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Nagaharu K, Izumi T, Maruyama M, Sugimoto Y, Ohishi K, Tawara I, Usui E, Tamaki S. Clinical Utility of Flow Cytometry for Detection of Anti-Jk b IgM in Acute Haemolytic Transfusion Reaction. Intern Med 2024; 63:1273-1275. [PMID: 37779057 PMCID: PMC11116007 DOI: 10.2169/internalmedicine.2639-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 08/20/2023] [Indexed: 10/03/2023] Open
Abstract
Acute hemolytic transfusion reaction (AHTR) is a rare but life-threatening complication of transfusion. We herein report a case of anti-Jkb IgM-related AHTR. Two hours after an 80-year-old man with myelodysplastic syndrome received a packed red blood cell (RBC) A+/Rh-/Jkb+/c- transfusion, he developed acute respiratory failure and a fever. Although he had tested negative in routine screening tests, the 37°C normal saline test was weakly positive for Jkb. We confirmed the presence of anti-Jkb IgM in the patient's serum by flow cytometry. This case demonstrates the potential utility of flow cytometry for IgM detection.
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Affiliation(s)
- Keiki Nagaharu
- Department of Hematology, Mie University Hospital, Japan
- Department of Hematology, Yokkaichi Municipal Hospital, Japan
- Department of Hematology, Japanese Red Cross Ise Hospital, Japan
| | - Takuya Izumi
- Department of Hematology, Japanese Red Cross Ise Hospital, Japan
| | - Mitsuko Maruyama
- Transfusion Medicine and Cell Therapy, Mie University Hospital, Japan
| | - Yuka Sugimoto
- Department of Hematology, Mie University Hospital, Japan
| | - Kohshi Ohishi
- Transfusion Medicine and Cell Therapy, Mie University Hospital, Japan
| | - Isao Tawara
- Department of Hematology, Mie University Hospital, Japan
| | - Eiji Usui
- Department of Hematology, Japanese Red Cross Ise Hospital, Japan
| | - Shigehisa Tamaki
- Department of Hematology, Japanese Red Cross Ise Hospital, Japan
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2
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Liwski R, Greenshields A, Grace I, Cheng C, Quinn JG. Development of multiplexed flow cytometry-based red blood cell antibody screen and identification assays. Vox Sang 2024; 119:344-352. [PMID: 38175141 DOI: 10.1111/vox.13584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 12/06/2023] [Accepted: 12/17/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND AND OBJECTIVES The purpose of this study was to develop a high-throughput method of performing red blood cell antibody screens and identification by utilizing flow cytometry and intracellular dyes to allow a multiplexed assay where three-cell screens can be performed in a single test well and 11-cell panels in three test wells. MATERIALS AND METHODS Reagent red blood cells were labelled using Violet Proliferation Dye 450 (V450) and Oregon Green fluorescent dyes, which bind intracellular proteins to allow up to four cells to be interrogated in a single test well. Sixteen 3-cell screen panels and ten 11-cell identification panels were tested using sera with known antibody specificity. Antibody binding was detected using secondary anti-immunoglobulin G and anti-immunoglobulin M fluorescently labelled antibodies. RESULTS Intracellular dyes allowed clear separation of the different screen and identification panel test cells. Three distinct populations of V450+, Oregon Green+ and negative for both stains were demonstrated in the screening panel and an additional double positive for V450 and Oregon Green was utilized to include a fourth cell in the identification panel testing to increase throughput. A total of 158 screen or identification panel RBC/serum combinations were tested against different known antibodies, and expected results were obtained with 100% concordance. CONCLUSION This study demonstrates the successful development of a high-throughput multiplexed flow cytometry-based red cell antibody screen and identification panel assays. This method could be implemented in clinical laboratories to complement existing antibody detection methods. The multiplexing enabled via intracellular staining could be utilized to further augment other flow cytometry-based transfusion assays.
