Cell Antibody Screening Research Articles

Polyethylene glycol antiglobulin tube versus gel microcolumn: influence on the incidence of delayed hemolytic transfusion reactions and delayed serologic transfusion reactions

Our institution has reported on delayed hemolytic transfusion reaction (DHTR) and delayed serologic transfusion reaction (DSTR) incidence changes. From January 1993 to June 2003, a polyethylene glycol (PEG) tube-based technique was used for red blood cell (RBC) antibody screen. In June 2003, a gel microcolumn technique was implemented. Impact of this on antibody detection and DHTR and DSTR incidence was investigated. Positive antibody screen frequency and antibody specificity from January 2002 to March 2003 and July 2003 to September 2004 were compared. Overall incidence of DHTR and DSTR as well as the number and identity of the RBC antibodies implicated from August 1999 through June 2003 (PEG) and July 2003 through July 2007 (gel) were compared. The mean length of hospital stay (LOS) and number of RBC units transfused per patient were compared. Equivalent numbers of antibody screens were performed with equivalent numbers of positive screens. Significant differences were not seen in the detection of clinically significant antibodies but significantly fewer clinically insignificant antibodies were detected with gel. Ninety-six DHTRs and DSTRs were diagnosed. The LOS and number of transfused RBC units were not statistically different. A significantly higher incidence of DHTRs and DSTRs was seen with PEG compared to the gel. The gel microcolumn method is similar to the PEG in detecting clinically significant antibodies but detects fewer clinically insignificant antibodies. The implementation of gel resulted in a lower incidence of DHTRs and DSTRs compared to PEG.

IMMUNOHEMATOLOGY: Novel antibody screening cells, MUT+Mur kodecytes, created by attaching peptides onto red blood cells

BACKGROUND: Antibody screening and identification panels are generally limited by the natural antigenic phenotypes present in their source donor population. However, the recent ability to attach peptides to the surface of cells has opened up the opportunity to create red blood cells (RBCs) with antigen profiles specifically designed for antibody screening and identification in a target population.STUDY DESIGN AND METHODS: Clinically significant antibodies to variant glycophorins (GPs) such as GP.Mur are more commonly seen in certain Asian populations. Using peptides representative of the MNS antigens MUT and Mur, RBC antibody screening cells were created using KODE cell surface engineering constructs. MUT‐, Mur‐, and MUT+Mur‐modified RBCs, known as kodecytes, were tested against monoclonal reagents and polyclonal sera with specificity for epitopes on GP.Mur‐positive RBCs.RESULTS: Kodecytes retained their normal expression of intrinsic blood group antigens while expressing the new epitopes attached by KODE technology. The MUT, Mur, and MUT+Mur kodecytes, although unreactive with the various monoclonal reagents, were appropriately reactive with polyclonal sera containing antibodies reactive with GP.Mur‐positive RBCs.CONCLUSIONS: This study used selected MUT and Mur peptides and KODE cell surface engineering technology to create MUT+Mur kodecytes suitable for the detection and identification of RBC antibodies in human serum or plasma. This technology has the potential to create a large range of specialized RBCs for antibody screening and identification.

Risk factors for RhD immunisation despite antenatal and postnatal anti-D prophylaxis.

ObjectiveTo identify risk factors for Rhesus D (RhD) immunisation in pregnancy, despite adequate antenatal and postnatal anti-D prophylaxis in the previous pregnancy. To generate evidence for improved primary prevention by extra administration of anti-D Ig in the presence of a risk factor.DesignCase–control study.SettingNation-wide evaluation of the Dutch antenatal anti-D-prophylaxis programme.PopulationCases: 42 RhD-immunised parae-1, recognised by first-trimester routine red cell antibody screening in their current pregnancy, who received antenatal and postnatal anti-D Ig prophylaxis (gifts of 1000 iu) in their first pregnancy. Controls: 339 parae-1 without red cell antibodies.MethodsData were collected via obstetric care workers and/or personal interviews with women.Main outcome measureSignificant risk factors for RhD immunisation in multivariate analysis.ResultsIndependent risk factors were non-spontaneous delivery (assisted vaginal delivery or caesarean section) (OR 2.23; 95% CI:1.04–4.74), postmaturity (≥42 weeks of completed gestation: OR 3.07; 95% CI:1.02–9.02), pregnancy-related red blood cell transfusion (OR 3.51; 95% CI:0.97–12.7 and age (OR 0.89/year; 95% CI:0.80–0.98). In 43% of cases, none of the categorical risk factors was present.ConclusionsIn at least half of the failures of anti-D Ig prophylaxis, a condition related to increased fetomaternal haemorrhage (FMH) and/or insufficient anti-D Ig levels was observed. Hence, RhD immunisation may be further reduced by strict compliance to guidelines concerning determination of FMH and accordingly adjusted anti-D Ig prophylaxis, or by routine administration of extra anti-D Ig after a non-spontaneous delivery and/or a complicated or prolonged third stage of labour.

