Routine Antibody Screening Research Articles

Human immunodeficiency virus infection among inner-city adolescent parturients undergoing routine voluntary screening, July 1987 to March 1991

OBJECTIVE: The objective of our study was to describe the human immunodeficiency virus epidemic among pregnant adolescents undergoing follow-up in a large inner-city hospital. STUDY DESIGN: We conducted a case-control study comparing demographic and risk behaviors of seropositive and seronegative adolescents (aged 13 to 20) identified from a population under going routine voluntary antibody screening at Grady Memorial Hospital in Atlanta, Georgia, between July 1987 and March 1991. RESULTS: Of 10,794 pregnant adolescents screened, 51 (4.7/1000) were infected with human immunodeficiency virus. More than one fourth of case patients were ≤17 years old. Significantly more case patients than controls reported a history of crack cocaine use (10 [19.6%] vs 23 [8.2%] p < 0.05). A majority (58.8%) of case patients reported no risk factors for infection, and the remainder (41.2%) were presumably infected by heterosexual contact. Thirty-nine controls (13.8%) had self-identified risk factors for infection. CONCLUSIONS: Pregnant adolescents in our center are at risk for human immunodeficiency virus infection and should be targeted for human immunodeficiency virus education and risk reduction counseling. ( Am J Obstet Gynecol 1992;167:1096–9.)

Obstetric significance of cardiolipin antibodies in subjects without systemic lupus erythematosus

SummaryForty consecutive cardiolipin antibody positive sera were identified and the case notes of the corresponding patients reviewed. Thirteen of these patients were females without systemic lupus erythematosus who had been pregnant at least once. Five (38 per cent) of them had had proteinuric pre-eclampsia in first pregnancy. There was also a high frequency of history of miscarriage in these patients. A review of their known clinical and laboratory features failed to reveal characteristics which could be confidently used to predict cardiolipin antibody positivity in apparently healthy patients, and we suggest that routine antenatal screening for cardiolipin antibodies may be justified.

203 Incidence and prevalence of HIV infection in a prenatal population undergoing routine voluntary antibody screening, July 1987 to June 1990

203 Incidence and prevalence of HIV infection in a prenatal population undergoing routine voluntary antibody screening, July 1987 to June 1990

Antibody detection using pooled sera and a solid phase system

Abstract The purpose of the study was to evaluate the feasibility of substituting the lmmucor CaptureTM-R solid phase (SP) antibody detection system for our routine donor antibody screen. Our routine procedure (RP) used a 12-drop pool of six donor sera and one drop of pooled reagent red cells. with 37°C incubation and indirect antiglobulin test readings. The SP system was used according to the manfacturer’s directions except that one drop of the pooled sera (rather than an individual serum) was added to each microwell. In parallel tests of 888 donor pools and of 70 stored sera containing known alloantibodie with SP were comparable to results with RP. After implementation of SP for donor antibody detection, 1,135 donor pools were tested. Results with SP appeared satisfactory when compared to previous records. We concluded that the Immucor CaptureTM-R system can be used for antibody detection using pooled donor sera. Immunobematology 1991; 7:73-75

Erythrocyte antibodies in AIDS are associated with mycobacteriosis and hypergammaglobulinemia

Positive direct antiglobulin results prior to transfusion in some of our AIDS patients, as well as some reports in the literature on red cell antibodies in AIDS patients, prompted us to investigate the prevalence of erythrocyte antibodies in AIDS patients with transfusion requiring anemia. In addition we studied the question of relevant correlations with clinical diagnosis and with hematological and immunological laboratory parameters. Of 145 consecutive hospitalized AIDS patients (CDC criteria), 34 (23%) presented with anemia requiring transfusion. With each cross-match a routine antibody screening was performed. In cases of positive reaction additional antibody differentiation was done. Diagnoses, hematologic parameters, and therapy were studied retrospectively. Agglutination was positive in at least one test for 41% (14/34) (group 1). C3d, anti I, cold agglutinins, and IgG occurred most frequently (n = 9/8/7/6 out of 14). Seventy-five per cent (12/14) had leukopenia (less than 4000/microliters), 57% (8/14) had thrombocytopenia (less than 150,000/microliters), and 43% (6/14) showed both. Average values for leukocytes, thrombocytes, and CD4-positive lymphocytes did not differ significantly in patients with (group 1) and without (group 2) erythrocyte antibodies. Average gamma globulin levels were significantly increased in group 1 (23.2 g/l versus 16.9 g/l; p less than 0.001). In group 1, 64% (9/14) had proven mycobacteriosis (6 atypical), in contrast to only 15% (3/20) in group 2 (p less than 0.05). There were no significant differences between the two groups in prevalence of other opportunistic infections, malignant lymphoma, and Kaposi's sarcoma. Autoimmune versus infectious pathogenesis of pathologic erythrocyte antibodies in AIDS has been discussed in the literature.(ABSTRACT TRUNCATED AT 250 WORDS)