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Affiliation(s)
- Robert Liwski
- Department of Pathology and Laboratory Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Nova Scotia Health Authority, Central Zone, Halifax, Nova Scotia, Canada
| | - Anna Greenshields
- Department of Pathology and Laboratory Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Nova Scotia Health Authority, Central Zone, Halifax, Nova Scotia, Canada
| | - Ian Grace
- Nova Scotia Health Authority, Central Zone, Halifax, Nova Scotia, Canada
| | - Calvino Cheng
- Department of Pathology and Laboratory Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Nova Scotia Health Authority, Central Zone, Halifax, Nova Scotia, Canada
| | - Jason George Quinn
- Department of Pathology and Laboratory Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Nova Scotia Health Authority, Central Zone, Halifax, Nova Scotia, Canada
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Baskaran RKR, Link A, Porr B, Franke T. Classification of chemically modified red blood cells in microflow using machine learning video analysis. SOFT MATTER 2024; 20:952-958. [PMID: 38088860 DOI: 10.1039/d3sm01337e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
We classify native and chemically modified red blood cells with an AI based video classifier. Using TensorFlow video analysis enables us to capture not only the morphology of the cell but also the trajectories of motion of individual red blood cells and their dynamics. We chemically modify cells in three different ways to model different pathological conditions and obtain classification accuracies for all three classification tasks of more than 90% between native and modified cells. Unlike standard cytometers that are based on immunophenotyping our microfluidic cytometer allows to rapidly categorize cells without any fluorescence labels simply by analysing the shape and flow of red blood cells.
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Affiliation(s)
- R K Rajaram Baskaran
- Division of Biomedical Engineering, School of Engineering, University of Glasgow, Oakfield Avenue, Glasgow G12 8LT, UK.
| | - A Link
- Division of Biomedical Engineering, School of Engineering, University of Glasgow, Oakfield Avenue, Glasgow G12 8LT, UK.
| | - B Porr
- Division of Biomedical Engineering, School of Engineering, University of Glasgow, Oakfield Avenue, Glasgow G12 8LT, UK.
| | - T Franke
- Division of Biomedical Engineering, School of Engineering, University of Glasgow, Oakfield Avenue, Glasgow G12 8LT, UK.
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Otsu M, Tanabe Y, Iwakiri A, Arima K, Uchiyama A, Yamamoto M, Ohtani S, Endo H, Komoto M, Miyazaki K. A report on a modified protocol for flow cytometry-based assessment of blood group erythrocyte antigens potentially suitable for analysis of weak ABO subgroups. Transfusion 2023; 63:463-469. [PMID: 36597800 DOI: 10.1111/trf.17239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 11/30/2022] [Accepted: 12/05/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Flow cytometry (FC) has proven its utility in scrutinizing AB antigen expression in red blood cells (RBCs), cooperating with serological tests for accurate blood group typing. However, technical difficulties may impair the characterization of weak ABO subtypes when background noises appear at non-negligible levels. STUDY DESIGN AND METHODS We sought to establish an FC method that could prevent antibody-induced hemagglutination and an increase in cellular autofluorescence, two major issues inherent to RBC-FC analysis of AB expression. We optimized fixatives, multicolor-staining protocols, and sequential gating strategies. Blood samples from weak ABO subtype cases, Bm and Ael , were analyzed with the established protocol. RESULTS The optimized mixture of glutaraldehyde and formaldehyde successfully generated fixed RBCs resistant to agglutination while maintaining low autofluorescence. These features allowed co-staining of leukocyte- and erythrocyte-markers, which enabled sequential gating strategies facilitating the precise AB antigen analysis in purely single RBCs with minimum background noises. By the established FC analysis, we could detect in the Bm sample a small RBC population exhibiting weak B antigen expression. The assay also proved it feasible to identify a small population (0.04%) of RBCs weakly expressing the A antigen in the Ael sample confirmed as harboring a rare c.816dupG ABO variant allele. CONCLUSION The RBC-FC analysis described here allows the detection of AB antigens weakly expressed in RBCs while achieving minimum background noise levels in negative control samples. Overall, the modified protocol provides a quick and reliable assay valuable in transfusion medicine and is potentially applicable to the characterization of rare weak ABO variants.
