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Sanders DR. Comparison of solid-phase red cell adherence and microcolumn agglutination technology using untreated and enzyme-treated red blood cells. Immunohematology 2023; 39:166-171. [PMID: 38179782 DOI: 10.2478/immunohematology-2023-024] [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] [Indexed: 01/06/2024]
Abstract
Screening for clinically significant antibodies is crucial in transfusion medicine and is a routine part of pre-transfusion testing. The indirect antiglobulin test (IAT) is the most reliable and effective test for detecting clinically significant alloantibodies reacting at the antihuman globulin phase. Two of the main methods used for antibody detection and identification are solid-phase red cell adherence (SPRCA) and microcolumn agglutination technology (CAT), with or without enzyme-treated red blood cells (RBCs). This study was undertaken to detect and identify alloantibodies by performing antibody screen (ABS) and antibody identification (ABID) testing using SPRCA and CAT, with and without ficin-treated RBCs. Residual patient samples collected between 1 December 2020 and 19 May 2021 were saved, de-identified, and frozen at ≤-30°C before testing for alloantibodies. Seventy antibodies were detected in 53 samples among the 203 samples that underwent an ABS. Of those samples, 150 (73.0%) were nonreactive, 47 (23.1%) yielded positive results with both CAT and SPRCA, and six (3.0%) yielded positive ABS results with SPRCA only. Fifty-three samples that underwent ABID by both methods yielded eight samples with antibodies identified by SPRCA only. Additional enhancement of the CAT method by the use of ficin-treated RBCs was required to detect seven of the eight SPRCA-only antibodies; one sample remained nonreactive regardless. SPRCA testing detected clinically significant antibodies without the addition of enzyme-treated RBCs that was necessary in the CAT testing.
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Affiliation(s)
- D R Sanders
- SBBCM, Blood Bank Technical Specialist-Central, Immucor, Inc., 32062 DiStefano Court, Fraser, MI 48026, United States
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2
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Yılmaz U, Yaşar A, Öngören Ş, Başlar Z, Ar MC. Short-Term Clinical Outcomes of Packed Red Blood Cell Transfusions with Isolated Enzyme-Phase Crossmatch Incompatibility: A Single-Center Cross-Sectional Study. Turk J Haematol 2023; 40:50-63. [PMID: 36510383 PMCID: PMC9979731 DOI: 10.4274/tjh.galenos.2022.2022.0284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Acute hemolytic transfusion reactions (AHTRs) are feared complications of packed red blood cell (PRBC) transfusions. This study aimed to investigate the clinical consequences of isolated enzyme-phase crossmatch-incompatible PRBC transfusions by clinically observing all events during the study period at a single institution with the primary goal of detecting AHTRs. Ninety-four transfusions of interest were administered during the study period. Laboratory investigations were adequate in 73 episodes, where no AHTR developed and a mean hemoglobin concentration rise of 1.1 g/dL was documented. Three transfusions were terminated prematurely; however, further investigations ruled out AHTR. The remaining 21 transfusions were also completed uneventfully without noteworthy clinical deterioration. This study’s results provide clinical validation to omit pretransfusion screening with enzyme-phase crossmatch and document the safety and short-term efficacy of isolated enzyme-phase incompatible transfusions. The findings may encourage future clinical research to better understand the long-term efficacy of such transfusions, which may be valuable for transfusion-dependent patients.
