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Sanders DR. Comparison of solid-phase red cell adherence and microcolumn agglutination technology using untreated and enzyme-treated red blood cells. Immunohematology 2023; 39:166-171. [PMID: 38179782 DOI: 10.2478/immunohematology-2023-024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
Screening for clinically significant antibodies is crucial in transfusion medicine and is a routine part of pre-transfusion testing. The indirect antiglobulin test (IAT) is the most reliable and effective test for detecting clinically significant alloantibodies reacting at the antihuman globulin phase. Two of the main methods used for antibody detection and identification are solid-phase red cell adherence (SPRCA) and microcolumn agglutination technology (CAT), with or without enzyme-treated red blood cells (RBCs). This study was undertaken to detect and identify alloantibodies by performing antibody screen (ABS) and antibody identification (ABID) testing using SPRCA and CAT, with and without ficin-treated RBCs. Residual patient samples collected between 1 December 2020 and 19 May 2021 were saved, de-identified, and frozen at ≤-30°C before testing for alloantibodies. Seventy antibodies were detected in 53 samples among the 203 samples that underwent an ABS. Of those samples, 150 (73.0%) were nonreactive, 47 (23.1%) yielded positive results with both CAT and SPRCA, and six (3.0%) yielded positive ABS results with SPRCA only. Fifty-three samples that underwent ABID by both methods yielded eight samples with antibodies identified by SPRCA only. Additional enhancement of the CAT method by the use of ficin-treated RBCs was required to detect seven of the eight SPRCA-only antibodies; one sample remained nonreactive regardless. SPRCA testing detected clinically significant antibodies without the addition of enzyme-treated RBCs that was necessary in the CAT testing.
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Affiliation(s)
- D R Sanders
- SBBCM, Blood Bank Technical Specialist-Central, Immucor, Inc., 32062 DiStefano Court, Fraser, MI 48026, United States
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2
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Kenneday G, Chih HJ, Finch S, Ellery P. Does decreasing the incubation period used in the antibody screen affect its sensitivity? Transfus Med 2023; 33:379-389. [PMID: 37728214 DOI: 10.1111/tme.13009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 07/13/2023] [Accepted: 09/09/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND Pre-transfusion testing (PTT) encompasses a set of mandatory laboratory tests performed before red blood cell transfusion. The antibody screen, one component of PTT, commonly includes a 10-20 min incubation. The primary aim of this study was to determine if this period can be reduced when using current immunohematology methodologies. METHODS AND MATERIALS Antibody screens were performed on reagent samples using Glass or Gel-based column agglutination technologies (CAT) and a solid phase red cell adherence (SPRCA) assay, with incubation periods of 1, 5, 10 and 15 min, and 20 min (SPRCA assay only). For each method, the shortest period producing a minimum of a 1+ reaction with all reagent samples was considered optimal. The sensitivity of each assay using the optimal period was calculated after performing antibody screens on 100 patient samples. RESULTS AND DISCUSSION It was demonstrated that the incubation period in the SPRCA and Glass CAT systems can be reduced to 5 and 10 min, respectively, while achieving high assay sensitivity (98.9% in both). The incubation period in the Gel CAT system cannot be reduced from 15 min. Significant association between titre and reaction strength was observed for all three screening methods (p < 0.001 for both CAT methods, p = 0.041 for SPRCA). This study demonstrates that the incubation period used in the antibody screen can be reduced when using systems employing the Glass CAT and SPRCA methods, without affecting assay sensitivity. If confirmed, it could result in faster completion of PTT.
