1
|
Hutspardol S, Boyd LF, Zamar D, Sham L, Kalar D, Mi J, Marcon K, Shih AW. The impact of an antibody investigation algorithm emphasizing specificity on reducing potential false-positive warm autoantibody detection at a Canadian tertiary care centre. Vox Sang 2024; 119:53-61. [PMID: 37874787 DOI: 10.1111/vox.13552] [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: 06/12/2023] [Revised: 09/18/2023] [Accepted: 10/06/2023] [Indexed: 10/26/2023]
Abstract
BACKGROUND AND OBJECTIVES To reduce potential false-positive warm autoantibody (WAA) by solid-phase red cell adherence assay (SPRCA), our centre implemented a new antibody investigation algorithm (AIA) by classifying cases with panreactive SPRCA but negative saline-indirect antiglobulin test as 'antibody of undetermined significance' (AUS) after excluding clinically significant antibodies. We assessed the effects of the new AIA and subsequent alloantibody formation in patients with AUS. MATERIALS AND METHODS Samples from patients with positive SPRCA screens between 1 September 2017 and 31 August 2021 were selected for the study. Frequencies of antibodies classified by the old and new AIAs were compared using Fisher's exact test. Patient demographics, transfusion history and antibody formation in cases of AUS were collected. RESULTS A significant reduction in potential WAA frequencies from 127/1167 (11%) to 53/854 (6%) was observed (p < 0.001) when compared between the old and new AIAs among 2021 positive SPRCA antibody screens. While no patients with AUS later transitioned to potential WAA using the new AIA, four patients developed alloantibodies, including anti-E, anti-C, both anti-C and anti-E, and anti-Wra . CONCLUSION A significant reduction in the frequencies of potential false-positive WAA detection at our centre was observed after implementing the new AIA, leading to less resource and phenotypically matched red blood cell (RBC) use. Some patients still developed subsequent RBC alloimmunization, so clinically relevant alloantibodies should be carefully excluded before determining AUS, taking forming or evanescent antibodies into consideration.
Collapse
Affiliation(s)
- Sakara Hutspardol
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Pathology and Laboratory Medicine, Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada
| | - Lyz Frances Boyd
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - David Zamar
- Department of Pathology and Laboratory Medicine, Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada
| | - Lawrence Sham
- Department of Pathology and Laboratory Medicine, Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada
| | - Debbie Kalar
- Department of Pathology and Laboratory Medicine, Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada
| | - Jian Mi
- Department of Pathology and Laboratory Medicine, Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada
| | - Krista Marcon
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Pathology and Laboratory Medicine, Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada
| | - Andrew W Shih
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Pathology and Laboratory Medicine, Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada
- Centre for Blood Research, University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
2
|
de Albuquerque da Veiga Conrado MC, Cardoso RA, Dezan MR, Oliveira VB, Neto ADC, Ziza KC, Krieger JE, Pereira AC, Sabino EC, Rocha V, Mendrone-Júnior A, Dinardo CL. Prevalence and laboratorial determinants of the clinical relevance of antibodies of undetermined specificity. Vox Sang 2019; 114:616-621. [PMID: 31183870 DOI: 10.1111/vox.12797] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 04/18/2019] [Accepted: 05/05/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVES Antibodies of unknown specificity (AUS) are frequently identified in the pre-transfusion testing. These antibodies can be insignificant or potentially cause post-transfusion haemolysis. Information about the prevalence of clinically relevant AUS is still lacking. Our aim was to predict the potential clinical relevance of AUS using the monocyte monolayer assay (MMA) and to identify the clinical and laboratorial determinants of AUS' significance. MATERIALS AND METHODS Antibodies of unknown specificity identified at a single institution from 2015-2017 were evaluated through MMA. A monocyte index (MI) of more than 5% was predictive of potential post-transfusion haemolysis. RESULTS Thirty-two patients with AUS were included in the study. Of the studied AUS, 37·5% (12/32) presented with a monocyte index (MI) more than 5%. In the group of significant AUS, 41·7% of the patients presented with sickle cell disease (SCD) and the AUS were associated with Rh antibodies in 75% of the cases. In the group of insignificant AUS, only 10% of the patients had SCD and the association with Rh antibodies was detected in 20% of the cases. The presence of Rh antibodies was independently associated with the AUS clinical relevance (P = 0·012). CONCLUSION More than one-third of the AUS are potentially clinically relevant, and the association with Rh antibodies is predictive of AUS relevance. Services must honour AUS in the pre-transfusion process in order to ensure transfusion safety.
