IMMUNOHEMATOLOGY AND BLOOD BANKING Flashcards
extracts made from the seed of plants which have blood group specificity
lectins
It is used as anti sera for antigen typing red cells
lectins
blood specificity : Anti - A
lectin :
Dolichos biflorus
blood specificity : Anti - B
lectin :
Bandeiraea simplicifolia
blood specificity : Anti - H
lectin :
Ulex europaeus
blood specificity : Anti - M
lectin :
Iberis amara
blood specificity : Anti - N
lectin :
Vicia graminea
blood specificity : Anti - T
lectin :
Arachis hypogea (peanut lectin)
blood specificity : Anti - Tn (Tn syndrome)
lectin :
Salvia sclaera
Anti-Tn or Tn syndrome is formerly known as
Permanent mixed-field polyagglutinability
It is the correlation of ABO antigens on red cells and the reciprocal agglutinating antibodies in the serum of the same individual
Landsteiner’s Rule / Landsteiner’s Law
won the nobel prize
Karl Landsteiner
year of the discovery of ABO blood group system
1901
first anticoagulant used and discovered by who
Sodium phosphate ; Braxton Hicks
the year 4th blood group (AB) was discovered (decastello & sturli)
1902
Universal donor of plasma
Group AB
- it has no antibodies in plasma
Universal donor of packed RBCs
Group O
- no antigens
Universal recipient of packed RBCs
Group AB
principle of forward typing
detection of ANTIGENS on patient’s RBC with known commercial ANTISERA
specimen and reagent used in forward typing
specimen: patient’s rbc
reagent: anti-sera
forward typing is also known as
front
cell
direct
formation of ABO antigens
5th-6th week of gestation (newborn, in utero)
peak production of ABO antigens
2-4 years of age
color of anti-sera: Anti-A
Blue
color of anti-sera: Anti-B
yellow
antisera used for Rh antigen that gives (+) or (-) for blood type
Anti-D
principle of reverse typing
detection of ABO antibodies (isoagglutinins) in serum of patient with known commercial RBCs
specimen and reagent used in reverse typing
specimen: patient’s serum
reagent: known cells or known commercial RBCs
formation of ABO antibodies
3-6 months of age
- not for newborn; maternal antibody is seen if used for newborn
peak production of ABO antibodies
5-10 years of age (continuous)
2 important classification of ABO antibodies
- IgM- cold reacting; react best at room temp; do not bind to complements
- IgG (immune antibodies - develops upon exposure causing hemolysis) - can cross placenta
used to washed out antibodies present
saline
unexpected reactions are obtained in the forward and/or reverse grouping
ABO Discrepancies
if there is antibody missing or extra antibody reacting, it has problem with patient’s ____
Serum (reverse grouping)
if there is antigen missing or extra antigen reacting, it has problem with patient’s ____
RBCs (forward grouping)
if the patient’s problem is both Serum and RBCs, in forward, RCBs must be ____ and _____ if reverse
in forward, RBCs must be washed and saline replacement if reverse
unexpected reactions due to:
- extra POSITIVE reactions
- WEAKLY or MISSING reactions
All ABO discrepancies must be ____ prior to reporting a patient or donor ABO group
resolved
it is usually the discrepant reactions
Weak reactions
it is much more common than antigen problems
antibody problems
steps in forward typing
step 1: anti-sera
step 2: RBC
steps in reverse typing
step 1: serum/plasma
step 2: known cells
Common sources of technical errors causing ABO discrepancies
- Incorrect or inadequate identification of blood specimens, test tubes, or slides
- Cell suspension either too heavy or too light
- Clerical errors or incorrect recording of results
- A mix-up in samples
- Missed observation of hemolysis
- Failure to add reagents
- Failure to add samples
- Failure to follow manufacturer’s instructions
- Uncalibrated centrifuge
- Overcentifugation or undercentrifugation
- Contaminated reagents
- Warming during centrifugation
Group I Discrepancies
problem:
- unexpected reaction with ____
- weakly reacting or missing ____
resolution:
