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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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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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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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Davis BH. Enumeration of Fetal Red Blood Cells, Hemoglobin-Specific RBC Cells, and F Reticulocytes in Human Blood. ACTA ACUST UNITED AC 2020; 90:e56. [PMID: 31899598 DOI: 10.1002/cpcy.56] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Recent advances in analytical cytometry have improved diagnostic tools for the study of erythropoiesis in anemic patients and resolution of differential diagnosis in diseases of the erythron. This article presents three applications of red blood cell (RBC) analysis-quantitation of fetal red cells, F-cell enumeration, and F-reticulocyte analysis-which improve diagnostic precision, sensitivity, and specificity, and provide better laboratory indicators of therapeutic efficacy in a variety of hematologic and obstetric disorders. Such advances also include the measurement and quantitation of RBC hemoglobins and their relative ribonucleic acid levels. These advances not only promise to improve diagnostic accuracy and laboratory precision over techniques such as the traditional manual reticulocyte counting method and the Kleihauer-Betke stain method for evaluating fetomaternal hemorrhage (FMH), but also serve as tools for newer assays of anemia diagnosis and improved clinical outcomes. In addition to the primary methods, supporting techniques for preparing spiked controls, automating data analysis, setting up a fetal hemoglobin acquisition protocol, and assaying reticulocytes using thiazole orange are also presented. © 2019 by John Wiley & Sons, Inc.
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Affiliation(s)
- Bruce H Davis
- Department of Pathology, University of Porto, Porto, Portugal
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Cormack OM, Guilfoyle F, Flynn CM. The prevalence of an elevated F cell population in a maternal and gynaecology cohort. Transfus Med 2019; 29:369-373. [PMID: 31429147 DOI: 10.1111/tme.12625] [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: 05/04/2018] [Revised: 05/21/2019] [Accepted: 07/27/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES This study aimed to determine F cell prevalence in a cohort of maternal and gynaecology specimens using QuikQuant anti-HbF flow cytometry (FC) kit and to investigate if the presence of maternal F cells can lead to fetomaternal haemorrhage (FMH) overestimation. BACKGROUND The gold standard to estimate FMH is the Kleihauer-Betke test (KBT). The KBT has proved to be insufficiently sensitive to detect low numbers of circulating fetal cells due to the presence of maternal F cells. At present, the prevalence of false positive KBT results due to raised maternal F cell population, defined as >5%, is poorly characterised. METHODS A total of 120 specimens were tested for the presence of F cells and fetal cells by KBT and anti-HbF FC. The results calculated were compared to determine FMH overestimation. RESULTS Of our cohort, 32% showed an elevated F cell population, of which 69% (27 of 39) were clinically significant according to KBT (>2 mL FMH). The mean FMH volumes by KBT and anti-HbF FC were 3·90 mL (0·20-35·40 mL) and 4·09 mL (0·20-9·70 mL), respectively. CONCLUSION The study highlighted that an elevated F cell level could be found in the cohort tested, with an F cell level of >10% causing significant FMH overestimation by KBT.
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Affiliation(s)
- O M Cormack
- Haematology Laboratory, Pathology Department, Coombe Women and Infants University Hospital, Dublin, Ireland
| | - F Guilfoyle
- Haematology Laboratory, Pathology Department, Coombe Women and Infants University Hospital, Dublin, Ireland
| | - C M Flynn
- Consultant Haematologist, St. James Hospital and Coombe Women and Infants University, Dublin, Ireland
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Wong L, Hunsberger BC, Bruce Bagwell C, Davis BH. Automated quantitation of fetomaternal hemorrhage by flow cytometry for HbF-containing fetal red blood cells using probability state modeling. Int J Lab Hematol 2013; 35:548-54. [DOI: 10.1111/ijlh.12060] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Accepted: 01/16/2013] [Indexed: 11/30/2022]
Affiliation(s)
- L. Wong
- Trillium Diagnostics; LLC; Brewer ME USA
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