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A intermediate (Aint) subtypes exhibit characteristics intermediate between A1 and A2. Plasma from Aint individuals contains different enzyme, UDP-GalNAc: fucosylgalactoside-a-3-N-acetylgalactosaminyl transferase, which is different from the enzyme in A1 and A2 plasma. We encountered the case of a 54-year-old female (having pneumonia and chronic kidney disease) for pre-transfusion testing. On routine grouping, we encountered group discrepancies. On testing, anti-A gave 4+, anti-B-0, anti-A1 lectin-2+, anti-H lectin, and anti-AB antisera gave 4+ reactions. Reverse grouping gave 4+ with B cells, 2+ at room temperature with A cells, and 4+ and 1+ at 37°C and 4°C. Saliva inhibition studies showed A and H substances. It was typed as an Aint group with warm anti-A1 antibody. It’s the 1st time ever we encountered Aint case with a warm type anti-A1 antibody. Here, O group packed red cells are the suitable blood units to transfuse.

Autoimmune hemolytic anemia (AIHA) is characterized by the presence of antibodies directed against self-antigens on red blood cells (RBCs) leading to progressive RBC destruction along with reduced red cell survival. Mixed-type AIHA is characterized by the presence of both warm and cold-autoantibodies. These autoantibodies may cause blood-group discrepancy or cross-match incompatibility leading to delay in arranging suitable blood unit for transfusion. The detection of autoantibodies by monospecific-direct antiglobulin test showing positive reaction on immunoglobulin G and C3d and presence of cold-agglutinins leads to the diagnosis. We report a rare case of mixed AIHA in a 15 years female showing severe anemia, blood group discrepancy, and cross-match incompatibility. She received transfusion of least incompatible packed RBCs without any untoward effect.

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