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Affiliation(s)
- Umut Yılmaz
- İstanbul University-Cerrahpaşa, Cerrahpaşa Medical Faculty, Department of Internal Medicine, Division of Hematology, İstanbul, Türkiye,* Address for Correspondence: İstanbul University-Cerrahpaşa, Cerrahpaşa Medical Faculty, Department of Internal Medicine, Division of Hematology, İstanbul, Türkiye E-mail:
| | - Alper Yaşar
- İstanbul University-Cerrahpaşa, Cerrahpaşa Medical Faculty, Department of Internal Medicine, İstanbul, Türkiye
| | - Şeniz Öngören
- İstanbul University-Cerrahpaşa, Cerrahpaşa Medical Faculty, Department of Internal Medicine, Division of Hematology, İstanbul, Türkiye
| | - Zafer Başlar
- İstanbul University-Cerrahpaşa, Cerrahpaşa Medical Faculty, Department of Internal Medicine, Division of Hematology, İstanbul, Türkiye
| | - Muhlis Cem Ar
- İstanbul University-Cerrahpaşa, Cerrahpaşa Medical Faculty, Department of Internal Medicine, Division of Hematology, İstanbul, Türkiye
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Titze TL, Hamnvik LHD, Hauglum IM, Carlsen AET, Tjeldhorn L, Nguyen NT, Akkök ÇA. Management of Wrong Blood Transfusion to an RhD Negative Woman in Labor. Int J Womens Health 2023; 15:1-6. [PMID: 36628052 PMCID: PMC9826603 DOI: 10.2147/ijwh.s390661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 12/06/2022] [Indexed: 01/12/2023] Open
Abstract
Blood transfusion is life-saving in massive hemorrhage. Before pre-transfusion tests with ABO and RhD typing results are available, O RhD negative packed red blood cell (PRBC) units are used without cross-matching in emergency. RhD negative girls and women of child-bearing age should always receive RhD negative blood transfusions to prevent RhD-alloimmunization because anti-D-related hemolytic disease of fetus and newborn (HDFN) can result in mild to severe anemia, and in a worst-case scenario death of an RhD positive fetus and/or newborn. However, "wrong blood to wrong patient" happens unintentionally. Here we report an emergency blood transfusion with one unit of RhD positive PRBCs to an RhD negative young woman when estimated blood loss was 2500 mL during delivery and surgical removal of retained placenta. Realizing the mistake, management with high dose anti-D immunoglobulin (Ig) was initiated to remove the RhD positive red blood cells (RBCs) from the patient's circulation. Such mitigation is recommended only for girls and women of child-bearing age. Follow-up was performed by flow cytometry until RhD positive RBCs were no longer detected. Ten months after the delivery, antibody screening was negative. However, we still do not know whether we managed to prevent RhD-alloimmunization.
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Affiliation(s)
- Thomas Larsen Titze
- Department of Laboratory Medicine, Vestre Viken Health Trust, Drammen, Norway
| | | | - Inga Marie Hauglum
- Department of Laboratory Medicine, Vestre Viken Health Trust, Drammen, Norway
| | | | - Lena Tjeldhorn
- Department of Immunology and Transfusion Medicine, Oslo University Hospital, Oslo, Norway
| | - Nhan Trung Nguyen
- Department of Immunology and Transfusion Medicine, Oslo University Hospital, Oslo, Norway
| | - Çiğdem Akalın Akkök
- Department of Immunology and Transfusion Medicine, Oslo University Hospital, Oslo, Norway,Correspondence: Çiğdem Akalın Akkök, Department of Immunology and Transfusion Medicine, Oslo University Hospital, Ullevaal, Kirkeveien 166, Oslo, N-0407, Norway, Tel +47 92 03 47 47, Fax + 47 22 11 88 50, Email
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Takeshita A, Watanabe H, Yamada C, Nadarajan VS, Permpikul P, Sinkitjasub A, Natalie CPH, Zhao S, Han KS, Kim DW, Suh JS, Kim HO, Kawabata K, Ishimaru K, Ohtomo N, Yamada N, Tomoda Y, Yurugi K, Ohto H. Erythrocyte Alloimmunity and Genetic Variance: Results from the Collaborative Study of Alloimmunity to Antigen Diversity in Asian Populations (All ADP). Transfus Apher Sci 2020; 59:102944. [PMID: 33228922 DOI: 10.1016/j.transci.2020.102944] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
As an East-Asian international study, we evaluated erythrocyte alloimmunity by gender and history of transfusion or pregnancy. In total, data from more than 1,826,000 patients were analyzed, from whom 26,170 irregular erythrocyte antibodies were detected in 22,653 cases. Antibody frequencies in these cases were as follows: anti-E, 26.8%; anti-Lea, 20.0%; anti-P1, 7.1%; anti-M, 6.4%; anti-Mia, 5.6%; anti-c + E, 5.6%; anti-Leb, 4.6%; anti-D, 2.8%; anti-Fyb, 2.6%; anti-Lea+Leb, 2.5%; anti-Dia, 2.0%; and others. For pregnant patients, anti-D (12.7%) was statistically more frequent. For transfused patients, anti-E (37.3%), anti-c + E (9.5%), anti-C + e (3.3%) and anti-Jka (3.1%) were significantly more frequent.
