Crossmatch Research Articles

Correlation Crossmatching Test with Effectiveness of Transfusion in Hemolytic Anemia Patients

Hemolytic anemia is anemia caused by the premature destruction of red blood cells. Transfusion with hemolytic anemia is a dilemmatic indication and is still based on clinical decisions. Several studies assessed the effectiveness of transfusions in hemolytic anemia patients with incompatible crossmatching showed effectiveness. This study aimed to analyze crossmatching with transfusion effectiveness in hemolytic anemia patients. Retrospective cohort observational study with medical record data from January 2019 to May 2022 of hemolytic anemia patients who got transfusion therapy. The variables included age, gender, hemoglobin levels before and after transfusion, crossmatching test, and transfusion effectiveness based on increased hemoglobin after transfusion 1 g/dL of 1 Pack Red Cell (PRC) unit. One hundred three (103) patients with hemolytic anemia 45 received PRC, 12 males (26.7%) and 33 females (73.3%). Ages 19 - < 45 years subjects had the most transfusions. Hemoglobin levels before and after transfusion showed significant differences (p-value =0.000) in the patients with a diagnosis of hereditary, unspecified, and autoimmune hemolytic anemias. The correlation between the effectiveness of transfusions with gender and age was not found (p=0.521, p=0.240). The correlation between crossmatching with the effectiveness of transfusion was not found (p=0.089). Hemolytic anemia patients with transfusion showed an increase in hemoglobin levels between before and after transfusion even with incompatible crossmatching. The correlation between the results of crossmatching with transfusion effectiveness in patients with hemolytic anemia was not found. Good premedication treatment can provide effective transfusion.

Overcoming interference from anti-CD38 in flow cytometric crossmatch testing

Overcoming interference from anti-CD38 in flow cytometric crossmatch testing

Evaluation of spurious Luminex bead reactions with HISTO SPOT® HLA AB, flow cytometry cross matching and adsorption with crossmatch and elution

Evaluation of spurious Luminex bead reactions with HISTO SPOT® HLA AB, flow cytometry cross matching and adsorption with crossmatch and elution

Frequency of ABO and Rhesus (D) blood group among blood donors and blood requisition and utilization patterns: An insight towards optimal blood usage in a tertiary care hospital.

Objective: To determine the distribution and frequency of blood groups among the blood donors and assess the blood requisition and utilization patterns in order to strategize optimal blood utilization. Study Design: Cross-sectional Descriptive study. Setting: Fauji Foundation Hospital, Rawalpindi. Period: January 2021 to January 2024. Methods: Blood bank data including blood donor name, gender, blood groups, blood requisitions, blood issuance and blood utilization was retrieved from Fauji Foundation hospital’s management information system and blood requisition and collection forms. The quality indicators of blood utilization i.e. crossmatch/transfusion ratio and transfusion probability was calculated and analyzed using SPSS 21. Results: 22483 blood donors donated blood at our blood bank facility from January 2021-january 2024. Mean age 31±10.2 years (range: 18–56 years). Majority of the blood donors were males 96.4% (n=21682) while 3.5% (n=801) were females. A total of 21733 were replacement donors while 750 were voluntary donors. The highest blood requests were from obstetrics/gynecology department while the highest blood utilization was by the medicine department. The overall cross match to transfusion ratio was 1.3. The highest cross match to transfusion ratio of 2.5 was from obstetrics/gynecology department while the lowest was from pediatrics and oncology departments. Conclusion: The blood group O positive was the commonest blood group. Although, blood transfusion quality indicators show effective utilization however the pattern varies among different departments. Evidence-based blood utilization strategies need to be implemented for optimal utilization of blood.

