#00062902

1.      A 68-year-old male diagnosed with aplastic anaemia was admitted to the emergency room of our hospital for breathlessness and fever. On investigations, his haemoglobin and platelet counts were 5.68g/dL and 63000 per mm3 of blood respectively. His low blood counts warranted an urgent transfusion of blood components.

2.      His blood grouping revealed a type-2 discrepancy. His cell grouping showed A Rh (D) weak reaction. His serum grouping showed agglutination with B pooled cells which confirmed his ABO status to be A-type. His Rh (D) status was rechecked with anti-sera of two different manufacturers and both showed a weak reaction in the conventional tube technique [CTT] macroscopically.

3.      We checked for his anti-Rh (D) agglutination microscopically and confirmed it to be a mixed field (Mf) under 10 x magnifications [Figure 1]. Additionally, his weak D testing using Anti-human globulin [IgG] was positive.

4.      The final interpretation of his blood typing was A Rh (D) mixed field? D Variant.

5.      The patient was eventually given a blood group report with the following transfusion advice:

• For red cell transfusion kindly consider A or O Rh D Negative donor cells
• When fresh frozen plasma and or platelets are required, either A or AB plasma products may be considered