Diagnosis, Incidence, and Prevention of Congenital Toxoplasmosis

Sir .—The recent overview of the literature on toxoplasmosis by Koskiniemi and colleagues 1 should have been more critical to achieve its purpose. It fails to distinguish between proven techniques and solutions with relatively untried procedures. Concerning the serologic diagnosis, the titers in none of the tests correlate with the severity of disease or infection; this is not a shortcoming of the Sabin-Feldman dye test but of the way some people interpret tests for toxoplasmosis. I also disagree with the statement that routine antibody screening is not diagnostic in children with sequelae of intrauterine infection. At least in the United States, where young children rarely become infected from the environment, intelligently applied tests are usually diagnostic. Two, not one, direct agglutination tests are marketed by Bio-Merieux, Lyons, France. The IgG test is useful for general serologic diagnosis. Not correctly identified was the more important capture test for IgM, which

Comparison between Results of Virus Neutralization Test and Those of Two ELISAs when Screening for Antibodies to Pseudorabies Virus in Thailand

The virus neutralization (VN) test and two enzyme-linked immunosorbent assays (blocking and indirect ELISAs) were used to detect antibodies to pseudorabies virus on serum samples of 1,000 pigs from the central part of Thailand. The results of these tests were compared to those of VN test. Using the VN test as standard, the blocking and indirect ELISAs showed respectively 95.12% and 99.37% relative sensitivity and 92.0% and 93.5% relative specificity. The two ELISAs were considered both as practical alternatives to the VN test. However, the indirect ELISA was the more suitable test for the routine screening for antibodies to pseudorabies virus in Thailand.

Latex agglutination test for detection of antibodies to Toxoplasma gondii.

A resurgence of interest in Toxoplasma gondii has occurred because this coccidian parasite causes lethal infections in immunologically compromised hosts and is responsible for at least 3,000 congenitally infected infants in the United States annually. Thus, rapid, specific, and inexpensive serologic tests are required for routine screening of patients, especially pregnant women. We have developed a latex agglutination test for antibodies to T. gondii which utilizes covalently coupled T. gondii antigens. When compared with an indirect immunofluorescence assay, the latex test had a sensitivity of 94% and specificity of 100%. Compared with an enzyme-linked immunosorbent assay, the latex test had 86% sensitivity and 100% specificity. When testing samples which exhibited nonspecific polar staining by the immunofluorescence assay, the enzyme-linked immunosorbent assay had a 50% false-positive rate, whereas the latex agglutination test yielded no false-positive results. Thus, the latex agglutination test provided an efficacious method for routine serological screening for antibodies to T. gondii.

Standardization of bromelin for use in routine one-stage antibody screening.

A simple standardization method for bromelin used in routine one-stage antibody screening is described. Bromelin proteinase activity was assayed using casein as the substrate, and converted to units. The use of proteinase activity units for standardization of bromelin resolves differences between commercial preparations.

日本人献血者血清中に見い出された抗Ｕ１｀ａ´抗体の第１例

The blood group antigen Ula was reported in 1968 for the first time by Furuhjelm et al..Antigen Ula is now recognized as the K-10 of the Kell blood group system.During the routine antibody screening tests, we found the first example of anti-Ula in Japanese 45-year-old healthy male donor's serum, who had been much transfused about 15 years before.This antibody didn't react with the usual commercial reagent red cell panels and auto cell, but reacted with the red cell for the antibody screening tests only by antiglobulin phase. As a result of following tests, it was confirmed that this antibody was anti-Ula.The reactions were disappeared by AET, DTT, ZZAP, Trypsin treatments for the red cells, but Ficin, Papain, Bromelin treatments were non-effective.These reaction patterns of anti-Ula indicated that antigen Ula surely belonged to the Kell system.From the screening tests with anti-Ula, it was revealed that the antigen frequency, gene frequency of Ula in Japanese are 0.49%, 0.002 respectively.Family studies of Ul (a+) showed that antigen Ula has an inherited character.Testing the cord cells, we confirmed that antigen Ula was well developed at birth.Since the Ul (a+) were found in Finns, Chinese by Furuhjelm et al. and in Japanese this time, it is suggested that these races may be derived from a same ancestry.

