Acquired Antibodies Research Articles

不規則抗体スクリーニング試薬0.8%セルスクリーンJ -Alba-の検討

不規則抗体スクリーニング試薬0.8%セルスクリーンJ -Alba-の検討

Prevalence of irregular red blood cell antibodies among healthy blood donors in South India

Background: Although antibody screening is mandatory according to the National Blood Policy of India, the prevalence of irregular red cell antibody and its specificities are not much reported in South Indian population. Aims and Objectives: The objective of this study is to find the prevalence of irregular red cell antibodies and positive direct antiglobulin test (DAT) in healthy blood donors in South India population. Materials and Methods: This is a retrospective observational study conducted in the department of transfusion medicine from April 2011 to March 2018 (7 years) at a tertiary care referral center, Chennai, Tamil Nadu. Red cell antibody screening of all voluntary blood donors was performed using commercial O cells (ID DiaCell Pool, DiaMed, Cressier sur Morat, Switzerland). Positive sera were further investigated to identify the irregular erythrocyte antibody by commercially available red cell panel (ID-DiaPanel, Diamed-ID Microtyping System). Results: A total of 40,629 donors were screened for the presence of irregular erythrocyte antibodies. A total of 57 (0.14%) donors showed the presence of irregular antibodies, in which 41 (71.9%) were alloantibodies. Most frequent alloantibodies identified were of MNS blood group system with anti-M being the highest (n = 15, 36.58%), followed by Rh blood group system. Sixteen (0.039%) donors were DAT positive, which were detected during routine crossmatching. Conclusion: Implementation of red cell antibody screening in all the blood donors routinely helped us understand the prevalence of antibodies in our region and its importance in providing compatible blood products and to avoid transfusion reactions.

Anti-D antibody in a D-positive patient: Autoantibody or development of alloantibody after platelet transfusion

Rh D (D or RH 1) is next clinically important blood group after ABO blood group system. Although most people are either D+ or D−, there are a large number of individuals having different forms of D variants; weak D, partial D, or DEL phenotypes. We present a case report of a 32-year-old male with a history of cough and cold for 5 days with development of petechial rashes all over the body from day 1 and afebrile and marked thrombocytopenia. He was transfused with multiple platelet concentrates. Initially, there was an absence of irregular red cell antibodies, but after 72 h of transfusion, he developed autoanti-D antibody. An accurate D-antigen identification is important and essential for pretransfusion evaluation to prevent antibody formation, and a partial D variant might be suspected when typing for the D antigen showing weaker-than-normal reactions. This case emphasizes that some partial D variants are likely to be missed by routine serological tests.

Frequency of irregular red cell antibodies in blood donor population

Introduction: Irregular red blood cell (RBC) antibodies may occur in blood donors and potentially can lead to transfusion reactions or decreased survival of transfused RBCs. Therefore, it is necessary to know the prevalence of alloantibodies in donors and their clinical significance. Aims and Objectives: The study was aimed to determine the prevalence of RBC alloantibodies in blood donors. Materials and Methods: ABO typing and RhD typing were performed using the fully automated immunohematology analyzer (Qwalys 3, Diagast, France). For RhD-negative samples, a “weak D” testing was also performed by tube technique using a blend (immunoglobulin M [IgM] + IgG) of anti-D antisera (Tulip Diagnostics, Goa, India). Antibody screening (3-cell panel) and identification (11-cell panel) were done by gel technique (LISS-Coombs AHG Card, Bio-Rad, Switzerland). The antibody titer was done using the tube technique. Results: During the study period, a total of 2310 donor samples were tested. Out of these, 2299 (99.56%) were male and 11 (0.44%) were female. ABO distribution was found to be maximum for blood group B (34.5%), followed by O (33.3%), A (22%), and AB (10.3%). Among the total donors, 2085 (90.3%) were RhD positive. All the RhD-negative samples were negative on “weak D” testing. Antibody screen was positive for only one sample (0.043%); the alloantibody identified was anti-M, which was reactive in anti-human globulin phase as well, and the titer was 1. It was from a male donor who had no history of transfusion. One sample (0.04%) showed autoantibody weak positive (wk+), and there was one ABO discrepancy (0.04%), which was due to weak subgroup of A. Conclusion: The prevalence of RBC alloantibodies is 0.043% (1/2310) in our donor population. As the sample size was small, larger studies are needed to determine the actual prevalence of alloantibodies in donors.