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Affiliation(s)
- Grace Kenneday
- Curtin Medical School, Curtin University, Perth, Western Australia, Australia
| | - Hui Jun Chih
- School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Susan Finch
- PathWest, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Paul Ellery
- Curtin Medical School, Curtin University, Perth, Western Australia, Australia
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3
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Liwski R, Clarke G, Cheng C, Abidi SSR, Abidi SR, Quinn JG. Validation of a flow-cytometry-based red blood cell antigen phenotyping method. Vox Sang 2023; 118:207-216. [PMID: 36633967 DOI: 10.1111/vox.13401] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 12/21/2022] [Accepted: 12/30/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND AND OBJECTIVES Current manual and automated phenotyping methods are based on visual detection of the antigen-antibody interaction. This approach has several limitations including the use of large volumes of patient and reagent red blood cells (RBCs) and antisera to produce a visually detectable reaction. We sought to determine whether the flow cytometry could be developed and validated to perform RBC phenotyping to enable a high-throughput method of phenotyping using comparatively miniscule reagent volumes via fluorescence-based detection of antibody binding. MATERIALS AND METHODS RBC phenotyping by flow cytometry was performed using monoclonal direct typing antisera (human IgM): anti-C, -E, -c, -e, -K, -Jka , -Jkb and indirect typing antisera (human IgG): anti-k, -Fya , -Fyb , -S, -s that are commercially available and currently utilized in our blood transfusion services (BTS) for agglutination-based phenotyping assays. RESULTS Seventy samples were tested using both flow-cytometry-based-phenotyping and a manual tube standard agglutination assay. For all the antigens tested, 100% concordance was achieved. The flow-cytometry-based method used minimal reagent volume (0.5-1 μl per antigen) compared with the volumes required for manual tube standard agglutination (50 μl per antigen) CONCLUSION: This study demonstrates the successful validation of flow-cytometry-based RBC phenotyping. Flow cytometry offers many benefits compared to common conventional RBC phenotyping methods including high degrees of automation, quantitative assessment with automated interpretation of results and extremely low volumes of reagents. This method could be used for high-throughput, low-cost phenotyping for both blood suppliers and hospital BTS.
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Affiliation(s)
- Robert Liwski
- Department of Pathology and Laboratory Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.,Nova Scotia Health Authority, Central Zone, Halifax, Nova Scotia, Canada
| | - Gwen Clarke
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada.,Canadian Blood Services, Edmonton, Alberta, Canada
| | - Calvino Cheng
- Department of Pathology and Laboratory Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.,Nova Scotia Health Authority, Central Zone, Halifax, Nova Scotia, Canada
| | - Syed Sibte Raza Abidi
- NICHE Research Group, Faculty of Computer Science, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Samina Raza Abidi
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jason George Quinn
- Department of Pathology and Laboratory Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.,Nova Scotia Health Authority, Central Zone, Halifax, Nova Scotia, Canada
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4
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Wu K, Wang H, Wang Y, Duan S, Gao X. A CNN-LASSO ensemble classification model for incomplete antibody reactants screening in coombs test. Technol Health Care 2022; 30:1463-1474. [PMID: 35599515 DOI: 10.3233/thc-213621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Precise classification of incomplete antibody reactants (IAR) in the Coombs test is the primary means to prevent incompatible blood transfusions. Currently, an automatic and contactless method is required for accurate IAR classification to avoid human error. OBJECTIVE We present an ensemble learning algorithm that integrates five convolutional neural networks and the least absolute shrinkage and selection operator (LASSO) regression algorithm into an IAR intensity classification model. METHODS A dataset including 1628 IAR and corresponding labels of IAR intensity categories ((-), (1+), (2+), (3+), and (4+)) was used. We trained the ensemble model using 1302 IAR and validated its performance using 326 IAR. The optimal ensemble model was used to assist immunologists in classifying IAR. The chord diagrams based on the human-machine interaction were established. RESULTS The ensemble model achieved 98.8%, 98.4%, 99.7%, 99.5%, and 99.4% accuracies in the (-), (1+), (2+), (3+), and (4+) categories, respectively. The results were compared with those of manual classification by immunologists (average accuracy: 99.2% vs. 75.6%). Using the model, all three immunologists achieved increased accuracy (average accuracy: +8.4%). CONCLUSIONS The proposed algorithm can thus effectively improve the accuracy and efficiency of IAR intensity classification and facilitate the automation of haemolytic disease screening equipment.