Antenatal screening for congenital infection with rubella, cytomegalovirus and toxoplasma.

The sera of 3,463 pregnant women were screened, at the first antenatal visit, for antibodies to rubella, cytomegalovirus (CMV) and Toxoplasma gondii. Rubella antibodies were detected in 97.5%, CMV antibodies in 71% and toxoplasma antibodies in 45% of women. Asymptomatic toxoplasmosis occurred during pregnancy in 3 of 609 (0.5%) and primary CMV infection in 5 of 338 (1.5%) initially seronegative women whose sera were retested at the end of their pregnancies. The observed incidence of toxoplasmosis was similar to that calculated on the basis of the age-related prevalence of antibodies found in this study. On the basis of these observations it is estimated that congenital toxoplasmosis and congenital CMV infection due to primary maternal infection each occurs in up to 2/1,000 infants in this community. Very few of these infants have obvious abnormalities at birth, but follow-up studies elsewhere have shown that many of them suffer significant long-term sequelae. Routine antenatal screening for rubella antibodies is well established and justifiable for this preventable congenital infection. However, routine antenatal screening for CMV antibodies cannot be justified at present, since neither immunization nor treatment is available. Further information is required to determine the cost-effectiveness of routine antenatal screening for toxoplasma antibodies and treatment of proven maternal infection during pregnancy.

The efficacy of performing red cell elution studies in the pretransfusion testing of patients with positive direct antiglobulin tests.

In order to evaluate the efficacy of performing red cell elutions in pretransfusion testing, the serologic records of 638 patients with positive direct antiglobulin tests (DAT) were reviewed. These patients were identified by routine antibody screening procedures that included an autologous control. DAT results on the red cells of these patients showed 279 with IgG and C3d sensitization, 319 with IgG alone, and 40 with C3d sensitization alone. Of 638 patients' red cell eluates, 401 demonstrated no reactivity, 154 demonstrated panagglutination, and 60 demonstrated passively acquired anti-A,B. Only 23 of 638 patients had alloantibody sensitization of their red cells. Of the 23, 19 had serum antibody corresponding to the specificity of antibody detected in the eluate. Thus, only four of 638 (0.6%) eluates gave results unavailable by serum testing alone. This study indicates that routine eluate investigation provides little useful information in assuring compatibility. Serum antibody testing and careful review of the clinical and transfusion history constitute appropriate pretransfusion testing in patients with positive direct antiglobulin tests. Eluate testing should be restricted to cases in which immune hemolysis is suspected clinically.

Problems associated with the presence of immunofluorescent heterophile antibody in sera submitted for autoantibody screening

A small proportion of sera submitted for routine immunofluorescent antibody screening contains heterophile antibodies. The reaction patterns produced by the heterophile antibody may be confused with or mask specific autoantibody patterns, leading to false positive or false negative autoantibody results. In this study we report the development of a method in which fresh sheep red cells are used to absorb heterophile antibody from sera without affecting specific autoantibody which may be present. This technique was used on a panel of 142 sera known to contain heterophile antibody but not initially reported as containing specific autoantibodies by immunofluorescence. After absorption with sheep red cells the heterophile antibody was completely removed from the sera under test and 27 (19%) specimens were shown to contain previously undetected autoantibodies. Only 6 (4%) of the sera, however, contained autoantibodies at a titre which would be reported as a positive result on routine screening. These results suggest that there may be a significant number of sera submitted for routine autoantibody screening which contain autoantibodies that are masked by the presence of heterophile antibody. Selective use of the absorption technique offers a simple solution to this problem.

A LISS spin enzyme method for the detection of red cell antibodies and its use in routine antibody screen procedures.