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Affiliation(s)
- Makoto Otsu
- Department of Transfusion and Cell Transplantation, Kitasato University School of Medicine, Sagamihara, Japan
- Department of Clinical Laboratory, Kitasato University Hospital, Sagamihara, Japan
| | - Yuji Tanabe
- Department of Clinical Laboratory, Kitasato University Hospital, Sagamihara, Japan
| | - Ayako Iwakiri
- Department of Clinical Laboratory, Kitasato University Hospital, Sagamihara, Japan
| | - Kazuna Arima
- Department of Clinical Laboratory, Kitasato University Hospital, Sagamihara, Japan
| | - Anna Uchiyama
- Department of Clinical Laboratory, Kitasato University Hospital, Sagamihara, Japan
| | - Marina Yamamoto
- Department of Clinical Laboratory, Kitasato University Hospital, Sagamihara, Japan
| | - Shinichi Ohtani
- Department of Transfusion and Cell Transplantation, Kitasato University School of Medicine, Sagamihara, Japan
- Department of Clinical Laboratory, Kitasato University Hospital, Sagamihara, Japan
| | - Hiroshi Endo
- Department of Clinical Laboratory, Kitasato University Hospital, Sagamihara, Japan
| | - Mina Komoto
- Department of Clinical Laboratory, Kitasato University Hospital, Sagamihara, Japan
| | - Koji Miyazaki
- Department of Transfusion and Cell Transplantation, Kitasato University School of Medicine, Sagamihara, Japan
- Department of Clinical Laboratory, Kitasato University Hospital, Sagamihara, Japan
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5
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Liwski R, Clarke G, Cheng C, Abidi SSR, Abidi SR, Quinn JG. Validation of a flow-cytometry-based red blood cell antigen phenotyping method. Vox Sang 2023; 118:207-216. [PMID: 36633967 DOI: 10.1111/vox.13401] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 12/21/2022] [Accepted: 12/30/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND AND OBJECTIVES Current manual and automated phenotyping methods are based on visual detection of the antigen-antibody interaction. This approach has several limitations including the use of large volumes of patient and reagent red blood cells (RBCs) and antisera to produce a visually detectable reaction. We sought to determine whether the flow cytometry could be developed and validated to perform RBC phenotyping to enable a high-throughput method of phenotyping using comparatively miniscule reagent volumes via fluorescence-based detection of antibody binding. MATERIALS AND METHODS RBC phenotyping by flow cytometry was performed using monoclonal direct typing antisera (human IgM): anti-C, -E, -c, -e, -K, -Jka , -Jkb and indirect typing antisera (human IgG): anti-k, -Fya , -Fyb , -S, -s that are commercially available and currently utilized in our blood transfusion services (BTS) for agglutination-based phenotyping assays. RESULTS Seventy samples were tested using both flow-cytometry-based-phenotyping and a manual tube standard agglutination assay. For all the antigens tested, 100% concordance was achieved. The flow-cytometry-based method used minimal reagent volume (0.5-1 μl per antigen) compared with the volumes required for manual tube standard agglutination (50 μl per antigen) CONCLUSION: This study demonstrates the successful validation of flow-cytometry-based RBC phenotyping. Flow cytometry offers many benefits compared to common conventional RBC phenotyping methods including high degrees of automation, quantitative assessment with automated interpretation of results and extremely low volumes of reagents. This method could be used for high-throughput, low-cost phenotyping for both blood suppliers and hospital BTS.
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Affiliation(s)
- Robert Liwski
- Department of Pathology and Laboratory Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.,Nova Scotia Health Authority, Central Zone, Halifax, Nova Scotia, Canada
| | - Gwen Clarke
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada.,Canadian Blood Services, Edmonton, Alberta, Canada
| | - Calvino Cheng
- Department of Pathology and Laboratory Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.,Nova Scotia Health Authority, Central Zone, Halifax, Nova Scotia, Canada
| | - Syed Sibte Raza Abidi
- NICHE Research Group, Faculty of Computer Science, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Samina Raza Abidi
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jason George Quinn
- Department of Pathology and Laboratory Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.,Nova Scotia Health Authority, Central Zone, Halifax, Nova Scotia, Canada
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6
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Immunoglobulin isotype compositions of ABO specific antibodies are dependent on the individual patient blood group and blood group specificity: Results from a healthy donor cohort. J Immunol Methods 2021; 494:113053. [PMID: 33933472 DOI: 10.1016/j.jim.2021.113053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/30/2021] [Accepted: 04/05/2021] [Indexed: 12/28/2022]
Abstract
Antibodies specific for the blood group ABO system antigens are of clinical significance and immunological interest. Routine clinical methods typically employ direct or indirect haemagglutination methods to measure IgM and IgG, respectively. We have developed a simple, single tube method to quantify IgM, IgG, and IgA specific for A and B antigens in order to improve accuracy and reproducibility, and to investigate the relationships between ABO group antibody type, and antibody level. Plasma samples from 300 healthy blood donors were studied. Levels of IgM and IgG binding to reagent group A and B red cells were measure by agglutination (HA) and multi-colour flow cytometry (MC-FC). IgA was also measured by MC-FC. Our FC method was found to be significantly more reproducible than HA for the measurement of blood group A and B specific antibodies. We found statistically significant correlations between antibodies measured by GC-HA and MC-FC, but sufficient differences to indicate that these methods are not equivalent. By MC-FC, IgM, IgG and IgA levels and isotope profiles were found to be dependent on both the donor ABO type and the specificity of the antibody. This study demonstrated heterogeneity in the immunoglobulin class profiles of ABO-blood group specific antibodies within the healthy population. Differences in isotype profiles of ABO-blood group specific antibodies may indicate fundamental differences in the immune mechanisms that generate these antibodies. This is likely to be relevant to the clinical situations where management or diagnosis depend on ABO-specific antibody detection and measurement.
