MATERIALS/EQUIPMENT  A few agglutinated cells may be
cover using a Nescofilm.
 Commercially available gel  Gum label (optional) visible below the band.
4. Centrifuge for 15 seconds at 3,400 rpm using a specially
card for ABO forward and  Nescofilm  Mixed-field. A band of red blood
designed gel card centrifuge.
backward typing  Marking pen 5. Observe and interpret the result. cells at the top part of the gel or
 mf dispersed throughout the gel
Gloves  Test tube rack
 column, and
Centrifuge  Automatic pipette
  a pellet in the gel bottom as a
Wasserman test tubes  Micropipettor
NEGATIVE RESULT.
 Hemolysis in the microtube with
REAGENT/ SAMPLES
the very few or no red blood cells
− Normal saline solution in a wash bottle (85%-95%)
H in the gel column.
− ANTICOAGULATED BLOOD from a patient: Centrifuge
 Report if hemolysis is present in
for 5 minutes at 3,400 rpm to separate the plasma:
the microtube but not in the
a. Wash the packed red blood cells
sample.
b. Set aside the plasma

EDLET CHRISTINE S. DIONISIO | BSMT 3B-3-1 6

 LESSON 3: ABO FORWARD/REVERSE TYPING (MANUAL AND GEL METHOD)

 transplantation, DISCREPANCY GROUPS

 Acquired B antigen, (weak rx with GROUP 1: Ab: Weak Ab, Missing Ab
Anti-B in forward typing; this is GROUP 2: Ag: Weak Ag, Missing Ag
only acquired as they are usually GROUP 3: Plasma proteins: Rouleaux formation
Type A) Miscellaneous: Mixed
 B (A) Phenomenon,
 Out of group transfusion. Note:
Mixed-filled  Recent Transfusion,  Discrepancy usually has weak reaction
cell reactivity  Transplantation, (can be  Always check the history of patient
transplant of hematopoietic cell or  **Ex. In ABO subgroup: A reaction with forward
bone marrow that may produce Anti-A, and 1+ rx in A1 cell in reverse: Usually, it is A2
different cell) subgroup because it has few Anti-A1 Ab.
ABO DISCREPANCIES  Fetomaternal Hemorrhage,
− When a discrepancy is encountered, the DISCREPANT  Twin or dispermic/chimerism EXAMPLE: Evaluate then Solution
RESULTS must be recorded, but interpretation of the o Chimerism: (there may be
ABO group must be delayed until the discrepancy has mixing of cells between
been resolved. the twin who are alive and  Observe for the weak rx
− If the SPECIMEN IS FROM A DONOR UNIT, the unit deceased: creating 2  Evaluate:
must be quarantined and cannot be released for populations of cells; or o Anti-A: 4+ (Type A); Anti-B: 1+ (weak rx)
transfusion. there may be an exchange o Anti-A,B: 4+ ✔ (strong rx since it has rx with
− When an ABO discrepancy is identified in a patient, of red cells between the Anti-A)
it may be necessary to transfuse group O red cells twins, and antibodies are
pending an investigation. It is important to obtain a o A1 cells: 0 ✔ (No rx since it has no Ab against
not being produced) A)
sufficient pretransfusion blood sample from the o Dispermic- an egg cell is
patient to complete any additional studies that may o Anti-B: 4+ ✔ (Has Ab against B cells)
fertilized by 2 sperm (very
be required.  Observation:
rare)
o Anti-A Individual with few amount of
Weak/Missing  Group 1 discrepancy
Red Cell Testing Problems and Problems with Serum Antigen B. This may be ACQUIRED B
Serum  Age related (less than 4 to 6
or Plasma Testing o Check px medical history
reactivty months old, elderly),
Category Causes  Solution:
 ABO subgroup**, o You may mix the px cell and serum= If it has
Weak/  ABO Subgroup,  Hypogammaglobulinemia,
Missing Red  Leukemia, no rx: Confirmed A cellls (since A cells must
(decreased IgG) not react on its own plasma)
cell Activity  transfusion,  transplantation o Then, to confirm Anti-B, use polyclonal
 intrauterine transfusion, Extra serum  Cold autoantibody, antisera= If it has no rx: ABO discrepancy:
 transplantation, reactivity  cold alloantibody, (previous Possibly it is Acquired B
 excessive soluble blood group exposure, transfusion,
substance (usually in underlying transplantation, pregnancy)
pathological conditions; found  serum antibody to reagent
excessively in plasma; it may mask constituent,
the red cell or it may interfere  Excess serum proteins, (may be
with antisera causing weak rx) due to improperly washed red cell)
Extra red cell  Autoagglutinins/excess protein  transfusion of plasma proteins,
reactivity coating red cells, transplantation,
 Unwashed red cells (plasma  Infusion of intravenous immune
proteins), globulins
 antibodies to patient’s serum to
reagent constituent,

EDLET CHRISTINE S. DIONISIO | BSMT 3B-3-1 7

 LESSON 3: ABO FORWARD/REVERSE TYPING (MANUAL AND GEL METHOD)

TECHNICAL ERRORS REFERENCES

Technical problems with a sample or during testing can also
lead to problems in ABO grouping, including:
1. Specimen mix up.
2. Too heavy or too light red cell suspensions.
3. Failure to add reagents.
4. Missed observation of hemolysis.
5. Failure to follow the manufacturer’s
instructions.
6. Under- or overcentrifugation of tests.
7. Incorrect interpretation or recording of test
results.
Notes from the discussion of Ms. Janielle M. Fajardo, RMT,
MLS (ACSPi)
Cavite State University Immunohematology Laboratory
handouts: Lesson 3
 -Cardona, C.C, Martin , G.L, and Garcia- Meim, R. (2016)
Laboratory Manual in Blood Banking 2nd Edition
 Kung M. K., Grossman B.,J, Hilyer, C.D., Westhoff (2014)
Technical Manual 18th Edition
 Whitlock, S. A., Immunohematology for Medical
Laboratory Technicians 2010

RESOLVING ABO DISCREPANCIES

1. Repeat the test with the same sample
2. Incubating red cells at 4°C, (if the weak rx is for
Ab) using enzyme-treated red cells, and
conducting adsorption and elution studies.
3. RETESTED using different monoclonal and
human polyclonal reagents. (In forward)
4. To resolve an ABO discrepancy caused by an
anti-A1 in a group A individual, red cells should
be tested with DOLICHOS BIFLORUS LECTIN,
which agglutinates group A1 but not A2 and
weaker A subgroups.
 Reaction occurs: A1 group
 No reaction: A2 group
5. Testing at 37°C without centrifugation and
cold autoadsorption
6. Saline replacement or saline dilution can be
used to distinguish rouleaux from
agglutination and identify ABO antibodies.
 Group 3 Discrepancy; true
agglutination: even after washing,
aggltn remains
 Rouleaux: after NSS, “nawawala ‘yung
false aggltn”
7. AUTOAGGLUTINATION caused by IgM can
also be inhibited or dispersed by incubating
red cells in the presence of either
DITHIOTHREITOL or 2-
AMINOETHYLISOTHIOURONIUM BROMIDE

EDLET CHRISTINE S. DIONISIO | BSMT 3B-3-1 8