Maximum surgical blood order schedule: A key component of perioperative blood management in neurosurgery

Abstract: CONTEXT: Institute specific protocols are needed to reduce unnecessary cross matches. Type and screen policies for surgical procedures which does not require blood and maximum surgical blood order schedule (MSBOS) for procedures which require blood units are the two protocols in use currently. AIM: To compare the effect of maximum surgical blood order schedule in neurosurgery between pre- and post-implementation. SETTINGS AND DESIGN: It is a study of 5 years’ duration (4 years retrospective and 1 year prospective) conducted at the departments of transfusion medicine, neurosurgery and neuroanesthesia. SUBJECTS AND METHODS: The patients above 18 years for whom blood requisition were sent were included, whereas those who underwent emergency procedures, massive transfusion, or had underlying bleeding disorders were excluded. The MSBOS was developed based on 4 years’ retrospective data and the new protocol was followed for 1 year. The transfusion indices were compared between preimplementation and postimplementation. RESULTS: A total of 2462 patients were included in the retrospective period, whereas it was 746 in the prospective group. Overall, reduction of crossmatch to transfused ratio from 3.6 to 2.4 and increase of blood utilization from 27.40% to 41.55% was observed. The patients for whom type and screen were performed increased from 18% in the retrospective period to 75% in the prospective period. Eighteen out of 30 common procedures were managed with T and S and seven of them did not require even a single unit of red blood cells intraoperatively. CONCLUSIONS: Our study highlights the importance of including both diagnosis and procedure to formulate MSBOS and the use of modified formulas “transfusion index for type and screen and transfusion probability for type and screen” for revision of MSBOS.

Effects of Various Concentrations of Pronase on Flow Cytometric Crossmatching Patients Treated With Rituximab and Donor HLA-Specific Antibodies.

Pronase pretreatment can reduce rituximab (RTX) interference by degrading CD20 in B-cell flow cytometry crossmatch (FCXM) testing. However, it may also reduce the assay sensitivity by degrading HLA molecules. We investigated the effects of various pronase concentrations on RTX interference and the analytical sensitivity of B-cell FCXM testing. Using 59 patient serum samples and 38 donor lymphocyte samples, we designed 97 recipient-donor pairs and divided them into three groups according to RTX use and the presence of weak-to-moderate donor HLA-specific antibody (DSA) reactions: RTX+/DSA-, RTX+/DSA+, and RTX-/DSA+. FCXM was performed after pretreating lymphocytes with six different pronase concentrations (0, 0.5, 1, 2, 3, and 4 mg/mL). With B-FCXM testing, false-positive results due to RTX in the RTX+/DSA- group markedly decreased with increasing pronase concentrations. The median channel shift values in the RTX+/DSA+ and RTX-/DSA+ groups did not significantly decrease when the pronase concentration was increased from 1 mg/mL to 2 or 3 mg/mL. All eight RTX+/DSA+ cases that were positive at 1 mg/mL pronase but negative at 2 or 3 mg/mL had mean fluorescence intensity (MFI) DSA values of less than 3,000 except for DQ5 (MFI: 5,226). With T-cell FCXM, false-positive results were observed in 2.9% of 315 FCXM tests with pronase pretreatment. Higher concentrations (2 or 3 mg/mL) of pronase effectively eliminated RTX interference but still carried a risk for false negativity for weak DSA reactions in B-cell FCXM. Higher pronase concentrations can be used as an auxiliary method to detect moderate-to-strong DSA reactions in RTX-treated patients.

Evaluation of Pre-Transfusion Crossmatch Test Using Microscanner C3.

A pre-transfusion crossmatch test is crucial for ensuring safe blood transfusions by identifying the compatibility between donor and recipient blood samples. Conventional tube methods for crossmatching have limitations, including subjectivity in result interpretation and the potential for human error. In this study, we evaluated the diagnostic performance of a new crossmatch test using Microscanner C3, which can overcome these shortcomings. The crossmatch test results using the method were obtained in 323 clinical samples. The sensitivity, specificity, positive predictive value, negative predictive value, and concordance rate of the crossmatch test using Microscanner C3 were 98.20%, 100.00%, 100.00%, 98.11%, and 99.07%, respectively. The diagnostic performance of the new system offers a promising alternative to conventional tube methods for pre-transfusion crossmatch testing. Microscanner C3 could also increase the automation, standardization, and accuracy of crossmatch tests. The crossmatch test using Microscanner C3 is thought to increase the efficiency and reliability in identifying blood samples suitable for transfusion, thereby improving patient safety and optimizing the use of blood products in clinical settings.

