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The page below is a sample from the LabCE course ABO Typing Discrepancies. Access the complete course and earn ASCLS P.A.C.E.-approved continuing education credits by subscribing online.

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Example: Unexpected Reaction in Forward Typing

Forward (Cell) Grouping
Reverse (Serum) Grouping
Anti-A
Anti-B
Anti-A,B
A1 Cells
B Cells
4+
2+
4+
0
4+
Most probable ABO type: Group A
Possible Causes: A(B) phenotype, patient cells coated with IgG, acquired B antigen.
Some strategies for resolution: Review patient history. Retype with monoclonal reagents made from another clone or human polyclonal reagents if available; perform an antibody screen to detect autoantibody; perform a direct antiglobulin test (DAT); or wash patient cells and retest.
Testing patient plasma with patient red blood cells
Patients who are truly group A, without any true B antigen, will demonstrate a negative auto control. Since there is no B antigen present on the patient's red cell and there is anti-B in patient plasma, no agglutination should form.

Patient Red CellPatient PlasmaResulting Reaction
A antigen (No B antigen) Anti-B Negative