Anti-Kpa–induced severe delayed hemolytic transfusion reaction

Abstract Kpa is a low-frequency antigen occurring in less than 2 percent of the Caucasian population. Mild to moderate delayed hemolytic transfusion reactions (DHTR) and hemolytic disease of the fetus and newborn attributable to anti-Kpa have been reported. Severe overt DHTR has not been reported with anti-Kpa. A case of a severe DHTR attributed to anti-Kpa after multiple RBC transfusions is being reported. A 52-year-old Caucasian woman received multiple units of RBCs for a lower gastrointestinal bleed. She was referred to our institution for hepatic and renal failure, which was supported by laboratory findings of peak LDH, bilirubin, BUN, and creatinine elevations. Hemoglobin had dropped on Day 10 after transfusion. The DAT and antibody screen (ABS) were negative. Initial workup and subsequent ABS were negative. Anti-Kpa was identified when an additional RBC panel was tested. One of the RBC units transfused was incompatible by antihuman globulin (AHG) crossmatch with the patient’s plasma and typed positive for Kpa. DHTR was confirmed after extensive workup. The patient responded to supportive therapy and experienced an uneventful recovery. DHTR may not be considered when DAT and ABS are negative. However, correlation of recent transfusion with signs and symptoms should alert the clinician to entertain and investigate a DHTR that should include the AHG crossmatch of all implicated RBC units. The severity of the reaction also raises concerns as to when and what antigen specificity should be considered for inclusion in the antibody screening cells. Immunohematology 2009;25:44–47.

Groupes sanguins et recherche des anticorps antiérythrocytaires : analyse d’erreurs au contrôle national de qualité en 2006

Further to a survey set up in 2006 over 2600 laboratories by the French agency for health product safety (AFSSAPS), seven ABO grouping errors and 53 negative answers to red blood cell antibody screening with a serum containing anti-RH1 antibody, have been found. A questionnaire sent to the involved laboratories revealed non-analytical errors already met in previous cases. Besides, the analytical stage has also induced red blood cell antibody screening errors due to a wrong serum collection by the automat. Here are displayed the analysis of the questionnaire results and proposed corrections.

Donation testing

Donation testing

P104 Red cell antibody screening with DiaMed card and with ACT 24 semi-automatic agglutination analyser based on the detection of red cell antibodies

P104 Red cell antibody screening with DiaMed card and with ACT 24 semi-automatic agglutination analyser based on the detection of red cell antibodies

Role of enzyme‐treated cells in RBC antibody screening using the gel test: a study of anti‐RH1, ‐RH2, and ‐RH3 antibodies

The role of enzyme-treated cells (ETCs) in red blood cell (RBC) antibody screening has been the subject of controversy, and its place in the clinical routine remains to be determined. In this work, plasma samples containing anti-RH1 (anti-D; N = 10), anti-RH2 (anti-C; N = 10), or anti-RH3 (anti-E; N = 10) antibodies were studied. The samples were diluted in nonbuffered or buffered normal saline, as well as in a pool of AB plasma samples. Titers and scores were determined by means of the gel test, using the indirect antiglobulin test (IAT) as well as ETCs, with R(0)r, r'r, or r''r test cells. Our results showed that compared to the IAT, ETCs allowed a clearer detection of anti-RH2 and anti-RH3, but not of anti-RH1 antibodies. Based on our study, it is not clear whether the ETC phase of the gel test should be maintained for RBC antibody screening.

