Irregular Red Cell Antibodies Research Articles

Irregular red blood cell antibodies, abnormal hemoglobin and dangerous universal blood donor insights from a public blood center in a Brazilian metropolitan area

BackgroundImmunohematology tests are crucial in transfusion safety. This study aimed to assess irregular red blood cell (RBC) antibodies, abnormal hemoglobin and dangerous universal blood donors at a public blood center in a Brazilian metropolitan area. MethodsA cross-sectional study included all consecutive blood donors from January 2018 to December 2021 at the Brasília Blood Center Foundation, Federal District (FD), Brazil. ResultsAmong 205,965 blood donations, irregular RBC antibodies were found in 743 (0.4 %). Abnormal hemoglobin was observed in 5396 (2.6 %): 3959 (1.9 %) with Hb AS, 1344 (0.7 %) with Hb AC, and 93 (< 0,1 %) with other hemoglobin variants. Of O group donors, 12.5 % (9646) had hemolysins: 12.5 % (2410) both anti-A and anti-B, 8.7 % (9646) only anti-A, and 1.6 % (1763) only anti-B hemolysins. Female sex (p < 0.001) and increasing age (p < 0.001) were associated with irregular RBC antibodies. O and/or Rh(D)-positive blood groups had a lower prevalence of irregular RBC antibodies compared to other ABO and/or Rh(D)-negative groups. Age (p < 0.001) and female sex (p < 0.001) were associated with anti-A/anti-B hemolysins, while FD residency was associated with reduced incidence (p < 0.001). ConclusionAnti-A/anti-B hemolysins in O group donors, abnormal hemoglobin and irregular RBC antibodies pose risks to transfusion practice and should not be overlooked. Advancing age, female sex, ABO blood group other than O, or Rh(D)- negative are independently associated with the presence of irregular RBC antibodies. Dangerous universal blood donors were associated with advanced age, female gender, Rh(D)-positive blood type, and individuals residing in a Brazilian state other than where the blood center was located.

Prevalence and Characterisation of Irregular RBC Antibodies in Antenatal Females from a Tertiary Care Center in Northern India: A Cross-sectional Study

Introduction: Haemolytic Disease of the Foetus and Newborn (HDFN) is widely known to be caused by the presence of irregular Red Blood Cell (RBC) antibodies in pregnant females. To prevent HDFN, it is crucial to identify these antibodies in pregnant women. Aim: To evaluate the prevalence of irregular red cell antibodies in pregnant women in a tertiary care hospital. Materials and Methods: A cross-sectional retrospective study was conducted in the Department of Transfusion Medicine at Indraprastha Apollo New Delhi, from November 2009 to December 2017. A total of 8,217 prenatal females were examined for irregular red cell antibodies. Antibody screening and blood grouping were performed. The Capture-R ready screen was used to confirm screen-positive tests. Adsorption, elution, and other advanced techniques were utilised as needed. Data was collected from patient records and entered into a Microsoft excel spreadsheet. The statistical analysis was conducted using Statistical Package for Social Sciences (SPSS) software version 14.0 (USA). Statistical tests, including the Chi-squared and Fisher’s exact test, were performed, with a p-value less than 0.05 considered statistically significant. Results: Out of the 8,217 prenatal females examined, 105 (1.27%) had positive screening results with the four cell panel. Red cell alloimmunisation was observed in groups that were RhD negative (n=93/105; 88.57%) and positive (n=12/105; 11.42%). The most prevalent alloantibody among RhD negative individuals was alloantibody anti-D (n= 83/93; 89.24%), followed by alloantibody anti C+ anti D (n=13/93; 13.97%). Anti-D was the most prevalent alloantibody overall (n=83/105; 79.04%). Conclusion: Alloimmunisation rates were notably high among women lacking the Rh D antigen. Individuals with a history of adverse obstetric outcomes showed a statistically significant association with alloimmunisation. Therefore, it is recommended to screen such individuals for alloantibodies to enable early detection and improve the management of HDFN.

Comparison of the Detection Rate and Specificity of Irregular Red Blood Cell Antibodies Between First-Time Pregnant Women and Women With a History of Multiple Pregnancies Among 18,010 Chinese Women.