Maximum surgical blood ordering schedule for elective surgical procedures in Omdurman teaching hospital, Sudan

BackgroundThe need for blood during a surgical procedure is greater than what blood banks are able to provide. There is an excessive amount of blood being ordered for elective surgeries, surpassing the actual requirements. Only 30% of the cross matched blood is actually used in these surgeries. The accuracy of estimating the transfusion needs before a surgical procedure can be determined by looking at the cross match to transfusion ratio and the transfusion index. “These indicators play a crucial role in developing the maximum surgical blood ordering schedule; in this study, these indicators were tested.”Aim of studyIs to determine the efficiency of blood ordering and transfusion practices for patients undergoing elective surgeries.MethodsThis study is a prospective cross-sectional hospital-based study done at Omdurman Teaching Hospital-Sudan. Conducted for the duration of 6 months period from July to December 2019.The study participants were patients who underwent elective surgical procedures in general surgery and Urology departments as total coverage sample over a period of study duration. Ethical clearance obtained from ethical committee of Sudan Medical Specialization Board.ResultsTwo hundreds seven patients included in this study, the amount of blood units requested were 443-unit, cross matching for 98.6% (n 437) of units were done. Only 100 unit were Transfused (22,8%). The calculated CT ratio was 4.4, transfusion index was 1.6 and transfusion probability was 29.9%.ConclusionTransfusion probability and transfusion index of the present study were optimal but comparatively higher than the standard guidelines as most of the cross matched blood was not utilized.

#2562 Effect of rituximab on post-transplant outcome in highly sensitized patients

Abstract Background and Aims Pre-transplant sensitization is important risk factor for the development of antibody-mediated rejection (ABMR) and can result in inferior long-term allograft survival in kidney transplantation (KT). The aim of this study was to investigate the effect of pre-transplant Rituximab infusion on the clinical outcome in highly sensitized patients. Method The study included 128 consecutive recipients who received renal transplant between 05/2022 and 12/2023, of them 68 patients showed the result of panel-reactive antibody higher than 30%, but showed negative crossmatch test before transplantation. Out of them, 44 patients who took pre-transplant Rituximab at a dose of 375 mg/m2 belonged to Rituximab group and remained 24 patients were regarded as control group. We compared the development of ABMR, the change of allograft function and allograft survival rate between 2 groups after KT. Results Between two groups, no difference was found in baseline characteristics such as age at KT, gender, pre-transplant dialysis duration, primary renal disease. The mean value of PRA and HLA mismatching number, the type of main immunosuppressive agent did not differ as well. After KT, the development of ABMR was significantly lower in Rituximab group (5/44 (11.4%)) compared to control group (10/24 (41.7%), p < 0.005) and total rejection rate showed lower tendency in Rituximab group as well (p = 0.052). However, the incidence of CMV, fungal or bacterial infections was similar between the groups. Allograft function assessed by MDRD eGFR at 14 days after KT was significantly higher in Rituximab group compared to control group, but at 6 and 12 months from KT, it did not differ between two groups. Allograft rejection free survival was significantly higher in Rituximab group compared to control group (p < 0.05). Conclusion In sensitized patients with high PRA but negative crossmatch, Rituximab was effective to prevent the development of ABMR without an increased incidence of opportunistic infections.

Type-specific whole blood still has a role in the era of low-titer O universal donor transfusion for severe trauma hemorrhage.

