Figure shows, Negative agglutination reaction in forward A-cells and B-cells and G (4+)
agglutination reaction in reverse grouping for A-serum and G (3+) agglutination reaction for Bserum. Hence the blood group is ‘O’ Rh+.
Case Report of a Panagglutination due to alloantibodies
Annapurna Ramesh, Deepak Bhandari, Ankit Mathur TTK Rotary
Regional Transfusion Centre, Bangalore, India
Background: Red cell serology is a complex area though appears as simple technology.
Panagglutinating sera are rare (0.089%) occurrence. Panagglutination is a patient sera agglutinates
with all red blood cells (RBCs) tested in first approach. Also agglutinates all RBCs screening and
identification of panel cells. A Panagglutinating serum is challenging dilemmas of the antibody
identification and to manage the patient transfusion wise, even in advanced countries. In this
situation, systematic workup is necessary to reduce the risk of error and optimize the sample use as
many tests need to be done and repetitions of few tests are necessary. Panagglutinating sera to high
frequency antigen e.g. Cartwright, Colton, Diego, Vel, Scianna etc is (0.002%), and due to auto
antibody is (0.087%)
Case Report: We investigated serum of a female patient 31years of age for Panagglutination, posted
for Spinal cord neurosurgery. We received her sample on 14 April 2011 for grouping and two units
PRBC reservation. She gave H/O G3, P1, A2, without previous H/O blood transfusions, H/ O treated
tuberculosis 2 years ago.
https://www.ajts.org/article.asp?issn=09736247;year=2012;volume=6;issue=1;spage=59;epage=129;aulast=
We sent the sample for Ab identification to TTK Regional Centre and found 2 + agglutination in all 11
Ab identification panel red cells; auto control was negative for agglutination (Bioview), DCT
Negative, tube technique did not pick up the alloantibody.
DCT Negative, auto control negative, Hb-11.6gm %, normal blood smear ruled out auto antibody and
alloantibody was causing Panagglutination.
Alloantibody to high-frequency antigen (HFA) - Ab corresponding to HFA usually best reacts by IAT,
uniform grading seen in panel cells and IAT tests with red cells.
Multiple antibodies to recognizing antigens (other than HFA) - differential Grading seen is due to
variable intensity and distribution of multiple antigens in panel cells.
Clinically insignificant High-titer, low-avidity (HTLA) antibodies usually agglutinate with W+ to 1+
grading in IAT.
Uniform 2+ agglutination in IAT suggested alloantibody to a HFA.
Chances of HTLA antibodies cannot be ruled out and further investigations such as extended cell
panel testing, genotyping and in vitro test for predicting the outcome of transfusing incompatible
blood are desirable.
Clinical Management: Informed all details to clinicians. Blood was neither reserved nor utilized. Post
operative period was uneventful. Oral haemetenics prescribed.
Conclusion: In this case, panagglutination was due to HFA alloantibodies (? HTLA) acquired as a
result of pregnancy. Patients lacking high-frequency antigen with HFA alloantibodies are rare. Due to
rarity of blood donors lacking corresponding HFA, it is most difficult to arrange HFA negative blood.
Also in vitro pre-transfusion tests for predicting the outcome of transfusing incompatible blood are
invaluable in these rare cases.