- incubate patient’s _____________ @ RT for 15-30 minutes
- if still no reaction, incubate _____ @ ____ for 15-30 minutes
problem:
- REVERSE GROUPING
- ANTIBODIES
resolution:
- PATIENT’S SERUM with REAGENT A1 & B CELLS
- SERUM-CELL MIXTURE @ 4degC
examples of group I discrepancies
- Newborn (ABO antibody production not detectable until 3-5 months of age)
- Elderly (production of ABO antibody is depressed
- Leukemia (CLL) or Lymphoma (ML) or Patients using immunosuppressive drugs demonstrating hypogammaglobulinemia
Group II Discrepancies
problem:
- unexpected reaction with ____
- weakly reacting or missing ____
resolution:
- incubate patient’s _____________ @ RT for 30 minutes
- if still no reaction, incubate _____ @ ____ for 15-30 minutes
problem:
- FORWARD GROUPING
- ANTIGENS
resolution:
- patient’s RBC with reagent ANTI-SERA
- TEST MIXTURE @ 4degC
examples of group II discrepancies
- subgroups of A & B
- Leukemia - weakened A or B antigens
- Hodgkin’s disease - mimic depression of antigens
- Acquired B phenomenon - weak reactions with anti-B antisera (blood type A)
Group III Discrepancies
problem:
- unexpected reaction with ____
- protein or plasma abnormalities —>
resolution:
- forward grouping: wash patient’s RBCs several times with ____
- reverse grouping: ____ technique [serum=saline]
problem:
- FORWARD & REVERSE GROUPING
- ROULEAUX formation or PSEUDOAGGLUTINATION (false agglutination)
resolution:
- SALINE; wash RBC 2-3x; wash cord cells 6-8x (due to wharton’s jelly)
- SALINE REPLACEMENT (serum is removed and replaced by an equal volume of saline)
example of group III discrepancies
- Elevated levels of globulin - MM, Waldenstrom’s macroglobulinemia, other plasma cell dyscrasias, and certain moderately advance cases of Hodgkin’s lymphomas
- Elevated levels of fibrinogen
- Plasma expanders (Dextran & Polyvinylpyrrolidone)
- Wharton’s Jelly (cord samples)
ABO antigens are made up of _____ & _______
glycolipids and glycoproteins
precursor of A & B antigens (sugar)
Oligosaccharides
group in ABO discrepancies wherein discrepancies between forward and reverse grouping are due to ______
group IV; MISCELLANEOUS PROBLEMS
Group IV Discrepancies
problem:
- potent cold autoantibodies —> yield +coomb’s/antiglobulin test
resolution:
- incubate patient’s _____________ @ 37degC for short period of time —> washed saline 3x @37degC —> retype
if not successful:
- forward: patient’s rbc + ______
- reverse: reagent rbcs and serum can be _______ for 10-15 minutes, mixed, tested, and read @ 37degC
- convert the test to _____ if necessary
resolution:
- patient’s RBC
if not successful:
- 0.01 M dithiothreitol (DTT)
- incubate/warmed @ 37degC
- AHG Phase
Group IV Discrepancies
problem:
- Weakly reactive Anti-A or Anti-B
resolution:
- may not react at 37degC
if reverse typing is still negative:
- ________ (patient’s cells with patient’s serum) - remove cold autoantibody from serum
- the ______ can then be used to repeat the serum typing @ RT
- Cold autoabsorption
- absorbed serum
Group IV Discrepancies
problem:
- _______ - this happens to those blood types that have subgroups
resolution:
- _______ - produce small amount of Anti-H
- A2B & A2 - produce _____
- serum grouping can be repeated using at least 3 examples of _________(known reagent cells) and _________ control (patient’s serum mixed with patient’s rbcs)
- test patient’s rbc with ________ (lectin specific for A1 antigen)
problem:
- Unexpected ABO isoagglutinins
resolution:
- A1B & A1
- Anti-A1
- A1, A2, B cells ; O cells
- Autologous
- Dolichos biflorus
once the unexpected alloantibodies are identified, this should be used in the reverse grouping
reagent A1 and B cells that is negative for corresponding antigen
these are ABO water soluble substances found in saliva and other body fluids
ABH SECRETOR
Principle of detection in ABH secretor
based on agglutination inhibition/neutralization
secretor that produce A, B, H in secretions
SeSe and Sese
it is a non secretors; no A, B, H soluble substances found in secretions