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Affiliation(s)
- Akihiro Takeshita
- Transfusion and Cell Therapy, Hamamatsu University School of Medicine, Hamamatsu, Japan.
| | - Hiroko Watanabe
- Transfusion and Cell Therapy, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Chiaki Yamada
- Transfusion and Cell Therapy, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | | | - Parichart Permpikul
- Transfusion Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Attapong Sinkitjasub
- Blood Bank, Taksin Hospital, Medical Service Department of Bangkok Metropolitan, Bangkok, Thailand
| | - Chan Pui Ha Natalie
- Blood Bank, Prince of Wales Hospital, Hong Kong Special Administrative Region
| | - Shuming Zhao
- Transfusion Medicine, Southwest Hospital, Third Military Medical University, Chongqing, China
| | | | - Dae Won Kim
- Laboratory Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Soul, South Korea
| | - Jang Soo Suh
- Laboratory Medicine, Kyungpook National University Hospital, Kyungpook National University, School of Medicine, Daegu, South Korea
| | - Hyun Ok Kim
- Laboratory Medicine, Yonsei University College of Medicine, Soul, South Korea
| | - Kinuyo Kawabata
- Blood Transfusion and Transplantation Immunology, Fukushima Medical University, Fukushima, Japan
| | - Ken Ishimaru
- Blood Service Headquarters, Japanese Red Cross Society, Tokyo, Japan
| | - Naoki Ohtomo
- Center for Transfusion Medicine and Cell Therapy, Tokyo Medical and Dental University, Tokyo, Japan
| | - Naotomo Yamada
- Department of Transfusion Medicine, Saga University, Saga, Japan
| | - Yutaka Tomoda
- Laboratory Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Kimiko Yurugi
- Clinical Laboratory, Kyoto University Hospital, Kyoto, Japan
| | - Hitoshi Ohto
- Blood Service Headquarters, Japanese Red Cross Society, Tokyo, Japan
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Alharbi A, Batarfi K, Kiseo P, Saleh J, Shareefi A, Nourah ALH. Detection of anti-f on a 51-year-old Saudi female. JOURNAL OF APPLIED HEMATOLOGY 2020. [DOI: 10.4103/joah.joah_59_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Sawierucha J, Posset M, Hähnel V, Johnson CL, Hutchinson JA, Ahrens N. Comparison of two column agglutination tests for red blood cell antibody testing. PLoS One 2019; 13:e0210099. [PMID: 30596807 PMCID: PMC6312228 DOI: 10.1371/journal.pone.0210099] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 12/16/2018] [Indexed: 11/25/2022] Open
Abstract
Background Several sensitive methods are available for red blood cell (RBC) antibody screening. Among these, gel and glass card systems have demonstrated comparably good performance in retrospective studies and are widely used in routine patient diagnostics, but their performance in prospective studies has not been sufficiently characterised. Patients and methods Gel card (Bio-Rad DiaMed) and glass bead-based (Ortho Clinical Diagnostics) column agglutination technologies were used to screen for antibodies prospectively (group A) and for antibody identification in stored and fresh samples known to contain RBC antibodies retrospectively (group B). Untreated reagent RBCs and either papain-treated (Bio-Rad) or ficin-treated panel C cells (Ortho) were used for antibody identification. Results RBC-reactive antibodies were detected in 22 of 1000 group A samples, three of which tested positive only by gel card agglutination, and four only by glass bead agglutination (including one false positive each). Group B comprised 202 sera with known antibodies: 33 of these samples contained 36 antibodies detected only by gel card agglutination, whereas 9 samples contained antibodies detectable only by glass bead-based agglutination. Discrepancies mostly involved weak antibodies reactive by enzyme only. Two sera contained antibody mixtures that neither system detected completely. Of note, in antibody differentiation batches one and two, anti-Lua was reactive in 7 of 7 and 1 of 8 samples, respectively. Conclusion Both column agglutination tests for red cell antibodies had equal sensitivity and specificity with unstored samples. In stored samples, weak and enzyme-only antibodies were more frequently detected with the gel card system.
