Anomalous ABO

reactions.
Recognise unexpected or
missing reactions in cell or
serum group and describe
the possible causes.
 Cell group Serum group
ABO
group Anti-A Anti-B Anti-A,B A1 cells B cells O cells

A 4 0 4 0 4 0
B 0 4 4 4 0 0
O 0 0 0 4 4 0
AB 4 4 4 0 0 0
Anomalies due to additional or missing
antigens or antibodies.
 Cell group Serum group
ABO
group Anti-A Anti-B Anti-A,B A1 cells B cells O cells

A 3 0 4 3 4 0
B 0 4 4 4 0 2
O 0 0 0 0 0 0
AB 3 4 4 2 0 0
Additional or missing antigens or antibodies.
Transient depression of
antigens in acute leukaemia
lowering of transferase levels.
absence or reduced amounts of
original antigen in some cells.
Patients cells tested with Patients serum tested with
Anti-A Anti-B Anti-A,B A1cells Bcells Blood Group
w/mf - w/mf 0 4 A
0 0 0 0 4 A
0 w/mf w/mf 4 0 B
0 0 0 4 0 B
 Transient acquired B in
intestinal disorders
Anti-A Anti-B Anti-A,B A1cells Bcells Ocells
4 2 4 0 4 0
Some group A1 patients e.g. with intestinal
obstruction, colon or rectal cancer.
B-like antigen reacting with anti-B.
?bacterial enzyme (deacetylase)
Weak Or Absent
Expected Antibodies
Anti-A Anti-B Anti-A,B A1cells Bcells Ocells Blood
Group
0 0 0 1 w 0 O
0 3 3 0 0 0 B
4 0 4 0 w/0 0 A

New-born or elderly.
Hypogammaglobulinemia.
CLL or non Hodgkin's lymphoma.
Immunosuppression post BMT.
 Weak or absent expected
cell reaction.
High quantities ABH substance in some
secretors.
Ovarian cysts and carcinoma of the stomach
Can neutralize anti-A/anti-B typing reagents.
Patients cell group Patients serum group
Anti-A Anti-B Anti-A,B A1cells Bcells Ocells Blood Group
0 0 w/0 3 0 0 B
0 0 w/0 0 3 0 A
0 0 w/0 0 0 0 AB
 Irregular alloantibodies
Other cold antibody than anti-A or anti-B.
e.g. anti-M, -P1, -H, -Lea and anti-Leb
Corresponding antigen present on reagent A, B
or O cells.
Panagglutination: antibody to high freq. antigen.
Anti-A Anti-B Anti-A,B A1cells Bcells Ocells Blood Group
0 0 0 4 4 2 O
4 0 4 1 3 1 A
0 4 4 4 3 4 B
Polyagglutination
Discrepant reactions with polyclonal anti-A
and/or anti-B reagents.
Bacterial enzymes in vivo or in vitro expose
hidden RBC T and Tk antigens.
Anti-T and anti-Tk normally present in adults.
MoAbs do not have anti-T, -Tk.

Anti-A Anti-B Anti-A,B A1cells Bcells Auto Blood Group

3 4 4 3 0 3 B

4 4 4 0 3 4 A

3 3 3 4 4 3 O
Anomalous serum reactions

Unexpected reactions
A subgroups with anti-A1
Cold allo antibodies
Cold autoantibodies
Rouleaux
Missing or weak reactions
Newborn, elderly
Disease associated
Anomalous RBC reactions
Unexpected reaction Missing/weak reaction
Acquired B ABO subgroup
Polyagglutination Age
Rouleaux Disease

Mixed field reaction

Massive transfusion of A or B
patient with group O blood
BMT /SCT
A3 subgroup
Subgroups

Reactivity of cells with anti-A1,

anti-A, anti-B, anti-AB, anti-H;
Reaction of serum with A1 cells.
Presence of antigen in saliva of
secretors.
Detection by adsorption and elution
techniques.
Subgroups
Extended ABO blood grouping.

anti-A1 anti-A anti-B anti-A,B A1 cells A2 cells B cells O cells saliva

A2 0 2/3 0 4 +/- 0 4 0 AH
A3 0 MF 0 MF 0 0 4 0 A,H
Ax 0 0/1 0 2 +/- 0 4 0 A,H
Ael 0 0 0 1 0 0 4 0 H
B3 0 0 MF MF 4 4 0 0 B,H
Bx 0 0 w 2 4 4 w 0 B,H
Bel 0 0 0 w 4 4 0 0 H
Subgroups example
Anti-A Anti-B Anti-A,B A1cells Bcells Ocells
3 0 4 2 4 0
Interpretation
Cell group A;
Serum group ?O,
discrepancy reaction with A1 cells
?subgroup of A with anti-A1, or
irregular antibody reacting with antigen
on A1 reagent cells.
Further tests
Test patients cells against
-anti-A1 lectin: reacts with A1 not A2.
-anti-H reagent: stronger reaction with
subgroup than A1.
-own serum to check for autoantibodies.
Test patients serum against
-A1 and A2 cells to see if antibody is
anti-A or anti-A1.
-Antibody screening cells to rule out
irregular alloantibodies.
Association with disease

Group A Gastric cancer

Group B Pancreatic cancer
Gastric and duodenal ulcers.
Low clotting factor VIII (FVIII)
Group O
and von Willebrand factor (vWF).
Less severe p falciparum malaria.