sese
Glycoprotein
Type 1 precursor chain
B 1-3 linkage of D-galactose and N-acetylglucosamine
soluble substances in blood type A
A & H soluble substances
soluble substances in blood type B
B & H soluble substances
soluble substances in blood type AB
A, B, & H soluble substances
soluble substances in blood type O
H soluble substances
in agglutination inhibition/neutralization test, no agglutination means
positive
it has a lot of H antigens
O cells
it detects anti-IgG or anti-complement
AHG Testing (Coomb’s test)
reagent of AHG testing
Polyspecific AHG and Monospecific AHG
contain antibody to human IgG & C3d to component of human complement
Polyspecific AHG
in Polyspecific AHG, this complement may also be present
Anti-C3b
this type of reagent in coomb’s test can facilitate agglutination when RBCs have been sensitized with IgG or C3d or Both
Polyspecific AHG
commercially prepared polyspecific AHG contains antibody activity against ______
IgA and IgM HEAVY CHAINS
polyspecific mixture contains antibody activity to _____
KAPPA & LAMBDA LIGHT CHAINS
contains anti-IgG and anti-C3d (may contain other anticomplement and other anti-immunoglobulin antibodies)
Rabbit Polyclonal
contains a blend of rabbit polyclonal antihuman IgG and Anti-C3d is a murine monoclonal IgM antibody
Rabbit/Murine Monoclonal Blend
contain only one antibody specificity that is either anti-IgG or C3d/C3b
Monospecific AHG
License monospecific reagents commonly used are:
Anti-IgG
Anti-C3d
Anti-C3b
type of monospecific reagent that contains anti-IgG with no anticomplement activity
Anti-IgG (Rabbit Polyclonal)
Murine monoclonal IgM antibody secreted by a hybridoma cell line
Anti-IgG (Gammaclone AHG)
main component of Anti-complement (anti-C3d)
murine monoclonal antibody to C3d
this will cause the agglutination of RBCs coated with human C3d and/or C3b complement components
Anti-C3d
Oligosaccharide precursor chain Type 1
B 1,4 —> D-galactose, 4- N-acetylglucosamine (H gene)
Oligosaccharide precursor chain Type 2
B 1,3 —> (Se gene)
In agglutination inhibition test, saliva is mixed with antisera. To inactivate the enzymes, it must be heated at __________
56degC for 10 minutes
these are diluted to prevent postzone
saliva and antisera
It detects In Vivo sensitization of RBCs with IgG or complement components
Direct Antiglobulin Test (DAT)
Detected by ONE-STAGE procedure
Direct Antiglobulin Test (DAT)
Clinical application: HDFN
In vivo sensitization: _______
Maternal antibody coating fetal RBCs
Clinical application: HTR
In vivo sensitization: ________
Recipient antibody coating donor RBCs
Clinical application: AIHA
In vivo sensitization: _______
Autoantibody coating individual’s RBCs
Detects In VITRO sensitization of RBCs with IgG or complement components
Indirect Antiglobulin Test (IAT)
Detected by TWO-STAGE procedure
Indirect Antiglobulin Test (IAT)
Focus of antibody detection
determine the irregular or unexpected antibodies
Primary important; produced in response to RBC stimulation through transfusion, transplantation or pregnancy
(ex. mother —> fetus)
Immune alloantibodies
Form as a result of exposure to environmental sources, such as pollen, fungus, and bacteria, which have structure similar to some RBC antigens
Naturally occurring alloantibodies
Antibodies produced in one individual and then transmitted to another individual via plasma-containing blood components or derivatives such as intravenous immunoglobulin (IVIG)
via transfusion mechanism from one individual to you
Passively acquired antibodies
Antibodies directed against antigens expressed on one’s own RBCs and generally react with all RBCs tested
own’s antibodies produced to target own red cell (antigen)
Autoantibodies
Phase of antibody detection used to detect antibodies reacting at room temperature
Immediate Spin (IS) Phase
Phase of antibody detection wherein IgG antibodies (if present in patient’s serum) will sensitize any reagent RBC that possess the target antigen