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Affiliation(s)
- Jonas Sawierucha
- Institute for Clinical Chemistry and Laboratory Medicine, Transfusion Medicine, University Hospital Regensburg, Regensburg, Germany
| | - Marion Posset
- Institute for Clinical Chemistry and Laboratory Medicine, Transfusion Medicine, University Hospital Regensburg, Regensburg, Germany
| | - Viola Hähnel
- Institute for Clinical Chemistry and Laboratory Medicine, Transfusion Medicine, University Hospital Regensburg, Regensburg, Germany
| | - Christian L. Johnson
- Institute for Clinical Chemistry and Laboratory Medicine, Transfusion Medicine, University Hospital Regensburg, Regensburg, Germany
| | | | - Norbert Ahrens
- Institute for Clinical Chemistry and Laboratory Medicine, Transfusion Medicine, University Hospital Regensburg, Regensburg, Germany
- * E-mail:
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Pessoni LL, Ferreira MA, Silva JCRD, Alcântara KCD. Red blood cell alloimmunization among hospitalized patients: transfusion reactions and low alloantibody identification rate. Hematol Transfus Cell Ther 2018; 40:326-331. [PMID: 30370410 PMCID: PMC6200715 DOI: 10.1016/j.htct.2018.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 04/05/2018] [Indexed: 11/20/2022] Open
Abstract
Background Unexpected red blood cell alloantibodies can cause hemolytic transfusion reactions. In this study, the prevalence of alloimmunization, the rate of identification of alloantibodies and the rate of blood transfusion reactions among transfused patients were identified in a clinical emergency hospital in Brazil. Methods Transfusions and clinical records of patients who had a positive indirect antiglobulin test between January and December 2013 were analyzed. Results Of 1169 patients who received blood transfusions, 28 had positive indirect antiglobulin tests, with one patient having two positive tests at different times, resulting in 29 positive tests during the period of this study. Alloantibodies were identified in 58.6% (17/29) of the cases. In 27.5% (8/29), identification was inconclusive and it was not possible to confirm alloimmunization. The rate of red blood cell alloimmunization was 1.71% (21/1169). Of 21 cases of alloimmunization, four (19%) were unidentified due to an unusual agglutination profile. All identified alloantibodies were clinically significant (10/17 anti-Rh, 5/17 anti-Kell and 2/17 anti-MNS). In two patients who had positive indirect antiglobulin tests, one had an unidentified alloantibody, and the other had an inconclusive test and developed a hemolytic transfusion reaction. Conclusion The prevalence of clinically important red blood cell alloantibodies and hemolytic transfusion reactions among patients with unidentified alloantibodies suggests that specific laboratory techniques should be performed to identify alloantibodies in cases of pan-reactivity or autoantibodies to improve transfusion safety.
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Affiliation(s)
- Lívia Lara Pessoni
- Hospital das Clinicas da Universidade Federal de Goiás (HC/UFG), Goiânia, GO, Brazil
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Hill BC, Hanna CA, Adamski J, Pham HP, Marques MB, Williams LA. Ficin-Treated Red Cells Help Identify Clinically Significant Alloantibodies Masked as Reactions of Undetermined Specificity in Gel Microtubes. Lab Med 2016; 48:24-28. [DOI: 10.1093/labmed/lmw062] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
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Kay B, Poisson JL, Tuma CW, Shulman IA. Anti-Jkathat are detected by solid-phase red blood cell adherence but missed by gel testing can cause hemolytic transfusion reactions. Transfusion 2016; 56:2973-2979. [DOI: 10.1111/trf.13782] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 07/15/2016] [Accepted: 07/17/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Brian Kay
- Los Angeles County + USC Medical Center and Keck School of Medicine of USC; Los Angeles California
| | - Jessica L. Poisson
- Los Angeles County + USC Medical Center and Keck School of Medicine of USC; Los Angeles California
| | - Christopher W. Tuma
- Los Angeles County + USC Medical Center and Keck School of Medicine of USC; Los Angeles California
| | - Ira A. Shulman
- Los Angeles County + USC Medical Center and Keck School of Medicine of USC; Los Angeles California
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Kim DJ, Sung HH, Park CE. Investigation of Red Cell Antiobody Screening Tests Gyeonggi Areas. KOREAN JOURNAL OF CLINICAL LABORATORY SCIENCE 2016. [DOI: 10.15324/kjcls.2016.48.1.36] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Dai-Joong Kim
- Department of Laboratory Medicine, Bundang Jesaeng Hospital, Seongnam 13590, Korea
| | - Hyun-Ho Sung
- Department of Clinical Laboratory Science, Dongnam Health University, Suwon 16328, Korea
| | - Chang-Eun Park
- Department of Biomedical Laboratory Science, Molecular Diagnostics Research Institute, Namseoul University, Cheonan 31020, Korea
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