ABO discrepancies can be maddening, because they tend to pop up at the WORST times in real life, and they can endlessly frustrate learners taking standardized exams. Nicole Draper says, “They’re not so bad!” She gives us three simple rules that will get you on the road to solving most of these cases quickly.

Dr. Nicole Draper

Dr. Nicole Draper

When ABO testing goes right, as it almost always does, it’s a very simple process. The forward grouping agrees with the reverse grouping (or the “front-type” is the same as the “back-type,” to use blood bankers’ lingo), and there is no question about what type of blood to give to a patient. However, occasionally, things don’t proceed quite as smoothly, and a dreaded “ABO discrepancy” occurs (cue the scary music!). This episode is all about how to approach and evaluate those situations.

Getting the Most From This Episode

Like many topics in immunohematology, the evaluation of ABO discrepancies is very visual. For that reason, the best way to listen to this episode is with the cases printed out or viewed on your computer, tablet, or mobile device screen. You can find everything you need to visualize what Dr. Draper describes in the interview further down on this page. My advice: Print out the handout and have it in front of you so you can try to solve the cases along with Dr. Draper.

Also, if you feel lost in just understanding the basics of ABO testing, so this episode feels completely beyond you, start by reading my blog post on the essentials of ABO testing, then come back and try listening to this episode.

-Get the clinical history
-Weakest reactions are usually discrepant
-Antibody problems are much more common than antigen problems

Nicole Draper, MD

Speaker Bio:

Nicole Draper, MD, is an Associate Professor of Clinical Practice in the Department of Pathology at the University of Colorado School of Medicine. She is the Associate Director of Transfusion Services at the University of Colorado Hospital in Aurora, CO, and helps direct numerous other transfusion services in throughout the Denver area in the CU system.

Nicole is a graduate of the University of Utah School of Medicine, and completed her Blood Banking/Transfusion Medicine Fellowship at Puget Sound Blood Center (Now Bloodworks) in Seattle, WA. She is a six-time winner of the “Summit Award for Pathology Resident Teaching” at CU, and has given presentations on ABO discrepancies at the AABB Annual Meeting in 2013 and 2016.

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DISCLAIMER: The opinions expressed on this episode are those of my guest and I alone, and do not reflect those of the organizations with which either of us is affiliated. Neither Dr. Draper nor I have any relevant financial disclosures.

The images below are generously provided by Dr. Draper. Click on an image to see a larger version. You may also click here to download a pdf version of these images to print or use to follow along.

Slide 1: First case (see xx:xx of audio)
Slide 2: Second case (see xx:xx of audio)
Slide 3: Causes of ABO discrepancies with "antibody gain"
Slide 4: Third case (see xx:xx of audio)
Slide 5: Summary of ABO discrepancies associated with "antigen gain"
Slide 6: Fourth case (see xx:xx of audio)
Slide 7: Fifth case (see xx:xx of audio)
Slide 8: Summary of ABO discrepancies associated with "antibody loss"
Slide 9: Sixth case (see xx:xx of audio); part 1
Slide 10: Sixth case (see xx:xx of audio); part 2
Slide 11: Summary of ABO discrepancies associated with "antigen loss"
Slide 12: Seventh case (see xx:xx of audio); part 1
Slide 13: Seventh case (see xx:xx of audio); part 2
Slide 14: Eighth case (see xx:xx of audio)

Music Credit

Music for this episode includes “Cuando te invade el temor” and “Reflejo,” both by Mar Virtual via the Free Music Archive. Click the image below for permissions and license details.
Creative Commons license and link

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