37 deg C Incubation Phase
Phase of antibody detection that detects IgG or complement-sensitized RBCs; AHG reagent (Coomb’s serum)
AHG Phase
In phases of antibody detection, this may be added prior to incubation at 37degC to increase the degree of sensitization
Enhancement reagent
AHG Phase Interpretation:
If the RBCs are coated with IgG antibodies, the ANTI-IgG ANTIBODY in the AHG reagent will create a bridge between sensitized reagent RBCs
Agglutination
AHG Phase Interpretation:
If there are no antibodies directed against any of the antigens present on the reagent RBCs, the RBCs will not be sensitized
No agglutination
RBC reagents source:
Group O individuals (Group O cells)
- Anti-A & Anti-B will not interfere with the detection to other blood group system
Antibody detection screen cells
R1R1 & R2R2
or
R1R1, R2R2 & rr
There should be ONE CELL that is POSITIVE for each of the following antigens:
D, C, c, E, e, K, k, Fya, Fyb, Jka, Jkb, Lea, Leb, P1, M, N, S, & s
Blood donor antibody screening is acceptable while patient antibody screening cannot be used
Pooled Reagent/Reagent Set
Phase of antibody detection that reacts best at room temperature or lower; capable of causing agglutination of saline-suspended RBCs
Anti-N, Anti-I, Anti-P1
IgM Class
(Immediate spin / 37 degC or lower)
Phases of antibody detection that reacts best at AHG Phase (warmer temperature @ 37 degC)
Anti-Rh, Anti-Kell, Anti-Duffy, Anti-S, Anti-s
IgG Class
(AHG Phase)
Phases of antibody detection that reacts at 37 degC
Anti-Lewis, Anti-M
IgM or IgG
(37 deg C Incubation Phase)
It is patient’s RBC tested against the patient’s serum (in the same manner as the antibody screen)
Autologous control
(+) Antibody screen
(-) Autologous control
there is a presence of
ALLOANTIBODY
(+) Autologous control
the _________ needs to be evaluated
Transfusion history (of the patient)
If the patient has not been transfused within the last 3 months, Autologous control is POSITIVE, there is presence of __________ or ____________
AUTOANTIBODIES or ANTIBODIES TO MEDICATION
A Positive autologous control and exhibits mixed-field appearance is caused by ________ coating the circulating donor of RBCs
ALLOANTIBODIES
Screen cells (+); reacts at SAME PHASE & STRENGTH
Single Antibody Specificity
Screen cells (+); reacts at DIFFERENT PHASES & STRENGTH (IS, 37degC, AHG)
Multiple Antibodies
Screen cells (+)
Autocontrol/DAT (+)
Autoantibodies
In the presence of complement anti-Lea, anti-Leb, anti-pp1pk, & anti-vel causes _________ hemolysis
In vitro
Complement associated with Mixed-field agglutination
Anti-Sda & Anti-Lua/b
- The appearance under the microscope appears “stack of coin”
- Not a significant finding in antibody screening tests
- Does not interfere with AHG Phase
- Non-specific aggregation of RBCs (altered albumin-to-globulin ratio – MM or those who received high molecular weight plasma expanders [dextran])
Presence of Rouleaux
This test is used in the following situations:
1. Detection of incomplete (non-agglutinating) antibodies to potential donor RBCs (compatibility testing) or to screening cells (antibody screen) in serum
2. Determination of RBC phenotype using known antisera (e.g., Weak D, any other antigen testing that requires this test)
3. Titration of incomplete antibodies
Indirect Antiglobulin Test
Clinical application: Antibody Detection
Tests: a.) Compatibility testing
b.) Antibody Screening
In vitro sensitization: __________
a.) Recipient antibody reacting with donor cells
b.) Antibody reacting with screening cells
Clinical application: Antibody Identification
Tests: Antibody Panel
In vitro sensitization: __________
Antibody reacting with panel cells
Clinical application: Antibody Titration
Tests: Rh Antibody Titer
In vitro sensitization: __________
Antibody & Selected Rh cells
Clinical application: RBC Phenotype
Tests: RBC antigen dectection (ex. Weak D, K, Fy)
In vitro sensitization: __________
Specific antisera + RBCs to detect antigen
