A patient with hypogammaglobulinemia shows an ABO discrepancy after 4C enhancement. What is the likely cause and corrective step?

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Multiple Choice

A patient with hypogammaglobulinemia shows an ABO discrepancy after 4C enhancement. What is the likely cause and corrective step?

Cold agglutinins that react at low temperatures can create ABO discrepancies when testing at 4°C. In this scenario, an autoantibody like anti-I binds red cells at cold temperatures, producing unexpected agglutination that misleads ABO typing. The appropriate fix is to remove these cold antibodies through a cold autoabsorption process—adsorbing the autoantibody from the patient’s serum using I antigen-bearing red cells—and then repeat the ABO test at room temperature. This eliminates the interference from the cold antibody, giving an accurate ABO result. Saline washes won’t remove the autoantibody, misidentifying A1 cells isn’t addressing the underlying interference, and transfusing incompatible units would be unsafe and unnecessary.

Cold agglutinins that react at low temperatures can create ABO discrepancies when testing at 4°C. In this scenario, an autoantibody like anti-I binds red cells at cold temperatures, producing unexpected agglutination that misleads ABO typing. The appropriate fix is to remove these cold antibodies through a cold autoabsorption process—adsorbing the autoantibody from the patient’s serum using I antigen-bearing red cells—and then repeat the ABO test at room temperature. This eliminates the interference from the cold antibody, giving an accurate ABO result. Saline washes won’t remove the autoantibody, misidentifying A1 cells isn’t addressing the underlying interference, and transfusing incompatible units would be unsafe and unnecessary.

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