Whole blood can be ABO-type specific (type-specific whole blood (TSWB)) or low-titer O universal donor (low-titer O whole blood (LTOWB)). Having previously used LTOWB, the US Armed Forces Blood Program began using TSWB in 1965 as a method of increasing the donor pool. In contrast to military practice, the Association for the Advancement of Blood and Biotherapies formerly the American association of blood banks (AABB), from its first guidelines in 1958 until 2018, permitted only TSWB. Attempting to reduce time to transfusion, the US military reintroduced LTOWB in the deployed environment in 2015; this practice was endorsed by the AABB in 2018 and is progressively being implemented by military and civilian providers worldwide. Low-titer O whole blood is the only practical solution prehospital. However, there are several reasons to retain the option of TSWB in hospitals with a laboratory. These include (1) as-yet ill-defined risks of immunological complications from ABO-incompatible plasma (even when this has low titers of anti-A and -B), (2) risks of high volumes of LTOWB including published historical advice (based on clinical experience) not to transfuse type-specific blood for 2 to 3 weeks following a substantial LTOWB transfusion, (3) uncertainty as to the optimal definition of "low titer," and (4) expanding the potential donor pool by allowing type-specific transfusion. Several large randomized controlled trials currently underway are comparing LTOWB with component therapy, but none address the question of LTOWB versus TSWB. There are sufficient data to suggest that the additional risks of transfusing LTOWB to non-group O recipients should be avoided by using TSWB as soon as possible. Combined with the advantage of maintaining an adequate supply of blood products in times of high demand, this suggests that retaining TSWB within the civilian and military blood supply system is desirable. TSWB should be preferred when patient blood group is confirmed in facilities with a hematology laboratory, with LTOWB reserved for patients whose blood group is unknown.

Comparison of Safety and Cost of Cross-match Tests and Antibody Screening before Blood Transfusion in Patients Undergoing Orthopedic Surgery: A Cross-sectional Study

Introduction: Planning for blood request and balancing supply and demand are still contentious issues in hospitals and blood transfusion centers. This study aimed to compare the safety and cost-effectiveness of two pre-transfusion tests for red blood cells in patients undergoing orthopedic surgery. Method: In this descriptive-analytical cross-sectional study, patients undergoing surgery who required blood transfusion during the operation were included via convenience sampling method. The necessary information for this study was collected using a researcher-made checklist consisting of two parts: background information, blood bag information, and information related to potential complications. The cost estimation of the tests was also extracted using the records. The findings were analyzed using descriptive and inferential statistics with SPSS software (version 18), and the significance level was set at 0.05. Results: A total of 212 patients with a mean age of 44.98 years were included in the study. Cross-match was performed for 108 patients (50.9%), and antibody screening test was used for 104 patients (49.1%). Regarding complications after blood transfusion, at least one sign was observed in 12 patients (5.7%). Jaundice, fever, and itching were the most common symptoms. The cross-match to transfusion (C/T) ratio was higher than international standard criteria (5.25 vs. 2.5). Conclusion: The results of this study demonstrated that the safety and accuracy of both pre-transfusion methods were similar, and no significant difference was observed. However, the cross-match test was more cost-effective compared to the match antibody screening test.

Lymphocyte Crossmatch Testing or Donor HLA-DP and -DQ Allele Typing Effectiveness in Single Cord Blood Transplantation for Patients With Anti-HLA Antibodies Other Than Against HLA-A, -B, -C, and -DRB1