Clinically significant alloantibodies:
- Causes low survival of RBCs possessing the target antigen
- Typically IgG
- React @: 37degC and/or AHG Phase of IAT
Tasks and purposes of IAT task
- Incubate RBCs with antisera
- Perform a minimum of three saline washes
- Add antigloblulin reagent
- Centrifuge
- Examine for agglutination –> (+) agglutination; (-) no agglutination
- Grade agglutination reactions
- Add antibody-coated RBCs to negative reactions –> countercheck/control only
REMEMBER THIS
If (+) screen cells (SC) –> ALLOANTIBODIES
If (+) AHG –> WARM REACTING / 37degC (IgG)
If (+) IS (immediate spin) –> COLD REACTING (IgM)
Guidelines for Interpretation
Autocontrol
a.) Negative - ______
b.) Positive - _______
a.) ALLOANTIBODY
b.) AUTOANTIBODY
Guidelines for Interpretation
Phases
a.) IS - _____
b.) 37degC - ________
c.) AHG - _______
a.) COLD ANTIBODY (IgM)
b.) COLD ANTIBODY (some have higher thermal range) or WARM ANTIBODY
c.) WARM ANTIBODY (IgG) clinically significant
Guidelines for Interpretation
Reaction Strength
a.) 1 consistent strength - _______
b.) different strengths - _______
a.) ONE antibody
b.) MULTIPLE antibodies or DOSAGE
Common Blood Group System with Antibodies that Exhibit Dosage
- Rh (except D)
- Kidd
- Duffy
- MNSs
- Lutheran
Antibody Identification
Antibody Panel –> usually induces at least _____ panel cells
Panel cells –> ________
(+) - presence of antigen
(0) - absence of antigen
10 panel cells
panel cells –> Group O RBCs
Autocontrol should also be run with ALL panels
Autocontrol = ________ + __________
Patient’s RBC + Patient’s Serum
Perform Immediate Spin (IS)
–> grade agglutination
–> inspect for hemolysis
Perform 37 degC Phase (LISS)
–> add 2 drops of LISS, mixed & incubate for 10-15 minutes
–> mix/centrifuge
–> check for agglutination
Perform IAT (or AHG)
–> wash cells 3x with saline
–> add 2 drops of AHG
–> mix/centrifuge
–> check for agglutination
COLD REACTING ANTIBODIES
- P, I, Lewis, MN
- Naturally Occurring
- Generally IgM
- Can’t cross placenta
- Reacts best @ RT
- Not significant in HTR
WARM REACTING ANTIBODIES
- Kell, Kidd, Duffy, Ss
- Requires Exposure
- Generally IgG
- Can cross the placenta
- Reacts best at 37degC
- Significant in transfusion reactions
Enzyme Classification
Enhance by ENZYME
ABO
Rh
Kidd
Lewis
I/I
P1
Enzyme Classification
Destroyed/Inactivated by ENZYME
MNSs
Duffy
Xga
Enzyme Classification
Not affected by ENZYME
Kell
The most important of all blood groups in both transfusion and transplant medicine
ABO System
Transfusion of an incompatible ABO type may result in:
Immediate lysis of donor RBCs
A foundation on which all other pretransfusion testing is based
ABO incompatibility
Most frequent cause of death in fiscal year (FY) 2015
Transfusion-related acute lung injury (TRALI)
First individual to perform forward and reverse grouping
Karl Landsteiner
Most frequently performed test in the blood bank
ABO Grouping
Interpretation of Blood Group
Anti-A : 0
Anti-B : 0
Blood Group O
Interpretation of Blood Group
Anti-A : 4+
Anti-B : 0
Blood Group A
Interpretation of Blood Group
Anti-A : 0
Anti-B : 4+
Blood Group B
Interpretation of Blood Group
Anti-A : 4+
Anti-B : 4+
Blood Group AB
Interpretation of Blood Group
A1 Cells : 4+
B Cells : 4+
Blood Group O
Interpretation of Blood Group
A1 Cells : 0
B Cells : 3+
Blood Group A
Interpretation of Blood Group
A1 Cells : 3+
B Cells : 0
Blood Group B
Interpretation of Blood Group
A1 Cells : 0
B Cells : 0
Blood Group AB
Characteristics of Routine Reagents Used for ABO Testing
Forward Grouping
Anti-A Reagent
- Monoclonal antibody
- Highly specific
- IgM
- Clear blue-colored reagent
- Expected 3+ to 4+ reaction
- Usually use 1-2 drops
Characteristics of Routine Reagents Used for ABO Testing
Forward Grouping
Anti-B Reagent
- Monoclonal antibody
- Highly specific
- IgM
- Clear yellow-colored reagent (contains an acriflavine dye)
- Expected 3+ to 4+ reaction
- Usually use 1-2 drops
Characteristics of Routine Reagents Used for ABO Testing