Background: There is insufficient evidence to assess the risk of the production of clinically important alloimmune irregular red blood cell (RBC) antibodies in first-time pregnant women. Methods: Using the microcolumn gel antiglobulin method, 18,010 Chinese women with a history of pregnancy and pregnant women were screened for irregular RBC antibodies, and for those with positive test results, antibody specificity was determined. The detection rate and specificity of irregular RBC antibodies in women with a history of multiple pregnancies (two or more) and first-time pregnant women were determined. Results: In addition to 25 patients who passively acquired anti-D antibodies via an intravenous anti-D immunoglobulin injection, irregular RBC antibodies were detected in 121 (0.67%) of the 18,010 women. Irregular RBC antibodies were detected in 93 (0.71%) of the 13,027 women with a history of multiple pregnancies, and antibody specificity was distributed mainly in the Rh, MNSs, Lewis, and Kidd blood group systems; irregular RBC antibodies were detected in 28 (0.56%) of the 4983 first-time pregnant women, and the antibody specificity was distributed mainly in the MNSs, Rh, and Lewis blood group systems. The difference in the percentage of patients with irregular RBC antibodies between the two groups was insignificant (χ 2 = 1.248, P > 0.05). Of the 121 women with irregular RBC antibodies, nine had anti-Mur antibodies, and one had anti-Dia antibodies; these antibodies are clinically important but easily missed because the antigenic profile of the reagent RBCs that are commonly used in antibody screens does not include the antigens that are recognized by these antibodies. Conclusion: Irregular RBC antibody detection is clinically important for both pregnant women with a history of multiple pregnancies and first-time pregnant women. Mur and Dia should be included in the antigenic profile of reagent RBCs that are used for performing antibody screens in the Chinese population.

Piperacillin-tazobactam induced immune hemolytic anemia led to increased renal impairment and eventual death from multiple organ failure in a patient with hypertensive nephropathy: case report and literature review

BackgroundPiperacillin is one of the most common drugs that cause drug-induced immune hemolytic anemia, but a complete description of the serological features and course of the disease is rare. This study completely describes the serological characteristics and course of a patient with hypertensive nephropathy who developed drug-induced immune hemolytic anemia and worsened renal function during repeated administration of piperacillin-tazobactam.Case presentationA 79-year-old male patient with hypertensive nephropathy who developed severe hemolytic anemia and worsened renal function during intravenous piperacillin-tazobactam anti-infective treatment due to lung infection. Serological tests showed that the result of the direct antiglobulin test for anti-IgG was positive (4 +) and anti-C3d was negative, and the irregular red blood cell antibody screening test was negative. Plasma samples collected at different times from 2 days before to 12 days after the discontinuation of piperacillin-tazobactam administration were incubated with piperacillin solution and red blood cells of O-type healthy blood donors at 37 °C, IgG piperacillin-dependent antibodies were detected, and the highest titer was 128. However, no tazobactam-dependent antibody was detected in any plasma samples. Therefore, the patient was diagnosed with piperacillin-induced immune hemolytic anemia. Although blood transfusion and continuous renal replacement therapy were given, the patient died of multiple organ failure 15 days after the administration of piperacillin-tazobactam was stopped.ConclusionThis is the first complete description of the disease course and serological changes of piperacillin-induced immune hemolytic anemia, which is bound to help deepen the understanding of drug-induced immune hemolytic anemia and draw profound lessons from it.

A Prospective Study on the Prevalence of Red Cell Alloimmunization via Fetomaternal Hemorrhage and its Association with Bad Obstetric History

Background and Objectives: The presence of irregular red cell antibodies in the serum of pregnant women is named maternal alloimmunization. Sensitizing events such as traumatic delivery and miscarriage can cause fetomaternal hemorrhage, increasing the risk of alloimmunization. Our objective was to estimate the prevalence of red cell alloantibodies among multigravidae and to study its association with those cases with bad obstetric history (BOH). Methods: This was a 1-year cross-sectional study done on 900 multigravidae in the Department of Transfusion Medicine, Medical College, Thiruvananthapuram. We excluded patients with a history of blood transfusion. Results: Out of 900 subjects, 49 (5.4%) were alloimmunized. The RhD-positive cases were predominant (77.4%), while 203 (22.6%) were RhD negative. Among the D-positive women, the prevalence of alloimmunization was 1.3%. The most frequent alloantibody identified was anti-D, followed by anti-G (18.4%). The alloantibodies identified among RhD-positive were anti-E, anti-c, anti-C, anti-Fya, anti-M, anti-Jka, and anti-Leb. We identified a total of 58 clinically significant alloantibodies. Thus, Rh blood group alloantibodies constitute 93.1% and the remaining 6.9% by other blood groups. Out of 159 cases with BOH, 17 were alloimmunized, and there was a statistically significant association between them (P = 0.001). Conclusion: Alloantibodies potentially causing hemolytic disease of the fetus and newborn were found in D-negative (19.7%) and D-positive (1.3%) mothers. The clinicians should change the current practice of screening only D-negative pregnant women, and antibody screening should be offered to all females or at least those with BOH. We may thus ensure early detection and periodic monitoring of all alloimmunized women.