The ScanGel System Shows at least Equal Sensitivity for the Detection of Red Cell Antibodies in Comparison to the ID Micro Typing System

Objective: The aim of this study was to compare 2 testsystems for red cell antibody screening. Materials andMethods: 30 fresh and 92 stored frozen samples withknown red cell antibodies (rbc-abs) and 356 consecutiveblood samples sent in for routine serology were investigatedin parallel using 2 different test systems: the IDMicro Typing System (test system A) and the ScanGelSystem (test system B). Results: Test system B demonstrateda significantly higher sensitivity (98.4 vs. 91.0%, p= 0.019) and equal specificity (99.7 vs. 100%) comparedto test system A. Conclusion: In this study, the ScanGelSystem was at least as good as the ID Micro Typing Systemin the detection of rbc-abs. It showed a significantlyhigher sensitivity that will have to be confirmed inprospective studies and across different batches of testcells.

自動輸血検査装置ＩＤ‐ＧｅｌＳｔａｔｉｏｎの使用経験‐試験管法及びＡｕｔｏＶｕｅとの比較検討‐

We compared the ID-GelStation (GS) with Auto Vue system (AV) equipment and standard tube test (TT) with regard to ABO and Rh blood typing and red cell antibody screening in 190 samples, 59 antibody-positive sera and 71 antibodies. GS showed an equal reaction to TT and AV in ABO cell typing and Rh typing. In ABO reverse typing, GS tended to show s stronger reaction than AV but a weaker reaction than TT, with which 9 of 109 samples needed to retested.In red cell antibody screening for 71 antibodies, the papain two-stage technique of GS apparently showed stronger reaction than the bromeline one-stage technique, especially for anti-Rh antibody. Further, GS detected antibodies such as anti-Fy, anti-Jk and anti-Jr which were detectable in antiglobulin testing. GS was more sensitive for anti-Rh antibody than AV in antiglobulin testing, the most important in the present blood transfusion tests. However, GS was less sensitive than the polyethylene glycol antiglobulin test (PEG-IgG) of TT. Only 4 of 10 anti-Fy and anti-Jk could be detected, suggesting that GS and AV, in which a low ionic strength solution (LISS) is used, have lower ability to detect low titer antibodies than PEG-IgG. Use of the more sensitive PEG-IgG may be for the detection of some low titer antibodies.

Psychological impact of islet cell antibody screening.

The purpose of this study was to evaluate the psychological impact of autoantibody screening and its results on at-risk individuals and family members. Individuals who were antibody positive (AP) were identified through a large-scale screening program conducted at our institute. The sample consisted of nine families in whom 10 AP youngsters (7 M, 3 F) were identified, ranging in age from 6-18 years (mean 11.8, median 10 yr). Seventeen parents and eight diabetic youngsters (mean age 15.2, median 16 yr) participated in the study. Reaction to autoantibody positivity was assessed with the Impact of Event scale (IES). The IES was answered twice: within a week from the disclosure of the AP status, and 3 months later. Parents scored higher than their diabetic children and AP children on both measures of the IES, Intrusion and Avoidance. Three months later both scores were significantly reduced in both the parents and the AP children; however, parents still scored significantly higher on both scores than the AP children. The results suggest that learning one's AP status induces significant anxiety, especially in parents of AP youngsters. Although this initial anxiety dissipates over time it still remains quite high after 3 months. The results highlight the importance of psychosocial counseling for all members of diabetes mellitus screening and prevention trials.

Micro‐Column Affinity Test and Gel Test: Comparative Study of Two Techniques for Red Cell Antibody Screening