An evaluation of irregular antibody profile in voluntary blood donors and blood transfusion recipients

An evaluation of irregular antibody profile in voluntary blood donors and blood transfusion recipients

When A is not A anymore: problems and pitfalls with blood group typing

Correct blood group typing is aprerequisite for transfusion. In most cases blood group determination is without problems; however, in individual cases various factors can complicate blood group determination and sometimes lead to confusing findings. For abetter understanding the clinician should have basic knowledge of blood typing. Blood group determination usually covers the AB0 blood groups, Rhesus and Kell systems; in addition, adirect Coombs test and an antibody screening test for the detection of irregular antibodies in the recipient are performed. Confusion of patients, blood samples, results or preparations can lead to severe consequences due to incompatible transfusion and must be prevented. In this context, bedside blood type testing before transfusion is of utmost importance. Problems in laboratory analysis as well as patient-related factors, such as the existence of irregular antibodies against red blood cells can complicate the immunohematology diagnostics. Certain medications, such as daratumumab, lead to asignificantly increased complexity in laboratory analyses. Massive transfusions can lead to chimerism with more than one population of circulating red blood cells. Hematopoetic stem cell transplantation can also lead to achange in blood groups as well as chimerism. In addition, there are various other rare causes that can result in difficulties in blood group determination, such as rare blood groups or rare disease-associated phenomena. In the case of problems in blood group determination, early and close cooperation with transfusion medicine is essential for the clinician.

Analysis of Relationship between Coagulation Function and Blood Transfusion in Patients with Emergency Rescue

Through researching preoperative coagulation function in the case of ABO-identical blood insufficient for emergency rescue transfusion according to recommended programs of special emergency rescue transfusion was carried out, the relationship between volume of blood products and coagulation function was analyzed. The surgical cases of blood transfusion more than 1 600 ml during operation were collected in our hospitals from Aug 2015 to Dec 2016（n=218）, these cases were divided into the normal coagulation group（Group A） and abnormal coagulation group（Group B）, and the patients of emergency rescue transfusion O type blood group（Group C）. The basic information of cases, the infused volume of red blood cell（RBC）, virus-inactivated frozen plasma（VIFP）, fresh frozen plasma（FFP）, cryoprecipitate（C）and platelets（P）, prothrombin time（PT）, activated partial thromboplastin time（APTT）, fibrinogen（FIB）and international normalized ratio（INR）were analyzed, the relationship between volume of blood transfusion and coagulation function were also analysed. At the same time, the efficiency and safety index were compared before and after transfusion. These indexes, such as hemoglobin（Hb）, indirect bilirubin（IBiL）, direct antiglobulin test（DAT）and irregular antibody were determined at the time-paints of 24 h, 3 d and 7 d after blood transfusion. The differences of age and blood type between group A and B was not statistically significant（P>0.05）. Proportion of A and AB type，transfusion volume of RBC, FFP, C and Plt all were significantly higher in group C （P<0.05）. PT, APTT, FIB and INR in group B and C were significantly different（P<0.05）, which related with the transfusion volume of RBC, FFP and C（P<0.05）. DAT and irregular antibody in every group was all negative before transfusion, No any new irregular antibodies had been detected after transfusion. Hb after blood transfusion was not statistically different before and after transfusion in group C, the IBiL level also was not significantly increased after blood transfusion（P > 0.05）. All those showed that emergency rescue transfusion was safe and effective. Preoperative coagulation function is one of factors inflnencing blood products transfusion volume during operation, which also is the basis for evaluating bleeding and blood transfusion. Emergency O type blood and ABO-matched blood transfusions show the same efficiency and safety.