Prevalence of Irregular Red Cell Antibodies in Healthy Blood Donors at a Stand-Alone Blood Centre in Gujarat

Background: Blood transfusion therapy involves multiple steps to ensure selection of safe blood component for transfusion. This includes testing for infectious markers, full ABO compatibility, free from any irregular red cell antibodies especially which are reacting at wide thermal amplitude and acceptable donor's red cell survival rates without destruction of recipient's red cells. Objective: This study was aimed to assess prevalence and type of irregular red cell antibodies in a large number of blood donor population at a standalone blood centre in Gujarat. Methods: This retrospective observational study included blood donor samples for antibody screening from January 2018 to March 2022. A total of 2,16,576 healthy blood donors including 2,00,493 (92.57%) males and 16,083 (7.43%) females were screened. Results: The prevalence of irregular red cell antibodies was 0.03 per cent in our donor population. Of the total 66 donors with red cell antibodies, 53(80.30%) had alloantibodies, 8(12.12%) had autoantibodies and 6 donors (9.09%) showed positive antibody screening with inconclusive results. We also found one case of cold antibody. Conclusion: Alloimmunization to red cell antigens is a challenging task for current transfusion practices. The antibody screening in blood donors may improve the quality and safety of blood transfusion in the recipients. It also reduces the risk of complications from incompatible blood transfusions. Keywords: antibody screening, allo-antibody identification, autoantibody, safe blood transfusion, hemolytic transfusion reaction.

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

CONTEXT:Alloimmunization by foreign red cell antigens is a matter of concern as it may lead to hemolysis in transfused patients as well as fetus of pregnant females.AIMS:This study aimed to perform a comparative analysis of prevalence and type of irregular antibodies in healthy donors, vis-a-vis blood transfusion recipients.SETTINGS AND DESIGN:Blood samples of 4000 individuals comprising healthy donors, exposed patients, and nonexposed patients were collected and were analyzed for irregular antibodies.MATERIALS AND METHODS:Commercially available three-cell antigen panel was used for the antibody screening. The samples positive in antibody screen were further subjected to an extended 11-cell panel for antibody identification in low-ionic strength saline with and without enzyme.STATISTICAL ANALYSIS:Statistical analysis was done using SPSS for Windows 15.0 program. Chi-square test was used for detecting statistical significance of exposure to red blood cell antigens in the formation of alloantibodies.RESULTS:Of the 4000 samples, antibodies were identified in 105 (2.6%) samples. Overall, nonexposed group showed a seropositivity of 0.36%, while the exposed group showed a seropositivity of 9.4%. Anti-D was the most common antibody found in 38 patients (33.3%). Anti-E was the most common antibody in males, while anti-D was the most common antibody in females.CONCLUSIONS:Since the risk of alloimmunization is more common in multitransfused patients, it is advisable to screen at least those cases for irregular antibodies.

Antibody Screening and Identification in Voluntary Blood Donors – Need of the Hour

Background and Objectives: Although unexpected antibody screening is mandatory according to the Food and Drug Administration and National Blood Policy, the prevalence of irregular red cell antibody and its specificities are not much reported in the donor population of western India. The objective of this study is to find the prevalence of unexpected antibodies in healthy blood donor population of western India. Methods: This is a retrospective study conducted in one of the largest stand-alone blood centers in western India. Data were retrieved from the Integrated Blood Bank Management System (powered by the blood center located in Ahmedabad) software. The data were analyzed for a period of 24 months, from March 1, 2019, to March 31, 2021. Unexpected antibody screening of all voluntary healthy blood donors was performed with fully automated blood grouping equipment Immucor NEO and Diagast EVO using commercial Capture-R Ready Indicator Red Cells (Immucor, USA) and Hemascreen Pool (Diagast, France). Further antibody identification was performed with 11 cell panels. Results: A total of 53,724 volunteer blood donors donated at our blood center during the study period comprised 51,185 (95.27%) male donors and 2539 (4.72%) female donors. A total of 25 (0.046%) donors showed the presence of unexpected antibodies. Most frequent alloantibodies were anti-M (n = 4, 16%) and multiple antibody (n = 4, 16%). Conclusion: Implementation of unexpected antibody screening in all the healthy blood donors routinely and identification of antibodies in antibody screen-positive donors helped us to understand the prevalence of antibodies in our region and its importance in providing compatible blood components which are devoid of irregular antibodies and to avoid delayed transfusion reactions.