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7
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Lucidi CA, Gerlach JA, Forney S, Jutkowitz LA, Scott MA. Analytic characterization of flow cytometric assays for detection of immunoglobulin G on canine erythroid cells, including detection of dog erythrocyte antigen 1 on erythroid precursors. Am J Vet Res 2018; 79:1123-1132. [PMID: 30372157 DOI: 10.2460/ajvr.79.11.1123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To develop and characterize flow cytometric assays for detecting IgG bound to canine erythrocytes and bone marrow erythroid precursors. SAMPLE Blood samples from 20 healthy and 61 sick dogs with (n = 33) or without (28) immune-mediated hemolytic anemia (IMHA) and bone marrow samples from 14 healthy dogs. PROCEDURES A flow cytometric assay for measurement of IgG on RBCs was developed, and appropriate positive control cells were generated. Analytic and diagnostic performance were characterized. The RBC IgG assay was then combined with density-gradient fractionation of aspirated bone marrow cells and a 2-color process to yield an assay for detecting IgG on nucleated RBCs (nRBCs). Cell sorting and cytologic examination confirmed target cell populations, and anti-dog erythrocyte antigen 1 (DEA1) blood-typing serum was used to generate IgG-positive nRBCs. RESULTS Within- and between-run coefficients of variation for the RBC IgG assay were 0.1% to 13.9%, and > 90% of spiked IgG-positive RBCs were detected. Diagnostic sensitivity and specificity of the assay for detection of IMHA were 88% and 93%, respectively. Cytologic findings for sorted bone marrow fractions rich in early-, mid-, and late-stage nRBCs from 3 healthy dogs indicated 89% to 98% nRBC purity. After IgG coating with anti-DEA1 blood-typing serum, IgG was detected on nRBCs from DEA1-positive, but not DEA1-negative, healthy dogs. CONCLUSIONS AND CLINICAL RELEVANCE The developed RBC IgG assay had favorable analytic and diagnostic performance for detection of IMHA in dogs and was successfully adapted to detect IgG on canine nRBCs of various maturation stages. The findings supported the presence of DEA1 on canine nRBCs.
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8
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Affiliation(s)
- A. K. Hult
- Division of Laboratory Medicine; Clinical Immunology and Transfusion Medicine; Office of Medical Services; Lund Sweden
- Division of Hematology and Transfusion Medicine; Department of Laboratory Medicine; Lund University; Lund Sweden
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Parker V, Tormey CA. The Direct Antiglobulin Test: Indications, Interpretation, and Pitfalls. Arch Pathol Lab Med 2017; 141:305-310. [PMID: 28134589 DOI: 10.5858/arpa.2015-0444-rs] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The direct antiglobulin test (DAT; sometimes referred to as the "Coombs" test) continues to be one of the most widely used assays in laboratory medicine. First described about 70 years ago, it is elegantly simple in design, yet it is widely complex in its applications and interpretations, and it is prone to false-positive and false-negative results. The overall objective of our review is to provide practicing pathologists with a guide to identify situations when the DAT is useful and to highlight disease-specific shortcomings as well as general pitfalls of the test. To accomplish these goals, this review will discuss the following: (1) the history of the DAT, (2) how the test is performed in the clinical laboratory, (3) clinical situations for its use, (4) its interpretation, and (5) the pitfalls associated with DAT assays, including causes of false positivity.