Collapse
Affiliation(s)
| | | | | | | | - Abel da Costa Neto
- Serviço de Hematologia, Hemoterapia e Terapia Celular, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Karen Chinoca Ziza
- Serviço de Hematologia, Hemoterapia e Terapia Celular, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - José Eduardo Krieger
- Laboratory of Genetics and Molecular Cardiology, Heart Institute (InCor), São Paulo, Brazil
| | | | | | - Vanderson Rocha
- Serviço de Hematologia, Hemoterapia e Terapia Celular, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,Department of Hematology, Churchill Hospital NHS BT, Oxford University, Oxford, UK
| | | | - Carla Luana Dinardo
- Fundação Pró-Sangue, Hemocentro de São Paulo, São Paulo, Brazil.,Institute of Tropical Medicine, Universidade de São Paulo, São Paulo, Brazil
| |
Collapse
|
3
|
Reese EM, Nelson RC, Flegel WA, Byrne KM, Booth GS. Critical Value Reporting in Transfusion Medicine: A Survey of Communication Practices in US Facilities. Am J Clin Pathol 2017; 147:492-499. [PMID: 28371931 PMCID: PMC5848379 DOI: 10.1093/ajcp/aqx025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES While critical value procedures have been adopted in most areas of the clinical laboratory, their use in transfusion medicine has not been reviewed in detail. The results of this study present a comprehensive overview of critical value reporting and communication practices in transfusion medicine in the United States. METHODS A web-based survey was developed to collect data on the prevalence of critical value procedures and practices of communicating results. The survey was distributed via email to US hospital-based blood banks. RESULTS Of 123 facilities surveyed, 84 (68.3%) blood banks had a critical value procedure. From a panel of 23 common blood bank results, nine results were selected by more than 70% of facilities as either a critical value or requiring rapid communication as defined by an alternate procedure. CONCLUSIONS There was overlap among results communicated by facilities with and without a critical value procedure. The most frequently communicated results, such as incompatible crossmatch for RBC units issued uncrossmatched, delay in finding compatible blood due to a clinically significant antibody, and transfusion reaction evaluation suggestive of a serious adverse event, addressed scenarios associated with the leading reported causes of transfusion-related fatalities.
Collapse
Affiliation(s)
- Erika M. Reese
- From the Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, MD
- Laboratories of Pathology, University of Maryland Medical Center, Baltimore
| | - Randin C. Nelson
- From the Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, MD
- Department of Pathology, Staten Island University Hospital, Staten Island, NY
| | - Willy A. Flegel
- From the Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, MD
| | - Karen M. Byrne
- From the Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, MD
| | - Garrett S. Booth
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN
| |
Collapse
|
4
|
Hart S, Cserti-Gazdewich CM, McCluskey SA. Red cell transfusion and the immune system. Anaesthesia 2014; 70 Suppl 1:38-45, e13-6. [DOI: 10.1111/anae.12892] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2014] [Indexed: 01/28/2023]
Affiliation(s)
- S. Hart
- Department of Anaesthesia and Pain Management; Toronto General Hospital; University Health Network; Toronto Ontario Canada
| | - C. M. Cserti-Gazdewich
- Department of Haematology; Toronto General Hospital; University Health Network; Toronto Ontario Canada
| | - S. A. McCluskey
- Department of Anaesthesia and Pain Management; Toronto General Hospital; University Health Network; Toronto Ontario Canada
| |
Collapse
|
5
|
Abstract
OBJECTIVES The full crossmatch is traditionally the final step in compatibility testing, acting as a serologic double check for ABO compatibility and unexpected RBC antibodies. In this review, we discuss the development of electronic crossmatch (EXM), an approach for determining when EXM can be used, and its strengths and weaknesses. METHODS Because EXM relies on highly sensitive screening assays, antibodies are frequently encountered whose clinical significance must be investigated and interpreted. Our approach is to obtain further history, perform enhanced tube testing, and consider tests of immune reactivity or RBC survival. RESULTS For those without clinically significant antibodies, we found two alternatives: immediate-spin crossmatch (IS XM) and EXM. IS XM is prone to error related to serologic interference, whereas EXM depends on the accuracy of the sample label, accurate data entry, and informatics to avoid errors. CONCLUSION EXM is an alternative to the serologic test in patients who have no clinically significant antibodies.
Collapse
Affiliation(s)
- Marshall A. Mazepa
- Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill
| | - Jay S. Raval
- Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill
| | - Yara A Park
- Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill
| | | |
Collapse
|