Donation testing and transfusion transmissible infections

Donation testing and transfusion transmissible infections

Frequency and clinical significance of red cell antibodies in pregnancy - A prospective study from India.

For appropriate management of hemolytic disease of the fetus and newborn (HDFN), it is important to detect irregular red cell antibody in the antenatal period. Though it is a simple one-step method, it is not part of routine antenatal screening in many developing countries. To reiterate the importance of antenatal antibody screening, we have assessed the frequency and clinical significance of irregular red cell antibodies in our patient population. A prospective study was carried out from October 2013 to May 2015 at a tertiary care center from south India. All antenatal samples received by the laboratory for red cell antibody screening were screened using a commercial three-cell screening panel. Antibody identification along with further Immunohematological techniques as required were performed for cases with positive screening results. Neonates of the alloimmunized cases were followed up to determine the clinical significance of the antibody. A total of 2336 antenatal mothers were screened for red cell antibodies. The overall rate of alloimmunization in the study group was 2.27%. Alloimmunization rate among RhD-negative pregnancies was 6.9%. Other than anti-D (49%), we identified anti-D + anti-C (5%), anti-G (5%), anti-c (5%), anti-E (2%), anti-e (2%), anti-H (Bombay phenotype) (7%), anti-M (2%), anti-Lea (2%), anti-Leb (12%), and autoantibodies (9%) in the maternal serum. Anti-D, anti-D + anti-C, anti-G, anti-c, and anti-H were found to be clinically significant in this study. This study showed that 1 in 125 RhD-positive pregnancies can develop red cell alloantibodies. Hence, implementing routine antenatal antibody screening irrespective of RhD status is essential.

Red blood cell alloimmunization and minor red blood cell antigen phenotypes in transfused Ghanaian patients with sickle cell disease.

The routine pretransfusion investigations in Southern Ghana involve only ABO-D blood group typing and ABO compatibility testing without screening for irregular red blood cell (RBC) antibodies. The prevalence and specificities of RBC antibodies and frequencies of most minor blood group antigens in transfused patients with sickle cell disease (SCD) in Ghana are not known and are the objectives of this study. This was a cross-sectional study that investigated transfused patients with SCD for the presence of irregular RBC antibodies and Rhesus, Kell, Duffy, Kidd, and Ss antigens. From a total of 154 patients (median age, 9 years), 10 patients (6.5%) possessed 13 antibodies, predominantly against D, C, and E antigens. In three patients, the antibodies (anti-D, anti-D + C, and anti-C + e) were against antigens they possessed by serology. Genotyping showed that two of these patients had variant RHCE genes that encode for weak and partial e antigens and one patient had a partial RHC gene. Frequencies of most RBC antigens were comparable with frequencies established among the African American population; however, K-k- and Jk(a-b-) phenotypes were more frequent and were present in 21% and 17% of patients, respectively. The prevalence of RBC alloimmunization in transfused Ghanaian patients with SCD was 6.5% and the majority of antibodies were against antigens of the Rh system. Our findings stress the need to include pretransfusion testing for RBC antibodies in patients with SCD, to improve transfusion safety.

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.

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.

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.

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%).

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.

Frequency of Red Cell Alloantibodies in Pregnant Females of Navsari District: An Experience that Favours Inclusion of Screening for Irregular Erythrocyte Antibody in Routine Antenatal Testing Profile.

Alloimmunisation due to irregular erythrocyte antibodies is a recognised cause of hemolytic disease of the fetus and newborn (HDFN). Prior knowledge of red cell alloimmunisation in pregnant females guides the obstetrician to monitor the foetus for HDFN and if required for appropriated intervention. As limited data are available on prevalence of red cell alloimmunisation in pregnant females in India, the current study was carried out to know the prevalence of red cell alloimmunisation in pregnant females coming at our laboratory. Screening for irregular erythrocyte antibodies was performed in 1960 pregnant females after obtaining informed consent between June 2015 and June 2016. MatrixTM screening and identification reagent red cells from Tulip Diagnostics (P) Ltd were used, and column agglutination technique was employed as a method for the test. Twenty antibodies (all of single specificity) were detected in 1960 samples giving a prevalence rate of alloimmunisation of 1.02%. Out of the 20 antibodies, 18 were identified to be anti-D, 1 was anti-c and 1 antibody was anti-H. The results obtained were then compared with those reported in the literature. Red cell alloimmunisation is not uncommonly observed in pregnant females; the information gained can help the obstetrician to identify high-risk cases to timely start antenatal and post-natal treatment. Obstetricians should request screening for irregular red cell antibody desirably in all pregnant females; however, if limiting factors are there, it should be done at least in select group of pregnant females having bad obstetric history.