Frecuency of antigens and alloantibodies of Diego system in blood

The Diego blood group is an irregular blood system which has been involved in cases of hemolytic disease of the newborn and post transfusion reactions, in this system have been identified 22 erythrocyte antigens, among which the pair Dia/Dib is the most important because those have the most immunogenic potential. This research aims to determine the frequency of antigen Dia and their respective alloantibody in the Ecuadorian population. Methods: It was performed a simple random sampling in the donor population, being later tested tube agglutination by the presence or absence of the antigen and its alloantibody Dia applying gel agglutination technique. It was observed an antigen prevalence of 25% against a 6.09% of percentage alloimmunization due to Dia antigen, without significant differences between men and women and these being independent of the age and origin of the donor, showing that there are some Diego positive cases in Ecuadorian population as probably cases of transfusional alloinmunization or due to fetal-maternal alloinmunization. The frequency distribution of antigens and alloantibodies from the Diego blood group is almost uniform in the population, due presumably to the high incidence of miscegenation in our country. Therefore it becomes vitally important the implementation of this blood system inside the protocols of irregular antibodies identification in Ecuadorian blood banks.

Daratumumab: Therapeutic asset, biological trap!

ObjectivesRecently, daratumumab has been included in the therapeutic strategies for myeloma patients. This molecule is an antibody directed against CD38, strongly expressed on plasma cells. Nevertheless, as CD38 is also present on erythrocyte membrane, daratumumab interferes with immunohaematological tests, complicating the selection of compatible blood. MethodsA total of 14 patients treated by daratumumab have been followed in our transfusion laboratory. Among them, 11 have been transfused. Dithiotreitol (DTT) has been used to inhibit the daratumumab's interference, in the pre-transfusion tests (irregular antibody screening and cross-match). ResultsThe red blood cell treatment with DTT has been very efficacious to inhibit the daratumumab's interference in 13 patients out of 14. Some precautionary measures had to be taken into account, especially the pH and the storage conditions. An extended pheno/genotype was an additional security element in the selection of compatible blood. To simplify and to optimize the laboratory practices, a decisional flow chart has been written. ConclusionDTT red blood cell treatment is very useful and efficacious in the pre-transfusion tests of patients treated with daratumumab. It allows to avoid the selection of blood bags only on the basis of an extended pheno/genotype, what is more secure and more ethical with respect to other at higher risk patients. A clear decisional flow chart allows a quality assurance gait. Collaboration with physicians is essential.

Are we missing out something in donor notification?

Background: Donor notification is an integral part of any blood collection facility. But regarding DAT positive donors there are no standard guidelines to notify them or to refer them to any clinician. Aim of this study was to suggest possible ways to manage DAT positive donors. Material and Methods: This was a retrospective study extended over past 5 years from 2013-2017 in a tertiary care health center. All whole blood donations were tested for ABO Rh, irregular antibody, HIV, HBV, HCV, SYPHILIS, and Malaria parasite. At the time of blood request if crossmatch came incomnpatible and antibody screen was negative we do DAT of the unit and if it comes positive then DAT work up was done. Result: Of total 55,310 donations, Twenty-two (0.04%) donors were DAT positive. From DAT positive donors, in 72% of cases IgG alone was responsible for DAT positivity of the unit, and in 18% of cases, involved IgG was subtyped as I gG1/IgG3. Conclusion: With the evidence of a significantly increased risk of cancer, especially hematologic malignancies, among blood donors with a positive DAT, donor notification is suggested. There should be a standardized protocol across the country about donor notification to avoid confusion and variations seen in different blood collection facilities.

Prevalence of irregular red cell antibody in healthy blood donors attending a tertiary care hospital in North India.