Anti-human leukocyte antigen (HLA) antibodies other than those against HLA-A, -B, -C, and DRB1 are a risk factor for engraftment delay and failure, especially in cord blood transplantation (CBT). The primary objective of this study was to assess the impact of the presence of anti-HLA antibodies on CBT and to evaluate the utility of lymphocyte crossmatch testing or additional HLA-DP and -DQ typing of CB units in improving transplant outcomes. We retrospectively assessed the engraftment rates and transplant outcomes of 772 patients who underwent their first CBT at our hospital between 2012 and 2021. Donors were routinely typed for HLA-A, -B, -C, and-DRB1 alleles, and the anti-HLA antibodies of recipients were screened before donor selection in all cases. Among patients who had antibodies against other than HLA-A, -B, -C, and DRB1 (n = 58), lymphocyte crossmatch testing (n = 32) or additional HLA-DP/-DQ alleles typing of CB (n = 15) was performed to avoid the use of units with corresponding alleles. The median patient age was 57 years (16 to 77). Overall, 75.7% had a high-risk disease status at transplantation, 83.5% received myeloablative conditioning regimens, and >80% were heavily transfused. Two hundred twenty-nine of the 772 recipients (29.6%) were positive for anti-HLA antibodies. There were no statistical differences in the number of infused CD34-positive cells between the anti-HLA antibody-positive and the anti-HLA antibody-negative patients. Of the 229 patients with anti-HLA antibodies, 168 (73.3%) had antibodies against HLA-A, -B, -C, and-DRB1 (Group A), whereas 58 (25.3%) had antibodies against HLA-DP, HLA-DQ, or -DRB3/4/5 with or without antibodies against HLA-A, -B, -C, and -DRB1 (Group B). No patients in both Groups A and B exhibited donor-specific anti-HLA antibodies against HLA-A, -B, -C, and -DRB1. The neutrophil engraftment rate was lower in patients with anti-HLA antibodies than in those without antibodies (89.9% versus 94.1%), whereas nonrelapse mortality (NRM) before engraftment was higher in antibody-positive patients (9.6% versus 4.9%). In patients who received 2 or more HLA allele-mismatched CB in the host-versus-graft (HVG) direction (n = 685), the neutrophil engraftment rate was lower in the anti-HLA antibody-positive recipients than in the antibody-negative recipients with significant differences (88.8% versus 93.8%) (P = .049). Similarly, transplant outcomes were worse in the antibody-positive patients with respect to 2-year overall survival (OS) (43.1% versus 52.3%) and NRM (44.0% versus 30.7%) than in the antibody-negative patients. In contrast, the results of Group B were comparable to those of the antibody-negative patients, while those of Group A were statistically worse than the antibody-negative patients in terms of all engraftment rate (88.6%), OS (34.2%), and NRM (49.0%). The presence of anti-HLA antibodies negatively impacts engraftment, NRM, and OS in CBT. However, HLA-DP/-DQ allele typing of CB units or lymphocyte crossmatch testing could be a useful strategy to overcome poor engraftment rates and transplant outcomes, especially in patients with anti-HLA antibodies against HLA-DP, HLA-DQ, or -DRB3/4/5.

Tdescore: An Accurate Photometric Classifier for Tidal Disruption Events

Optical surveys have become increasingly adept at identifying candidate tidal disruption events (TDEs) in large numbers, but classifying these generally requires extensive spectroscopic resources. Here we present tdescore, a simple binary photometric classifier that is trained using a systematic census of ∼3000 nuclear transients from the Zwicky Transient Facility (ZTF). The sample is highly imbalanced, with TDEs representing ∼2% of the total. tdescore is nonetheless able to reject non-TDEs with 99.6% accuracy, yielding a sample of probable TDEs with recall of 77.5% for a precision of 80.2%. tdescore is thus substantially better than any available TDE photometric classifier scheme in the literature, with performance not far from spectroscopy as a method for classifying ZTF nuclear transients, despite relying solely on ZTF data and multiwavelength catalog cross matching. In a novel extension, we use “Shapley additive explanations” to provide a human-readable justification for each individual tdescore classification, enabling users to understand and form opinions about the underlying classifier reasoning. tdescore can serve as a model for photometric identification of TDEs with time-domain surveys, such as the upcoming Rubin observatory.

EVALUATION OF INCOMPATIBLE CROSSMATCHES AT A TERTIARY CARE HOSPITAL IN CHENNAI – A PROSPECTIVE STUDY

Objectives: The primary goal in blood transfusion is that the transfused blood unit be compatible with the patient during crossmatching. This compatibility testing is performed before every administration of blood component. This cross-matching test helps to detect the presence of antibodies in the recipient against antigens over red blood cells of donor. The aim of this study was to evaluate the incidence and causes of in compatible crossmatches in patients by tube agglutination method. Methods: This was a retrospective cross-sectional study conducted by analyzing incompatible crossmatches encountered during routine compatibility testing between January and December 2021 at the Department of Transfusion Medicine, Government Kilpauk Medical College and Hospital, Chennai, Tamil Nadu, India. The analysis was done in March and April 2022. All crossmatches were done by tube agglutination technique. Data were entered in Microsoft Excel and analyzed. Descriptive statistics were given in summary statistics. Results: Out of the total of 12943 crossmatches performed, 0.3% (n=39/12943) were incompatible. About 76.9% (n=30/39) were seen in females while 69.2% (n=27/39) were seen in the age group 20–60 years. About 35.9% (n=14/39) of the incompatible crossmatches were due to autoimmune hemolytic anemia (AIHA). A root cause analysis protocol was formulated to resolve the incompatibility and ensure safe transfusion. Conclusion: AIHA was the most common cause of incompatible crossmatch. The root cause analysis protocol involves a thorough evaluation of the patient’s clinical condition, underlying pathology, and errors during technical procedure to identify the cause of incompatibility. Protocols should be developed in each blood center and a logical stepwise approach will enable the provision of safe transfusion.

