University of the Immaculate Conception

Medical Technology/ Medical Laboratory Science

Clinical Internship Program
Fr. Selga St., Davao City 8000, Philippines
|Tel nos. 221-8090 (local 118)| Fax .: (63-082) 226-2676|

CLINICAL CASE REPORT

Lanang Premiere Doctors Hospital, Inc.
Immunology-Serology / Blood Banking Section

October 31 – December 1, 2022

Acquired B in a 48-year-old Male with Gastrointestinal

Obstruction

A Clinical Case Report Presented to the

ISBB Clinical Instructors of the College of Medical and Biological Sciences

In Partial Fulfillment of the Internship Training for the

Degree of Bachelor in Medical Laboratory Science

Presented by: Stephanie Kate G. Arriola

Clinical Instructor: Mark Gabriel G. Sollano, RMT

 University of the Immaculate Conception
Medical Technology/ Medical Laboratory Science
Clinical Internship Program
Fr. Selga St., Davao City 8000, Philippines
|Tel nos. 221-8090 (local 118)| Fax .: (63-082) 226-2676|

I. Title: “Acquired B in a 48-year-old Male with Gastrointestinal Obstruction"

II. Author: Stephanie Kate G. Arriola

III. Definition of Keywords:

a) Antibody Screen – screening test to detect the presence of alloantibodies or
autoantibodies present.
b) Acquired B antigens – an uncommon ABO discrepancy that occurs when red
blood cells from blood group A patients come in contact with certain gram-negative
bacteria.
c) Escherichia coli – have a deacetylating enzyme that affects A sugar by converting
N-acetyl-D-galactosamine into D-galactosamine
d) Acetic anhydride – re-acetylates the A and diminishes the strength of acquired
B.
e) Secretors – people who can produce glycoproteins (H antigen) in their body fluids.
This antigen can be converted to A and/or B if the person carries A and/or B genes.

IV. PATIENT INFORMATION:

Patient ID Number:

01-24-59

Age and Sex:

48/M

Attending Physician:

Dr. Erliza Beldua

 University of the Immaculate Conception
Medical Technology/ Medical Laboratory Science
Clinical Internship Program
Fr. Selga St., Davao City 8000, Philippines
|Tel nos. 221-8090 (local 118)| Fax .: (63-082) 226-2676|

Clinical Impression:

a) Crampy abdominal pain c) Constipation

b) Distension d) Vomiting
Physical Examination:

a) Tachycardia c) Dry mucus membranes

b) Tympanic or hyper-resonant d) Orthostatic hypotension
abdomen e) High-grade fever

Lab Test/s Requested:

a) CBC
b) BUN
c) Creatinine
d) ABG
e) Abdominal Xray

V. PATIENT TEST RESULTS – LATEST

Blood Typing:
Anti-A Anti-B Anti-D A1 B cells D control
cells
Billy 4+ 1+ 3+ 4+ 3+

Antibody Screening:

IS 37 AHG CC IS 37 AHG CC IS 37 AHG CC IS 37 AHG CC

Billy 0 0 0 4+ 0 0 0 3+ 0 0 0 3+ 0 0 0 4+
 University of the Immaculate Conception
Medical Technology/ Medical Laboratory Science
Clinical Internship Program
Fr. Selga St., Davao City 8000, Philippines
|Tel nos. 221-8090 (local 118)| Fax .: (63-082) 226-2676|

CBC Test
Test Results Reference Range Interpretation
WBC 12.1 5-10 x 10^9/L High
Segmenters 0.76 0.55-0.65 High
Lymphocyte 0.15 0.25-0.35 Low
Monocyte 0/08 0.03-0.06 High
Eosinophil 0.01 0.02-0.04 Low
Hemoglobin 96 140-170.9/L Low
Hematocrit 0.29 0.40-0.50 (volume) Low
Platelet 291 150-350 x 10^9/L Normal

Chemistry test:
Test Result Reference range Interpretation
Creatinine 0.8 mg/dL 0.7-1.2 Normal
Sodium 137 mmol/L 137-145 Normal
Potassium 3.4 mmol/L 3.5-5.0 Low
Amylase 37uL 30-110 Normal