Abstract Background and Objectives: We describe the results of a comparative evaluation of a gel test (ID Micro Typing) and a micro‐column affinity test (MCAT, Cellbind Screen) for red cell antibody screening and identification under routine conditions. Materials and Methods: 3,000 serum samples of patients from the Mannheim University Hospital were tested in parallel by means of the gel test and the MCAT, using the low‐ionic‐strength‐saline indirect antiglobulin test and the protein G affinity technique, respectively. Test cells used were the same in all tests. In addition, we performed titration studies with all detected antibodies as well as with 59 frozen sera containing antibodies of known specificity. Results: A total of 154 antibodies (5.1%) were detected, 149 by gel test and 147 by MCAT. The overall sensitivity and specificity of the gel test was 96.8 and 96.5% and of the MCAT 95.5 and 97.2%. No significant differences between the gel test and MCAT were found when the titer scores of all 213 (fresh and frozen) antibodies were used to check the results. The mean scores for the gel test and the MCAT were 26.8 and 28.5, respectively. For anti‐Fya and anti‐Kell, a significantly higher titration score could be obtained in the MCAT, whereas anti‐Lua showed a significantly higher score with the gel test. Conclusion: For the screening of unexpected red blood cell antibodies, the MCAT is as sensitive as the gel indirect antiglobulin test. The sensitivity and specificity of the two systems are more or less the same although it seems that lgM antibodies are better detected by the gel test.

Micro–Column Affinity Test and Gel Test: Comparative Study of Two Techniques for Red Cell Antibody Screening

Background and Objectives: We describe the results of a comparative evaluation of a gel test (ID Micro Typing) and a micro–column affinity test (MCAT, Cellbind Screen) for red cell antibody screening and identification under routine conditions. Materials and Methods: 3,000 serum samples of patients from the Mannheim University Hospital were tested in parallel by means of the gel test and the MCAT, using the low–ionic–strength–saline indirect antiglobulin test and the protein G affinity technique, respectively. Test cells used were the same in all tests. In addition, we performed titration studies with all detected antibodies as well as with 59 frozen sera containing antibodies of known specificity. Results: A total of 154 antibodies (5.1%) were detected, 149 by gel test and 147 by MCAT. The overall sensitivity and specificity of the gel test was 96.8 and 96.5% and of the MCAT 95.5 and 97.2%. No significant differences between the gel test and MCAT were found when the titer scores of all 213 (fresh and frozen) antibodies were used to check the results. The mean scores for the gel test and the MCAT were 26.8 and 28.5, respectively. For anti–Fy^a and anti–Kell, a significantly higher titration score could be obtained in the MCAT, whereas anti–Lu^a showed a significantly higher score with the gel test. Conclusion: For the screening of unexpected red blood cell antibodies, the MCAT is as sensitive as the gel indirect antiglobulin test. The sensitivity and specificity of the two systems are more or less the same although it seems that IgM antibodies are better detected by the gel test.

Clinical evaluation of a solid-phase test for red cell antibody screening of pregnant women.

The aims of this study were to evaluate the results of a new solid-phase screening test for detecting atypical red cell (RBC) antibodies in a large number of pregnant women and to compare these results to the clinical outcome of the newborn. A total of 38,700 infants born in Stockholm were studied retrospectively. Of these infants, 18,500 were born to pregnant women screened with the solid-phase test. Data were collected on all newborns with a positive direct antiglobulin test (DAT) and on infants requiring an exchange transfusion or a blood transfusion. These data were correlated to the screening results for the mothers. Of 409 DAT-positive newborns, a serologic explanation for the positive DAT was found in 349. Three hundred four cases were due to ABO incompatibility between mother and child; 19 of these infants needed an exchange transfusion. Forty-two cases were due to unexpected maternal RBC antibodies; 11 of these infants were given an exchange transfusion. All 11 were identified before birth. Three other infants had DAT-positive tests due to ABO incompatibility and to unexpected maternal RBC antibodies. ABO incompatibility is a major indication for exchange transfusion in DAT-positive newborns. There was no evidence that the solid-phase screening test had failed to detect any clinically significant RBC antibodies. Finally, the results of this study do not indicate a need for routine screening of D+ women more than once during each pregnancy.

The distribution of the MiIII (Gp.Mur) phenotype among the population of Taiwan.

The MiIII (Gp.Mur) phenotype is rare among Caucasians but has a much higher incidence among some Oriental populations. In Taiwan the population is relatively heterogenous and, as expected, the incidence of the MiIII phenotype was found to vary markedly among the different ethnic groups. The highest frequencies of the MiIII phenotype were found among some of the indigenous groups, namely the Ami, Yami and Puyuma groups, being 88.4%, 34.3% and 21.2%, respectively, which are also the highest frequencies among any population group reported so far. Antibody screening cells and antibody identification panels containing the MiIII phenotype can obviously be obtained very easily from Ami blood donors and compatible blood for patients with anti-"Mia' can most easily be obtained from Chinese blood donors, except those living on the east coast.