The importance of removing interference caused by Darzalex® (daratumumab) in pre-transfusion testing

Introduction: Multiple myeloma (MM) is a hematologic malignacy characterized by the uncontrolled proliferation of abnormal plasma cells in the bone marrow. Darzalex® (daratumumab) has emerged as a highly effective therapeutic agent for MM, offering an additional treatment option for patients who have developed resistance to other therapies. However, the use of Darzalex® poses challenges in pre-transfusion testing due to its strong binding affinity of the monoclonal anti-CD38 antibody to CD38 protein, resulting in panreactivity with test erythrocytes and complicating the detection of erythrocyte alloantibodies. The objective of this case report is to outline the procedures, significance, and methodologies for mitigating this interference using the DaraEx® reagent. Case Report: We present the cases of three patients diagnosed with MM and treated with Darzalex® at our institution in 2023. Following the administration of Darzalex®, all three patients exhibited positive results on indirect antiglobulin tests (IAT). Cross-matching tests conducted with red blood cell concentrates also yielded positive results, with strengths ranging from 2+ to 3+. To eliminate interference, we used a specific DaraEx® reagent that utilizes Fab fragments of anti-CD38 to mitigate interference by masking CD38 on the cell surface. Subsequent application of this reagent resulted in negative IAT results for all three patients. However, one patient still displayed a weakly positive cross-matching test (<1+), suggesting that complete elimination of interference may not always be achievable with the DaraEx® method. Conclusion: Despite the availability of reliable methods such as dithiothreitol and the DaraEx® reagent for mitigating interference, complete success in eliminating interference remains elusive. This underscores the importance of implementing proactive measures to prevent interference. Patients undergoing Darzalex® therapy should undergo comprehensive immunohematological testing before medication administration. Given the increased need for blood transfusions in MM patients, ensuring the compatibility of blood products is essential for safe transfusion practices.

Ensuring Blood Grouping, Cross Matching, and Appropriate Storage and Delivery in Compliance with Quality Standards during Preparation and Delivery of the EQC Materials to the Participating Laboratories in Nairobi City County, Kenya

Ensuring Blood Grouping, Cross Matching, and Appropriate Storage and Delivery in Compliance with Quality Standards during Preparation and Delivery of the EQC Materials to the Participating Laboratories in Nairobi City County, Kenya

Blood Transfusion cross match on the basis of Phenotype & Rh Antigen in Donors and Receivers and Analysis of Variations

Background: In brief, knowing the local Rh blood group system frequency helps develop a donor pool for patients who need numerous transfusions and alloantibody-compatible antigen negative blood. Patients have been matched for component blood transfusions using ABO and Rh phenotypes since 2020. Our detection of all blood transfusion-needy patients began. Aim: Our department began To detect C, E, c, and e Rh-specific antigens in multi-transfused patients in 2020. Methods: For the aim of this investigation, 2300 patient samples were obtained from patients who required clinical blood transfusions at our hospital between March 2020 and October 2022. These samples were gathered for the purpose of this investigation. One patient was counted as a single sample even though they required repeated blood transfusions. 1900blood donor samples were provided by the Blood Centre of (duplicated samples were removed based on the identification numbers that were provided by the Blood Centre once they were identified). Results: The study obtained 4200 samples, including 1900donor and 2300patient samples. The allele frequency distribution of blood group antigens in the studied population was compared with the prevalence observed in the present study. The D antigen exhibited a frequency of 99.34% in the studied population, slightly lower than the prevalence observed in the present study at 98.9% (95% CI: 98.5 - 99.0). Conversely, the C antigen was found in 93.1% of the studied population, with a slightly higher prevalence observed in the present study at 99.1% (95% CI: 92.0 - 99.2). Implication: The study suggests serological testing is a cost-effective method for blood transfusion management, identifying Rh phenotypes. Compiling a database of donor Rh genotypes simplifies transfusion selection, reducing unfavorable responses. Pre-transfusion Rh phenotype examination is crucial for matching patient blood type with donor blood, reducing adverse reactions, and improving patient safety. Conclusion: In transfusion applications, serological testing are cost-effective for Rh phenotype identification but not genotypes. Creating a database of blood donors' Rh phenotypes and evaluating each patient before their initial transfusion should lessen adverse reactions and speed up antigen-negative blood availability, saving more patients. Keywords: Blood transfusion, phenotype, Rh antigen, donors, receivers, analysis of variations