Erythrocyte Alloimmunization and Autoimmunization among Blood Donors and Recipients visiting a Tertiary Care Hospital.

The ultimate aim of pretransfusion testing is the acceptable survival of donor red cells in recipient's body and antibody detection plays a critical role in achieving the same. The cornerstone of antibody detection method is detecting an unexpected antibody as against the expected antibodies of ABO blood group system. Autoantibodies can also interfere with the detection of clinically significant alloantibodies. To study the frequency of alloantibodies and autoantibodies in the healthy blood donors and patient population visiting our hospital. The Column Agglutination Technology (CAT) was used for ABO RhD blood grouping, Direct Antiglobulin Test (DAT), Autocontrol (AC), Indirect Antiglobulin Test (IAT) and red cell antibody screening and the unexpected reactions in any of these tests were recorded for further evaluation. Ethylene Diamine Tetra Acetic Acid (EDTA) blood samples were used for all these tests for both blood donors and admitted patients. The CAT was exercised for the blood grouping (using ABD-Reverse Diluent cassettes) and antibody screening (using 0.8% Surgiscreen, Ortho Clinical Diagnostics Limited, USA and Low Ionic Strength Saline Ortho BLISS with AHG cassettes) on the automated immunohaematology platform ORTHO AutoVue® Innova system (Ortho Clinical Diagnostics Limited, USA). Among all blood donors (n=6350), seven (0.11%) donors had showed unexpected reaction. Of these, four had positive antibody screen (three having naturally occuring antibodies 2=anti-M, 1=anti-Lea and 1=inconclusive) and the other three had positive DAT. Of all the patient samples (n=6136) screened for irregular red cell antibodies, four (0.06%) patients were found to have unexpected reaction revealing one (0.02%) with anti-M antibody and the other three (0.05%) had autoantibodies in their serum. The combined prevalence for both blood donor and recipient population (n=12,486) was found to be 0.11% at our center. The alloimmunisation among patient population was found to be lower than many other studies worldwide as our hospital does not cater to multitransfused or transfusion dependant patients with haematological disorders and majorly elective surgery patients with no history of previous blood transfusions visit our hospital.

The immunohaematology reference laboratory: the experience of the Policlinico Maggiore Hospital, Mangiagalli and Regina Elena Foundation, Milan.

A careful evaluation of the presence of irregular red cell antibodies must be carried out in patients undergoing transfusion therapy1–3. For immunised patients, the availability of donors of rare blood groups and access to banks and international registries enables compatible blood components to be found and assigned correctly even in the most difficult cases. The accreditation of laboratories that provide these services indicates not only fulfilment of the accreditation body's requisites regarding the quality system, structure and organisation, but also those related to the technical and professional capacities of the laboratory and its staff. The requisites on which accreditation is based are technical (warranting satisfactory levels of performance), economic (controlling the appropriateness of the services) and educational (promoting continuous training and exchange of knowledge and experience). Accreditation also facilitates the evaluation and comparison of structures, since the services are delivered and controlled according to internationally recognised models.

Alloimmunization in multitransfused liver disease patients: Impact of underlying disease.

Introduction:Transfusion support is vital to the management of patients with liver diseases. Repeated transfusions are associated with many risks such as transfusion-transmitted infection, transfusion immunomodulation, and alloimmunization.Materials and Methods:A retrospective data analysis of antibody screening and identification was done from February 2012 to February 2014 to determine the frequency and specificity of irregular red-cell antibodies in multitransfused liver disease patients. The clinical and transfusion records were reviewed. The data was compiled, statistically analyzed, and reviewed.Results:A total of 842 patients were included in our study. Alloantibodies were detected in 5.22% of the patients. Higher rates of alloimmunization were seen in patients with autoimmune hepatitis, cryptogenic liver disease, liver damage due to drugs/toxins, and liver cancer patients. Patients with alcoholic liver disease had a lower rate of alloimmunization. The alloimmunization was 12.7% (23/181) in females and 3.17% (21/661) in males. Antibodies against the Rh system were the most frequent with 27 of 44 alloantibodies (61.36%). The most common alloantibody identified was anti-E (11/44 cases, 25%), followed by anti-C (6/44 cases, 13.63%).Conclusion:Our findings suggest that alloimmunization rate is affected by underlying disease. Provision of Rh and Kell phenotype-matched blood can significantly reduce alloimmunization.