BACKGROUND:Alloantibodies may be detected in blood donors who have either been transfused previously or female donors with previous obstetric events. These antibodies can occasionally cause severe transfusion reaction, if a large amount of plasma or whole blood is transfused, as in massive transfusions and pediatric patients.AIMS:The present study aims to assess the prevalence of red cell antibodies in healthy blood donors at a tertiary care hospital-based blood bank in India.MATERIALS AND METHODS:A total of 82,153 donor samples were screened for irregular red cell antibodies between January 2012 and December 2015 at the Department of Transfusion Medicine, Indraprastha Apollo Hospitals, New Delhi. Antibody screening was performed by solid phase method using Immucor Capture–R ready screen (pooled cells) on fully automated immunohematology analyzer Galileo Neo (Immucor Inc., Norcross, GA, USA). Positive tests were further confirmed using Capture-R ready screen (4 cell panel). Advanced investigations to identify the antibody/ies were performed on confirmed positive samples. Antibody identification was conducted using various cell panels (Immucor Capture-R Ready-ID, Panocell-10, Ficin Treated). An advanced technique such as adsorption and elution was performed as per requirement.RESULTS:Screening with pooled cells and 4 cell panel was positive in 227 donors (0.27%), 150 of these donors had autoantibodies, 1 had autoantibodies with underlying alloantibody anti-Jka (0.001%), and 76 had alloantibodies (0.09%) alone in their plasma. Anti-M was the most common antibody (43 donors) identified, followed by anti-D (21 donors). Anti-N was detected in 4; anti-Jka, anti-C, and anti-E in two donors each followed by anti-P1 and anti-Leb in 1 donor.CONCLUSION:Antibodies against red cells can be present in healthy donors detection of which is important in providing safe blood to the patient. The prevalence of red blood cell antibody in healthy donors in this study was found to be 0.27%, while the prevalence of alloantibodies was 0.09%. The majority of alloantibodies were anti-M (56.57%) and anti-D (27.63%).

Management of daratumumab interference in Portuguese blood transfusion medicine: A literature review about unmet needs and challenges

Multiple Myeloma is a malignant disease of the bone marrow plasma cells that mainly affects older people, and whose prognosis is reserved on relapsing or refractory disease. The arrival of CD38 monoclonal antibody daratumumab into the market allowed an increase in overall survival rate, with limited associated toxicity, for pre-treated multiple myeloma patients. However, this antibody interferes with pre-transfusion tests since erythrocytes also express, even at reduced levels, CD38 receptors. A literature review and discussion about this topic was performed by a board of Portuguese Immuno-hemotherapy experts. Based on the literature review, the mechanisms by which daratumumab interferes with pre-transfusion tests and may mask the presence of irregular antibodies in plasma of treated patients, which may result in difficulties in preparing and delivering results and blood components to be transfused, were identified and discussed. In addition, the applicable strategies in clinical practice to mitigate this interference were identified, namely the denaturing method of CD38 with dithiothreitol, considered an inexpensive, reproducible, reliable and validated technique, although with logistic limitations and should not be ignored. The experts also assessed and discussed the main concerns and priorities of transfusion medicine services, considering the limitations of this technique and its implication in routines for tranfusional support. The experts agreed on the importance of communication between physicians, hematologists, immuno-hemotherapy specialists, nurses and patients, as well as the need to align all methodologies to develop global and universal protocols to the various clinical analysis laboratory centers.

Is it necessary for screening irregular antibodies of blood donors?

Is it necessary for screening irregular antibodies of blood donors?

Red Cell Alloantibody Screening: Comparative Analysis of Three Different Technologies

Background: The detection of irregular antibody is a critical issue in the management of red blood cell transfusion according to the Type & Screen (T&S) practice. In order to implement the T&S procedure at our blood bank, we compared three different automated analyzers based on column agglutination technique (CAT) or solid phase red cell adherence assay (SPACA) methods. Methods: Pre-transfusion antibody screening was performed in 986 patients candidate to elective surgery at low risk for red blood cell transfusion. We tested the following kits: the three-cell panel micro-CAT system ID-DiaCell I-II-III (DiaMed), the four-cell panel solid-phase system Capture-R Ready Screen-4 (Immucor), and the four-cell panel micro-CAT system Serascan Diana-4 (Grifols). Positive results were further investigated using corresponding identification panels, and discrepant results were investigated with all the antibody identification systems. Results: Among 986 samples, we observed 967 concordant negative results (98.1%), 8 concordant positive results (0.8% of cases), and 11 discrepant results (1.1%). Among discrepant samples, an alloantibody could been identified in two patents (anti-M, detected by Serascan Diana-4 and ID-DiaCell I, II, III; anti-Kp^a, detected by Capture-R Ready Screen-4 and Serascan Diana-4). Conclusion: Among the evaluated technologies, the four-cell panel micro-CAT system displayed the highest sensitivity and specificity with an optimal negative predictive value. These features might be relevant to the routine implementation of the T&S transfusion strategy.