Screening for IgA deficiency on the Olympus PK7100 by haemagglutination inhibition

Severe or life-threatening anaphylactic reactions during blood transfusion to patients with anti-IgA, though infrequent, can be avoided by transfusing blood products prepared from IgA deficient donors. This report describes the development and use a passive haemagglutination assay adapted for use on the Olympus PK7100 blood group analyser. Donor plasma samples identified as being presumptive IgA deficient were further screened by a manual passive haemagglutination inhibition technique and finally confirmed by means of a quantitative enzyme-linked immunosorbent assay. Of 5723 donors tested simultaneously for IgA deficiency, blood grouping and red cell antibody screening, six (1 in 954) were confirmed as IgA deficient (i.e. < 100 ng/ml of IgA). The test is simple and cost effective and can be used to establish a database of IgA-deficient donors.

Psychological impact of islet cell antibody screening for IDDM on children, adults, and their family members.

To describe the psychological impact of positive islet cell antibody (ICA) screening results in children and adults, as well as their parents and spouses. The psychological impact of ICA screening results was assessed subsequent to subjects' being informed of ICA-positive (ICA+) status and was re-evaluated 4 months later. Impact was measured using the state subscale of the State-Trait Anxiety Inventory (STAI) for adults or the State-Trait Anxiety Inventory for Children (STAIC), as well as structured interviews. A total of 34 ICA+ children, 34 ICA+ adults, 33 parents, and 25 spouses were evaluated. At initial notification of ICA+ status, clinically and statistically significant anxiety was observed in ICA+ children and adults and their family members (P < 0.001). Parents of ICA+ children were more anxious than spouses of ICA+ adults (P < 0.05). Child and parent anxiety were significantly correlated (P < 0.05); more-anxious children lived with more-anxious parents. No significant association was found between ICA+ adults' initial anxiety and their spouses' anxiety. For ICA+ participants and their family members, anxiety dissipated to normal levels in 4 months (P < 0.02). ICA+ children were less likely than parents to believe they would ever develop insulin-dependent diabetes mellitus (IDDM). Nevertheless, 52% of ICA+ children and 24% of ICA+ adults endorsed lifestyle or behavior changes as a result of their IGA+ status. Behavior change was associated with greater initial anxiety in both children and adults (P < 0.05 for both). These data suggest that notification of ICA+ status has both emotional and behavioral impact. Initial notification of ICA+ status is associated with considerable anxiety in both ICA+ individuals and their family members. In most cases, this initial anxiety appears to dissipate to normal levels over time. However, many ICA+ individuals report initiating lifestyle or health behavior changes in an effort to delay or prevent IDDM onset.

Use of standardized protease enzymes for antibody screening of blood donor samples with the microplate system AutoAnalyzer

Papain, bromelin and ficin can be standardized by the casein method for use in red blood cell antibody screening tests. The minimal and optimal enzyme activity for detecting blood group antibodies in donors, using the new Automated Pre-Transfusion Blood Testing System Olympus PK7200 by the two-stage method for all three enzymes, is one casein unit. One casein unit of proteinase activity changed the red blood cell surface charge to a low plateau value as measured by electrophoretic mobility and sialic acid content, and removed sterically inhibiting structures of surface protein as detected by SDS-PAGE.

Der Antikörpersuchtest Solidscreen II mit Papain- oder Bromelin-behandelten Testzellen in der klinischen Erprobung

We report the results of a study on red cell antibody screening in 2329 sera. We compared the Solidscreen II solid-phase test with the Solidscreen II enzyme tests (papain and bromelin) and the gel centrifugation test (DiaMed&amp;#47;bromelin).The sensitivity of the Solidscreen II papain test is higher than that of all other methods. Seven out of 9 antibodies in the Kidd system could not be detected in any other test, an important fact for optimal patient support.

Gel Test and column agglutination technology – Comparative study of two red cell antibody screening and identification systems

Article Gel Test and column agglutination technology – Comparative study of two red cell antibody screening and identification systems was published on January 1, 1995 in the journal Journal of Laboratory Medicine (volume 19, issue 1-12).