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10
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Borgmann DM, Mayr S, Polin H, Schaller S, Dorfer V, Obritzberger L, Endmayr T, Gabriel C, Winkler SM, Jacak J. Single Molecule Fluorescence Microscopy and Machine Learning for Rhesus D Antigen Classification. Sci Rep 2016; 6:32317. [PMID: 27580632 PMCID: PMC5007495 DOI: 10.1038/srep32317] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 08/02/2016] [Indexed: 01/24/2023] Open
Abstract
In transfusion medicine, the identification of the Rhesus D type is important to prevent anti-D immunisation in Rhesus D negative recipients. In particular, the detection of the very low expressed DEL phenotype is crucial and hence constitutes the bottleneck of standard immunohaematology. The current method of choice, adsorption-elution, does not provide unambiguous results. We have developed a complementary method of high sensitivity that allows reliable identification of D antigen expression. Here, we present a workflow composed of high-resolution fluorescence microscopy, image processing, and machine learning that - for the first time - enables the identification of even small amounts of D antigen on the cellular level. The high sensitivity of our technique captures the full range of D antigen expression (including D+, weak D, DEL, D-), allows automated population analyses, and results in classification test accuracies of up to 96%, even for very low expressed phenotypes.
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Affiliation(s)
- Daniela M. Borgmann
- University of Applied Sciences Upper Austria, School of Informatics, Communications and Media, Softwarepark 11, 4232 Hagenberg, Austria
| | - Sandra Mayr
- University of Applied Sciences Upper Austria, School of Applied Health and Social Sciences, Garnisonstrasse 21, 4020 Linz, Austria
| | - Helene Polin
- Red Cross Transfusion Service for Upper Austria, Krankenhausstrasse 7, 4020 Linz, Austria
| | - Susanne Schaller
- University of Applied Sciences Upper Austria, School of Informatics, Communications and Media, Softwarepark 11, 4232 Hagenberg, Austria
| | - Viktoria Dorfer
- University of Applied Sciences Upper Austria, School of Informatics, Communications and Media, Softwarepark 11, 4232 Hagenberg, Austria
| | - Lisa Obritzberger
- University of Applied Sciences Upper Austria, School of Informatics, Communications and Media, Softwarepark 11, 4232 Hagenberg, Austria
| | - Tanja Endmayr
- University of Applied Sciences Upper Austria, School of Applied Health and Social Sciences, Garnisonstrasse 21, 4020 Linz, Austria
| | - Christian Gabriel
- Red Cross Transfusion Service for Upper Austria, Krankenhausstrasse 7, 4020 Linz, Austria
| | - Stephan M. Winkler
- University of Applied Sciences Upper Austria, School of Informatics, Communications and Media, Softwarepark 11, 4232 Hagenberg, Austria
| | - Jaroslaw Jacak
- University of Applied Sciences Upper Austria, School of Applied Health and Social Sciences, Garnisonstrasse 21, 4020 Linz, Austria
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11
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Autologous Infant and Allogeneic Adult Red Cells Demonstrate Similar Concurrent Post-Transfusion Survival in Very Low Birth Weight Neonates. J Pediatr 2015; 167:1001-6. [PMID: 26363547 PMCID: PMC4661104 DOI: 10.1016/j.jpeds.2015.08.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 07/01/2015] [Accepted: 08/07/2015] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Based on the hypothesis that neonatal autologous red blood cell (RBC) survival (RCS) is substantially shorter than adult RBC, we concurrently tracked the survival of transfused biotin-labeled autologous neonatal and allogeneic adult RBC into ventilated, very low birth weight infants. STUDY DESIGN RBC aliquots from the first clinically ordered, allogeneic adult RBC transfusion and from autologous infant blood were labeled at separate biotin densities (biotin-labeled RBC [BioRBC]) and transfused. Survival of these BioRBCs populations were concurrently followed over weeks by flow cytometric enumeration using leftover blood. Relative tracking of infant autologous and adult allogeneic BioRBC was analyzed by linear mixed modeling of batched weekly data. When possible, Kidd antigen (Jka and Jkb) mismatches between infant and donor RBCs were also used to track these 2 populations. RESULTS Contrary to our hypothesis, concurrent tracking curves of RCS of neonatal and adult BioRBC in 15 study infants did not differ until week 7, after which neonatal RCS became shortened to 59%-79% of adult enumeration values for uncertain reasons. Analysis of mismatched Kidd antigen RBC showed similar results, thus, confirming that BioRBC tracking is not perturbed by biotin RBC labeling. CONCLUSIONS This study illustrates the utility of multidensity BioRBC labeling for concurrent measurement of RCS of multiple RBC populations in vivo. The similar RCS results observed for neonatal and adult BioRBCs transfused into very low birth weight infants provides strong evidence that the circulatory environment of the newborn infant, not intrinsic infant-adult RBC differences, is the primary determinant of erythrocyte survival. TRIAL REGISTRATION Clinicaltrials.gov: NCT00731588.
