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ABO Discrepancy: Example Four

Forward (Cell) Grouping

Reverse (Serum) Grouping

Anti-A
Anti-B
Anti-A,B
A1 Cells
B Cells
4+
0
4+
2+
4+

Unexpected reactions (including rouleaux) in reverse grouping.

Most probable ABO type: Group A

Possible causes: A2 patient with an anti-A1, abnormal serum proteins resulting in rouleaux formation, a room temperature reactive alloantibody, or a cold autoantibody.

Some strategies for resolution: Perform an antibody screen; test patient cells with anti-A1 lectin; or perform saline replacement techniques.