Identification of a novel ABO B(A)07 allele

To explore the molecular basis for a novel B(A) phenotype. Genomic DNA was abstracted from peripheral blood sample from the proband. ABO genotyping were carried out with sequence specific primer PCR (PCR-SSP). Exons 6 and 7 of the ABO gene were amplified with PCR and sequenced. Anti-A serum could not be adsorbed or eluted by the donor's red blood cells, and no irregular antibodies were found in the plasma. PCR-SSP showed that the ABO genotype of the donor was ABO *B/O. Sequencing results showed that one of the alleles was ABO *O02, while the other could not be defined but contained the following mutation points, 297A>G, 526C>G, 657C>T, 701C>T, 703G>A, 796C>A, 803G>C, and 930G>A. The data was accepted by the GenBank (the loading code was KM974887) and the Blood Group Antigen Mutation Database, and was confirmed to be a novel allele of B(A). A novel allele ABO *B(A)07 with 701C>T has been identified, which may facilitate further study on blood antigen variants and typing of the blood groups.

Analysis of Irregular Antibody Production in Severe β-Thalassemia Children with long-term Blood Transtusion and Its Correlation with RH Gene and Anemia Gene Mutation Site

To analyze the prevalence of irregular antibodies in children with severe β-thalassemia after long-term blood transfusion and its correlation with RH and anemia gene mutations site. One hundred twenty children with severe β-thalassemia and long-term blood transfusion were selected in our hospital, the genomic DNA was extracted and the genotype of RH factor were determined by PCR-SSP. The irregular antibodies and their types were screened and identified by the serological method, the gene types of the severe β-thalassemia were analyzed by reverse dot blot hybridization on DNA chip and PCR amplification. The major of RH genotypes in 120 children were Ce/Ce (59.17%) and CE/ce (25%), among them 10 children possessed the positive irregular antibodies (8.33%), out of these 10 children, the genotypes of RH factor were Ce/Ce in 6 cases, cE/cE, CE/ce, cE/ce and Ce/ce in one case; among these 10 children with positive irregular antibodies, the anemia gene mutations were IVs-11654M in 2 cases, cD4142M in 6 cases, 28M in 1 case, and CD71-72M in 1 case. Irregular antibodies produced by regular blood transfusion in children with severe β-thalassemia may be related with RH factor and anemia gene mutation sites.

Unusual Rhesus Antibodies as a Cause for Fetal Isoimmunisation

AbstractHemolytic disease of the newborn due to Rh isoimmunisation in a Rhesus D (Rh-D) negative mother with an Rh-D positive fetus is a well recognised entity. Although antibody to Rh-D antigen (anti-D antibody) was once the major cause of hemolytic disease of the fetus and newborn (HDFN), widespread adoption of antenatal and postnatal prophylactic anti-D immunoglobulin administration has resulted in a marked decrease in the prevalence of allo-immunisation due to the Rh-D antigen during pregnancy. However, at the same time, the maternal allo-immunisation to other red cell Rhesus antigens became more evident as a cause for HDFN, since no prophylactic immunoglobulins are available to prevent the formation of these antibodies. The authors report a case of a pregnant woman with AB negative blood group and positive indirect Coombs test (ICT) with rising middle cerebral artery peak systolic velocity (MCA-PSV) on follow up visits. Fetus required intrauterine transfusion. Fetal cord blood sampling revealed the fetus to be B negative and the direct Coombs test (DCT) was positive. On further testing, maternal serum was found to be positive for anti-D, anti-C and anti-G antibodies. Postnatally, the baby required double volume exchange transfusion. The authors highlight the importance of irregular antibody screening for women with obstetric history suggestive of HDNF. This could help in diagnosis and successful treatment of the affected fetus.