A technique for performing the enzyme phase of the antibody screen on red cells suspended in low-ionic-strength-salt solution (LISS) is described. The reliability of this LISS spin-enzyme (LSE) technique was compared with the two-stage papain-tile method, in the detection of 62 previously identified enzyme reacting antibodies. All 62 antibodies examined were detected by the LSE method, and no false-positive reactions were found. Using LSE and papain-tile methods in parallel, further assessment was obtained by screening 2000 sequential blood samples under routine service conditions. Fifty-six blood samples contained alloantibodies, of which 43 reacted by both methods, eight by the LSE method only, and five by the papain-tile method only. It was concluded that the LSE method was comparable to the papain-tile method.

LONG-TERM CADAVER ALLOGRAFT SURVIVAL IN THE RECIPIENT WITH A POSITIVE B LYMPHOCYTE CROSSMATCH

Over a 2 1/2-year period, prospective standard, T, and B lymphocyte crossmatches were performed in 45 cadaver renal transplants using the microlymphocytotoxicity technique. Twenty-three of the 45 recipients had a positive B lymphocyte crossmatch. Cumulative graft survival rates did not differ between recipients with a positive and negative B lymphocyte crossmatch. High levels of presensitization in routine lymphocytotoxic antibody screening or transplant number did not adversely affect graft survival in recipients with a positive B lymphocyte crossmatch. Five recipients had moderately positive standard crossmatches which were attributable to anti-B lymphocytotoxicity. Four of these five grafts are presently functioning with normal serum creatinine levels 9 to 14 months post-transplant. A positive B lymphocyte crossmatch is compatible with good long-term cadaveric renal allograft survival. In addition, a weakly positive standard crossmatch is not a contraindication to transplantation when the positive crossmatch is attributable to anti-B lymphocyte antibody.

Hemolytic Anemia With Mycoplasma Pneumoniae Pneumonia-Reply

In Reply.— In response to the letter of Birrow, Cable, and Klein, we find little basis to their belief that insufficient evidence was provided in our case report to implicate autocold agglutinin hemolysis. We agree that monospecific Coombs' sera were not used. However, the monospecific anti-γ-globulin was not commercially available to our hospital's laboratory in 1973. The patient was first tested on Sept 27, 1973, and a routine antibody screening and direct Coombs' test were performed. The direct Coombs' test was positive ( + 2). The antibody screening was strongly positive at room temperature and decreasing toward the antihuman globulin phase of testing. The patient's cells gave very grainy reactions in the typing, and the proper typings were performed on washed cells from a heparinized sample. Since the antibody screening decreased in strength, another sample was collected and clotted at 4 °C in attempts of absorbing out auto-cold antibody. After one

'Cold' IgG autologous anti-LW. An immunological comparison with immune anti-LW.

Abstract. In the routine antibody screening of 45,000 blood samples, 10 cases of cold‐reacting, autologous anti‐LW were discovered, using a low‐ionic strength‐polybrene Auto‐Analyzer. Two of these were shown to belong to the IgG, and one to the IgM class. The others were suspected to belong to the IgG class. An immune anti‐LW (from a D‐positive, LW‐negative patient) was used for comparison with the cold, ‘naturally‐occurring’ anti‐LW, and further comparisons were made with anti‐D. DEAE fractionation shows a much greater heterogeneity for anti‐LW than for anti‐D, but iso‐electrofocusing of the main IgG fraction shows similar iso‐electric points: 8.8 and 8.9 for anti‐D and anti‐LW, respectively. However, the autologous IgG anti‐LW showed an iso‐electric point of 8.2, representing a different relationship to the bulk of IgG. The ability for immune anti‐LW to discriminate between Rh‐positive and negative cells was far greater with the low‐ionic strength‐polybrene Auto‐Analyzer than with the bromelin‐methyl cellulose method. In manual testing, the DEAE fractions showed such a discriminating ability only with the IgM containing fractions.

