A technologist performing an ABO minor crossmatch experiences a 4+ reaction. What is the likely cause and the recommended action?

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Multiple Choice

A technologist performing an ABO minor crossmatch experiences a 4+ reaction. What is the likely cause and the recommended action?

In an ABO minor crossmatch, a 4+ agglutination strongly points to ABO incompatibility between the donor red cells and the recipient’s antibody-containing plasma. ABO incompatibility is highly immunogenic, so when the donor’s cells carry antigens that the recipient’s serum antibodies recognize, you see a strong, panagglutinating reaction. The most common cause for such a strong reaction is a clerical or labeling error leading to misidentification of the donor and recipient specimens. Because ABO typing hinges on correct pairing, misidentified samples can produce a seemingly incompatible result even though the actual donor and recipient are compatible. Therefore, the first step is to verify and correct the identities on both the patient specimen and the donor unit, then repeat the crossmatch with properly identified samples. If incompatibility persists after proper identification, the incompatible donor unit should be discarded and a different, ABO-compatible unit should be sought.

In an ABO minor crossmatch, a 4+ agglutination strongly points to ABO incompatibility between the donor red cells and the recipient’s antibody-containing plasma. ABO incompatibility is highly immunogenic, so when the donor’s cells carry antigens that the recipient’s serum antibodies recognize, you see a strong, panagglutinating reaction.

The most common cause for such a strong reaction is a clerical or labeling error leading to misidentification of the donor and recipient specimens. Because ABO typing hinges on correct pairing, misidentified samples can produce a seemingly incompatible result even though the actual donor and recipient are compatible.

Therefore, the first step is to verify and correct the identities on both the patient specimen and the donor unit, then repeat the crossmatch with properly identified samples. If incompatibility persists after proper identification, the incompatible donor unit should be discarded and a different, ABO-compatible unit should be sought.

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