Immunology Status of Patients During Kidney Transplant.

The immunology status of a patient has a crucial role in kidney transplant. We investigated the effectiveness of a desensitization protocol, guided by the immunology status of patients, for kidney transplant candidates. Antibody screening for human leukocyte antigens was conducted with the Luminex single-antigen microsphere bead assay method for 34 patients from June 2021 to June 2022. Donor human leukocyte antigen genotypes at 8 loci (A*, B*, С*, DRB1*, DQA1*, DQB1*, DPA1*, and DPB1*) were determined, to correlate the specificities of recipient human leukocyte antigen antibodies with donor antigens and identify unacceptable donor antigen combinations. Specialized immunology studies measured panel reactive antibody levels and human leukocyte antigen class I and class II antibodies. A crossmatch compatibility test using complementdependent cytotoxicity was conducted. Of the 34 patients, 10 completed all 3 stages of the desensitization therapy. Most patients experienced decreased sensitization to human leukocyte antigen class I and class II antibodies. Two patients achieved complete clearance of A1 and DQ5 antibodies, respectively, whereas 1 patient exhibited an increase in donor-specific antibody mean fluorescence intensity. Prior to desensitization therapy, the crossmatch compatibility test yielded positive results with T and B lymphocytes. After completing the therapy, the crossmatch test showed negative results in 4 cases with T lymphocytes and positive results with B lymphocytes. Plasmapheresis sessions effectively reduced circulating antibodies. However, the combination of rituximab and plasmapheresis alone did not achieve a negative crossmatch test required for kidney transplant. It is crucial to assess the reduction of donor-specific antibody quantity, considering both the percentage and the mean fluorescence intensity. To avoid false-positive results in crossmatch analysis, drug half-life must be considered. Laboratories should have various crossmatch techniques, such as flow cytometry and single-antigen microsphere bead assay technology, available for research and urgent cases that require crossmatch analysis.

Impact of Anti-M on Grouping and Cross Matching: The Challenges Faced in Three Cases

Anti-M, a frequently encountered antibody of the MNS blood group system, is commonly regarded as a naturally occurring saline agglutinin that can occasionally exhibit clinically significant behaviour. Particularly when reactive at 37°C or during the antiglobulin phase, it can complicate pretransfusion testing and patient management in the blood bank. Three distinct cases (2 males. 1 female) in varying clinical scenarios, ranging from surgery to acute coronary syndrome, are described. The present cases presented discrepancies in blood grouping and compatibility testing, highlighting the challenges posed by the presence of Anti-M antibodies that react at or above room temperature and during the antiglobulin phase, thus defying the usual expectations. It is imperative to provide antigen-negative red cells and those that are compatible by an Indirect Antiglobulin Test (IAT) when Anti-M is reactive at 37°C to ensure safe transfusion. Hence, there is a need to underscore the potential clinical implications in transfusion medicine, as well as the nuances of detecting, identifying, and managing the presence of Anti-M antibodies in patients requiring transfusion.

Deployment Optimization of Intelligent Wireless Sensor Network Using Graph Similarity Based on Multi-Granularity Cross Representation and Matching

Deployment Optimization of Intelligent Wireless Sensor Network Using Graph Similarity Based on Multi-Granularity Cross Representation and Matching