VI. PATIENT’S TEST RESULTS – PREVIOUS

Not Available

VII. DISEASE PATHOPHYSIOLOGY:

Intestinal obstruction is when a blockage occurs without vascular compromise. Ingested

fluid and food, digestive secretions, and gas accumulate above the obstruction. There will be
distension in the proximal bowel and the distal segment will collapse. The normal secretory and
absorptive functions of the mucosa are now depressed and the bowel wall will become edematous
and congested. With this, the Escherichia coli found in the colon will now have its way ongoing
into the bloodstream. This bacterium has enzymes known as deacetylases. This enzyme will
remove the acetyl group from the residue that gives A antigen its specificity, N-
acetylgalactosamine. This modification leaves the A-specific sugar as galactosamine. As a result,
certain monoclonal anti-B reagents used in blood typing will weakly agglutinate the Group A RBCs
carrying the acquired B antigen. This means that the patient has a weakly positive reaction with
anti-B in red cell grouping tests instead of the expected negative.
 University of the Immaculate Conception
Medical Technology/ Medical Laboratory Science
Clinical Internship Program
Fr. Selga St., Davao City 8000, Philippines
|Tel nos. 221-8090 (local 118)| Fax .: (63-082) 226-2676|

VIII. PATIENT RESULT VALIDATION:

PRE-ANALYTICAL AREA

Before performing blood typing, check the patient’s tube and the request form if it
matches. Check the Known A and Known B reagents for their expiration to avoid
erroneous results. Follow the proper usage of PPE to ensure that the MTOD has
protection against the possible disease the sample is carrying. Prepare all the materials
needed for the procedure.

ANALYTICAL AREA

Perform the blood typing using the tube method. Make sure to wash the packed
RBCs three times using the NSS. Follow the proper portion of washed RBCs and LISS
to have the ideal red cell suspension which will be used in forward typing. Do not forget
to mix well the Known A and Known B reagents before use. Follow the right time when
using a centrifuge. Avoid reusing micropipette tips to also avoid decontamination.

POST-ANALYTICAL AREA

Before releasing the result, let the procedure be validated by another MTOD. Print the
result and log the information twice in different record books. Also, let the MTOD who
validated the procedure sign both record books for record keeping. Deliver it to the nurse
station using the pneumatic tube. Keep the washed RBCs, the patient’s sample, and the
RCS inside the refrigerator for seven days. Other tubes used are now placed on a
container with water and bleach.

IX. PATIENT RESULT CORRELATION

TEST RESULT REFERENCE CORRELATION

RANGE
Blood AB “Positive" N/A The patient should be A positive,
Typing however, since there is the
presence of acquired B, the result
became AB positive because
there is an agglutination observed
in Anti-A and Anti-B during
forward typing.
 University of the Immaculate Conception
Medical Technology/ Medical Laboratory Science
Clinical Internship Program
Fr. Selga St., Davao City 8000, Philippines
|Tel nos. 221-8090 (local 118)| Fax .: (63-082) 226-2676|

CBC White blood cells are the body’s

defense mechanism against
infective organisms and foreign
substances. In this result, we can
conclude that there is an elevated
number of WBC which indicates
that there is an infection or
immunosuppression happening
inside the body.
Chemistry The result shows that there is a
Test decreased slightly potassium.
This is maybe due to the patient’s
vomiting or dehydration.

X-Ray Shows a N/A This is one of the common

distended large indicators that a patient is
bowel suffering from the bowel
obstruction
 University of the Immaculate Conception
Medical Technology/ Medical Laboratory Science
Clinical Internship Program
Fr. Selga St., Davao City 8000, Philippines
|Tel nos. 221-8090 (local 118)| Fax .: (63-082) 226-2676|

X. REFERENCES

1. Békássy, Toledo, Leoj, Kristofferson, Leopold, Perez, & Karpman. (2011).

Intestinal damage in enterohemorrhagic Escherichia coli infection. Pediatr
Nephrol, 26(11), 2059-2071. doi:10.1007/s00467-010-1616-9.
2. Sanchez, L. (2018). Disorders of the Gastrointestinal System. Equine Internal
Medicine., 709-842. doi:10.1016/B978-0-323-44329-6.00012-7
3. Chaffin, J. (2014). Acquired B phenotype.
https://labmedicineblog.com/2014/09/12/acquired-b-phenotype/