Results of an antibody screening programme at an antenatal clinic: relevance to haemolytic disease of the newborn and blood transfusion reaction

Results of a routine antenatal antibody screening programme from March 1967 to March 1970 were presented. 5,354 sera from 4,724 pregnancies were screened. The indirect antiglobulin and saline techniques at 37° on separate selected commercially available screening cells were used throughout. All patients were screened at their first visit and Rh negative patients again at approximately 28 and 36 wk. gestation. Antibodies were identified with commercial cell panels. Eighty sera contained detectable antibodies (1.7%). In 44 pregnancies (41 patients) the sera contained anti-D or anti-C + D and in 36 there were other antibodies. In 12 of these (2 anti-C, 2 anti-E, 1 anti-c, 6 anti-Kell (5 patients) and 1 anti-Fya) the antibody was capable of causing haemolytic disease of the newborn but only 2 babies from this group were affected and only one (an anti-Kell) required exchange transfusion. The remaining non-rhesus antibodies could have caused transfusion reactions or cross-matching difficulties (17 anti-Lewis and 7 unidentified antibodies). Of the 44 pregnancies in which anti-D or anti-E + D were found, 12 were negative, 8 were positive at the initial antibody screen and 24 were known from previous pregnancies. Some of the 12 developing detectable antibodies during the pregnancy produced quite severe haemolytic disease. There was a decreasing rate of appearance of new examples of anti-D in each year of the programme and only one of the 20 cases developing anti-D for the first time had had anti-D gamma globulin with her last pregnancy. The yield of antibodies relevant to haemolytic disease was small but the screening of all antenatal patients for antibodies was felt to be worthwhile for the anticipation of cross-matching difficulties and for its effect in improving standards.

Seroprevalence of cytomegalovirus antibodies among blood donors in Aminu Kano Teaching Hospital, Kano, Nigeria

Introduction: Transfusion transmissible infections (TTIs) may potentially lead to serious harm to recipients of blood transfusion. Cytomegalovirus (CMV) can be transmitted through blood transfusion, and its impact is the most severe among immunocompromised recipients. Its transmission can be reduced through screening of blood donors, blood and blood products for CMV antibodies, leuco-depletion or pathogen inactivation. Objective: This was a cross-sectional study conducted among 250 blood donors between October and December 2012 in Aminu Kano Teaching Hospital, Kano, Nigeria. To determine the prevalence of human immunodeficiency virus (HIV) I and II antibodies, HBsAg, hepatitis C virus (HCV) antibodies, syphilis and anti-CMV IgM and IgG antibodies. In addition, the type of donation and donation patterns were also assessed. Materials and Methods: Five milliliters were collected from the participants. One milliliter was dispensed into ethylenediaminetetraacetic acid (EDTA) container and mixed gently, the remaining 4 ml were dispensed into a plain bottle and was centrifuged; serum obtained was divided into two one was stored at − 20°C which was later used to test for the anti-CMV IgG/IgM antibodies, whereas the other portion was used for routine screening of TTIs. The EDTA sample was used to assess haemoglobin concentration. An interviewer administered simplified questionnaire was used to obtain information on demographic and other variables related to donation habits. Association between the socio-demographic characteristics of the blood donors and the anti-CMV antibodies was analysed. Similarly, association between the anti-CMV antibodies and the other routinely screened TTIs was assessed. Results were tested for evidence of statistical association. Results: Majority of the blood donors were males 242 (96.8%). One hundred and seven (42.6%) of the blood donors were within the age group of 25–34 years. Only 10.8% of the donors were voluntary donors whereas the remaining were family replacement donors. Prevalence rates of 100% and 4.4% were found for anti-CMV IgG and anti-CMV IgM antibodies, respectively. HBsAg, HIV I/II, anti-HCV antibodies and syphilis were prevalent in 6.8%, 1.2%, 0.8% and 0% of the donors, respectively. Conclusion: Seroprevalence of anti-CMV IgG and anti-CMV IgM antibodies among blood donors in this study was found to be 100% and 4.4%, respectively. Therefore, routine predonation screening for anti-CMV antibodies may not be cost effective. Leucocyte depletion and pathogen inactivation methods are better options. However, these can better be achieved when centralized system of blood transfusion is adopted. Therefore, there is a need to enhance the functional capacity of our national blood transfusion service.

Routine prenatal screening for atypical antibodies

One thousand eight hundred and ten prenatal patients were screened for atypical antibodies using pooled reagent red cells. †o(D). These potentially dangerous antibodies would not have been recognized by older “classic” procedures still routinely requested of and employed at many hospital laboratories. The value of screening all prenatal patients for atypical antibodies regardless of past history, parity, or Rh type is emphasized.