Reverse Grouping
Reagent A1 and B Cells
- Human source
- 4%-5% RBC suspension
- Expected 2+ to 4+ reaction
- Usually use 1 drop
Anti-A : 0
Anti-B : 0
Anti-AB: 0
A1 Cells : 4+
B Cells : 4+
Blood group O
Anti-A : 4+
Anti-B : 0
Anti-AB: 4+
A1 Cells : 0
B Cells : 2+
Blood group A
Anti-A : 0
Anti-B : 4+
Anti-AB: 4+
A1 Cells : 3+
B Cells : 0
Blood group B
Anti-A : 3+
Anti-B : 3+
Anti-AB: 3+
A1 Cells : 0
B Cells : 0
Blood group AB
If wrong ABO group is transfused, the ABO antibodies will cause ___________ resulting to patient death
rapid intravascular hemolysis
Routinely used reagent for performing ABO confirmation of group O donor; more economical to use
Anti-A,B reagent
Year the inheritance of the ABO blood group was first described
1924
Considered an amorph, as no detectable antigen is produced
O gene
Three (3) separate loci
ABO, Hh, Se
Has the same basic precursor material from which A, B, and H antigens all originate
Paragloboside or glycan
Precursor structure on which A and B antigens are made
H antigen
Glucosyltransferases and Immunodominant Sugars Responsible for H, A, and B Antigen Specificities
H gene elicits the production of an enzyme called a-2-L-fucosyltransferase that transfers the sugar to ______
L-fucose to an oligosaccharide chain, terminal galactose of type 2 chains
Sugars occupying the terminal positions of precursor chain and conferring blood group specificity are called
Immunodominant sugars
Term used to refer to the phenotype that lacks normal expression of the ABH antigens
Bombay
Glucosyltransferases and Immunodominant Sugars Responsible for H, A, and B Antigen Specificities
A gene elicits the production of an enzyme called a-3-N-acetylgalactosaminyltranferase that transfers the sugar to ______
N-acetyl-D-galactosamine (GalNAc); type 2
Glucosyltransferases and Immunodominant Sugars Responsible for H, A, and B Antigen Specificities
B gene elicits the production of an enzyme called a-3-D-galactosyltransferase that transfers the sugar to ______
D-galactose (Gal); type 2
Oligosaccharide chain, type 1 and 3 are primarily associated with
body secretions
Oligosaccharide chain, type 2 and 4 are primarily associated with
red blood cell membrane
Type of oligosaccharide chain that are more abundant and differ only in the linkage position of galactose (Gal) to N-acetylglucosamine (GlcNAc)
Type 1 and 2 chains
Comparison of ABH Antigens on RBCs with A, B, and H Soluble Substances
ABH Antigens on RBCs
- RBC antigens can be glycolipids, glycoproteins or glycosphingolipids
- RBC antigens are synthesized only on type 2 precursor chains
- Type 2 chain refers to a beta 1–>4 linkage
- The enzyme produced by the H (FUT 1) gene (a-2-L-fucosyltransferase) acts primarily on type 2 chains, which are prevalent on the RBC membrane
Comparison of ABH Antigens on RBCs with A, B, and H Soluble Substances
A, B, H Soluble Substances
- Secreted substances are glycoproteins
- Secreted substances are primarily synthesized on type 1 precursor chains
- Type 1 chain refers to a beta 1–>3 linkage
- The enzyme produced by the Se (FUT 2) gene (a-2-L-fucosyltransferase) preferentially acts on type 1 precursor chains in secretory tissues
Anti-A + Saliva + A cells : 4+
Anti-B + Saliva + B cells : 4+
Anti-H + Saliva + O cells : 0
Interpretation:
Type O Secretor
- H soluble substances
Anti-A + Saliva + A cells : 0
Anti-B + Saliva + B cells : 4+
Anti-H + Saliva + O cells : 0
Interpretation:
Type A Secretor
- A & H soluble subsances
Anti-A + Saliva + A cells : 4+
Anti-B + Saliva + B cells : 0
Anti-H + Saliva + O cells : 0
Interpretation:
Type B Secretor
- B & H soluble secretor
Anti-A + Saliva + A cells : 0
Anti-B + Saliva + B cells : 0
Anti-H + Saliva + O cells : 0
Interpretation:
Type AB Secretor
- A, B, H Soluble substances
Fluid in which A, B, and H substances can be detected in secretors
- Saliva
- Tears
- Urine
- Digestive juices
- Bile
- Milk
- Amniotic fluid
- Pathological fluids: pleural, peritoneal, pericardial, ovarian cyst