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12
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Bloch EM, Sakac D, Branch HA, Cserti-Gazdewich C, Pendergrast J, Pavenski K, Branch DR. Western immunoblotting as a new tool for investigating direct antiglobulin test-negative autoimmune hemolytic anemias. Transfusion 2015; 55:1529-37. [DOI: 10.1111/trf.13082] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 02/08/2015] [Accepted: 02/10/2015] [Indexed: 11/27/2022]
Affiliation(s)
- Evgenia M. Bloch
- Department of Laboratory Medicine and Pathobiology; University of Toronto
- Centre for Innovation; Canadian Blood Services
| | | | | | - Christine Cserti-Gazdewich
- Department of Laboratory Medicine and Pathobiology; University of Toronto
- Centre for Innovation; Canadian Blood Services
- Department of Medicine; University of Toronto
- Toronto General Hospital, University Health Network
| | - Jacob Pendergrast
- Department of Laboratory Medicine and Pathobiology; University of Toronto
- Department of Medicine; University of Toronto
- Toronto General Hospital, University Health Network
| | - Katerina Pavenski
- Department of Laboratory Medicine and Pathobiology; University of Toronto
- St. Michael's Hospital; Toronto Ontario Canada
| | - Donald R. Branch
- Department of Laboratory Medicine and Pathobiology; University of Toronto
- Centre for Innovation; Canadian Blood Services
- Department of Medicine; University of Toronto
- Toronto General Hospital, University Health Network
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13
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Alzate MA, Manrique LG, Bolaños NI, Duarte M, Coral-Alvarado P, González JM. Simultaneous detection of IgG, IgM, IgA complexes and C3d attached to erythrocytes by flow cytometry. Int J Lab Hematol 2014; 37:382-9. [PMID: 25269888 DOI: 10.1111/ijlh.12297] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2014] [Accepted: 09/02/2014] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Immune complexes attached to erythrocyte membrane are involved in autoimmune hemolytic anemia (AIHA) pathogenesis. Currently, direct antiglobulin test (DAT) is used for AIHA diagnosis; however, its performance can be variable. The aim of this study was to design a flow cytometry protocol for simultaneous detection of IgG, IgM, IgA immune complexes and C3d attached to erythrocytes in AIHA patients . METHODS A procedure was standardized for assessing independent or simultaneous IgG, IgM, IgA immune complexes and C3d, which were detected using secondary antibodies. The protocol developed was applied to blood samples of patients with AIHA, donors at risk of developing the disease, and healthy controls. RESULTS Twenty-four blood samples were assessed: nine patients with AIHA, five donors at risk of developing the disease, and 10 healthy controls. In the AIHA group, all were positive for C3d, seven for IgG, four for IgA, and one for IgM. Two AIHA patients that were negative for DAT-IgG and C3d were positive for C3d by flow cytometry. CONCLUSION Flow cytometry is a consistent method for identifying the presence of IgG, IgM, IgA immune complexes and C3d attached to erythrocytes and can be helpful for understanding the mechanisms involved in AIHA pathogenesis.