The development of D antibodies after D-mismatched kidney transplantation in a setting of reduced immunosuppression.

D antigens are not taken into account in the allocation of solid organs. Female transplant recipients with D antibodies as a consequence of D-mismatched kidney transplantation may develop hemolytic disease of the fetus and newborn in future pregnancies. We examined D antibody development in transplant recipients who received D-mismatched kidney transplantation in absence of D prophylaxis and in a setting of reduced immunosuppression. From 1993 until 2015, a total of 1355 kidney patients received transplantations in our center of whom 156 received a D-mismatched graft. A retrospective analysis was conducted; frozen stored sera obtained from transplant recipients 3 months after transplantation were tested for irregular red blood cell (RBC) antibodies using a three-cell screening and an identification panel. In the case of D antibody positivity, additional testing was performed 1 month before transplantation. In seven of 156 (4.5%) transplant recipients we found irregular RBC antibodies after transplantation, of which five (3.2%) were determined to be D antibodies. We observed only one (0.6%) recipient without D antibodies before transplantation. Although the risk of D antibody development is considerably lower after D-mismatched kidney transplantation than D-mismatched pregnancy, anti-D prophylaxis may still be advisable for female transplant recipients of childbearing age.

RETRACTED: Delayed Hemolytic Transfusion Reaction and Hyperhemolysis Syndrome without Detectable Alloantibodies or Autoantibodies in a Patient with Sickle Cell Disease: A Fatal Case Report and Literature Review.

L'éditeur a le regret de vous informer que cet article a déjà été publié dans: Journal of Blood Disorders & Transfusion, 2017, 8:4. DOI: 10.4172/2155-9864.1000388. Cette seconde publication faite par erreur a été retirée.

Experimental Study on Neonatal ABO or RhD Compatible Blood Transfusion

To investigate the safety and effectiveness of neonatal ABO or Rh(D) by using compatible blood transfusion through retrospective analysis of data from cases received compatible blood transfusion and type matched blood transfusion. The clinical data of 26 cases of neonatal compatible blood transfusion in Chinese Nanchang area from January 2014 to October 2016 were collected, and 26 cases of neonatal type-matched blood transfusion were selected according to ratio of 1:1 cases. The efficiency and safety index of 26 patients compatible blood transfusion were compared with that of type-matched blood transfusion. The efficiency indexes included: patients' basic characteristics, red blood cell (RBC) count, hemoglobin (Hb) level, hematocrit (Hct), and the safety indexes contain Hb level and indirect bilirubin (IBiL) value before and after blood transfusion, irregular antibody screening, direct antiglobulin test (DAT) results and the adverse reactions of blood transfusion. The age, sex, days of hospitalization between compatible blood transfusion and type matched blood transfusion were not statistically significantly different (P>0.05). The Hb level before transfusion, blood transfusion volume and the increase of Hb, Hct and RBC were not statistically significantly different between two groups (P>0.05). The values of Hb, Hct and RBC in 2 groups significantly increased at the day 1 after blood transfusion (P<0.05). No blood transfusion adverse reaction occurred in 2 groups. The IBiL value significantly decreased in compatible blood transfusion patients at the day 1 after blood transfusion (P<0.05). No new irregular antibodies had been detected after transfusion in all patients, and the others' DAT and screening for irregular antibodies were negative except 22 patients with neonatal hemolysis. The values of Hb and IBiL statistically significantly differenence were not in 12 patients between 1d, 3d, 7d after blood transfusion (P>0.05). The efficiency and safety between compatible blood transfusion and type matched blood transfusion are the same in neonatal blood transfusion. Compatible blood transfusion is a safe and effective in clinical blood transfusion.