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Affiliation(s)
- M A Alzate
- Grupo de Ciencias Básicas Médicas, School of Medicine, Universidad de los Andes, Bogotá, DC, Colombia
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14
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Meulenbroek EM, Wouters D, Zeerleder S. Methods for quantitative detection of antibody-induced complement activation on red blood cells. J Vis Exp 2014:e51161. [PMID: 24514151 DOI: 10.3791/51161] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Antibodies against red blood cells (RBCs) can lead to complement activation resulting in an accelerated clearance via complement receptors in the liver (extravascular hemolysis) or leading to intravascular lysis of RBCs. Alloantibodies (e.g. ABO) or autoantibodies to RBC antigens (as seen in autoimmune hemolytic anemia, AIHA) leading to complement activation are potentially harmful and can be - especially when leading to intravascular lysis - fatal(1). Currently, complement activation due to (auto)-antibodies on RBCs is assessed in vitro by using the Coombs test reflecting complement deposition on RBC or by a nonquantitative hemolytic assay reflecting RBC lysis(1-4). However, to assess the efficacy of complement inhibitors, it is mandatory to have quantitative techniques. Here we describe two such techniques. First, an assay to detect C3 and C4 deposition on red blood cells that is induced by antibodies in patient serum is presented. For this, FACS analysis is used with fluorescently labeled anti-C3 or anti-C4 antibodies. Next, a quantitative hemolytic assay is described. In this assay, complement-mediated hemolysis induced by patient serum is measured making use of spectrophotometric detection of the released hemoglobin. Both of these assays are very reproducible and quantitative, facilitating studies of antibody-induced complement activation.
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Affiliation(s)
- Elisabeth M Meulenbroek
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory Academic Medical Center, University of Amsterdam
| | - Diana Wouters
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory Academic Medical Center, University of Amsterdam
| | - Sacha Zeerleder
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory Academic Medical Center, University of Amsterdam.,Department of Hematology, Academic Medical Center, University of Amsterdam;
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Beck Z, Jagodzinski LL, Eller MA, Thelian D, Matyas GR, Kunz AN, Alving CR. Platelets and erythrocyte-bound platelets bind infectious HIV-1 in plasma of chronically infected patients. PLoS One 2013; 8:e81002. [PMID: 24282562 PMCID: PMC3839895 DOI: 10.1371/journal.pone.0081002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Accepted: 10/08/2013] [Indexed: 01/24/2023] Open
Abstract
Chronic HIV-1 infection is associated with persistent viremia in most patients, but it remains unclear how free virus may survive the potential hostile effects of plasma. We investigated whether sites might exist on the surfaces of circulating blood cells for protection of infectious HIV-1 particles. Red blood cells (RBC) either from blood of uninfected normal individuals, or from blood obtained without EDTA from chronically infected HIV-1 patients, invariably contained a small number of RBC having attached platelets as determined by flow cytometry, light microscopy, and immunofluorescence microscopy. After mixing normal RBC with platelet-rich plasma, discrete populations of RBC, platelets, and complexes of platelets attached to RBC were purified by fluorescence-activated cell sorting. Upon incubation of purified cells or platelets with HIV-1 followed by washing and co-incubation with CD4-positive peripheral blood mononuclear cells (PBMC), platelets, and platelet-RBC complexes, but not platelet-free RBC, caused infection of PBMC. Infection was prevented by pre-treating the platelet-RBC complexes with EDTA. Plasma and RBC (comprising a RBC/platelet-RBC mixture) from chronically infected patients with low viral loads were also co-incubated with PBMC ex vivo to determine the presence of infectious HIV-1. All freshly isolated plasmas from the HIV-1-infected donors, obtained in the absence of anticoagulant, were noninfectious. Interestingly, the RBC from most of the patients caused cell-cell infection of PBMC that was prevented by stripping the RBC with EDTA. A monoclonal antibody to DC-SIGN partially inhibited cell-cell HIV-1 infection of PBMC by normal RBC pre-incubated with platelets and HIV-1. We conclude: (a) platelet-free EDTA-free plasma from chronically infected HIV-1 patients, although containing viral RNA, is an environment that lacks detectable infectious HIV-1; (b) platelets and platelet-RBC complexes, but not purified RBC, bind infectious HIV-1; (c) DC-SIGN, and possibly other C-type lectins, may represent binding sites for infectious HIV-1 on platelets and platelet-RBC complexes.
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Affiliation(s)
- Zoltan Beck
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Silver Spring, Maryland, United States of America
| | - Linda L. Jagodzinski
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
| | - Michael A. Eller
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Silver Spring, Maryland, United States of America
| | - Doris Thelian
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Silver Spring, Maryland, United States of America
| | - Gary R. Matyas
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
| | - Anjali N. Kunz
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
| | - Carl R. Alving
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
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