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Affiliation(s)
- Keqing Wu
- School of Computer Engineering and Science, Shanghai University, Shanghai, China.,Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Science, Suzhou, Jiangsu, China
| | - Hongmei Wang
- CAS Key Lab of Bio-Medical Diagnostics, Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, Jiangsu, China
| | - Yujue Wang
- CAS Key Lab of Bio-Medical Diagnostics, Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, Jiangsu, China
| | - Shengbao Duan
- CAS Key Lab of Bio-Medical Diagnostics, Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, Jiangsu, China
| | - Xin Gao
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Science, Suzhou, Jiangsu, China.,Jinan Guoke Medical Engineering and Technology Development Co., Ltd., Pharmaceutical Valley New Drug Creation Platform, Jinan, Shandong, China
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5
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Koenigbauer UF. Laboratory Detection of Blood Groups and Provision of Red Cells. Transfus Med 2021. [DOI: 10.1002/9781119599586.ch9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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6
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Alshehri AA, Jackson DE. Non-Invasive Prenatal Fetal Blood Group Genotype and Its Application in the Management of Hemolytic Disease of Fetus and Newborn: Systematic Review and Meta-Analysis. Transfus Med Rev 2021; 35:85-94. [PMID: 33781630 DOI: 10.1016/j.tmrv.2021.02.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 02/03/2021] [Accepted: 02/12/2021] [Indexed: 11/17/2022]
Abstract
Hemolytic disease of fetus and newborn (HDFN) imposes great healthcare burden being associated with maternal alloimmunization against parental-inherited fetal red blood cell antigens causing fetal anemia or death. Noninvasive prenatal analysis (NIPT) provides safe fetal RHD genotyping for early identification of risk pregnancies and proper management guidance. We aimed to conduct systematic review and meta-analysis on NIPT's beneficial application, in conjunction with quantitative maternal alloantibody analysis, for early diagnosis of pregnancies at risk. Search for relevant articles was done in; PubMed/Medline, Scopus, and Ovid (January 2006April 2020), including only English-written articles reporting reference tests and accuracy data. Nineteen eligible studies were critically appraised. NIPT was estimated highly sensitive/specific for fetal RHD genotyping beyond 11-week gestation. Amplifications from ≥2 exons are optimum to increase accuracy. NIPT permits cost-effectiveness, precious resources sparing, and low emotional stress. Knowledge of parental ethnicity is important for correct NIPT result interpretations and quantitative screening. Cut-off titer ≥8-up-to-32 is relevant for anti-D alloantibodies, while, lower titer is for anti-K. Alloimmunization is influenced by maternal RHD status, gravida status, and history of adverse obstetrics. In conclusion, NIPT allows evidence-based provision of routine anti-D immunoprophylaxis and estimates potential fetal risks for guiding further interventions. Future large-scale studies investigating NIPT's non-RHD genotyping within different ethnic groups and in presence of clinically significant alloantibodies are needed.
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Affiliation(s)
- Abdulrahman Ali Alshehri
- Thrombosis and Vascular Diseases Laboratory, School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Denise E Jackson
- Thrombosis and Vascular Diseases Laboratory, School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia.
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Blomme S, De Maertelaere E, Verhoye E. A comparison of three column agglutination tests for red blood cell alloantibody identification. BMC Res Notes 2020; 13:129. [PMID: 32131887 PMCID: PMC7057655 DOI: 10.1186/s13104-020-04974-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 02/24/2020] [Indexed: 11/17/2022] Open
Abstract
Objective Commercial kits of column tests for pre-transfusion testing have progressively replaced conventional tube tests in most laboratories. Aim of this study was to compare three commercial test cell panels for the identification of irregular red blood cell (RBC) alloantibodies. Overall, 44 samples with a positive indirect antiglobulin test (IAT) by routine testing were used for comparison of following panels: Ortho RESOLVE® panelC (Ortho Clinical Diagnostics (OCD), Milan, Italy), ID-DiaPanel(-P) (Bio-Rad Laboratories, CA, USA) and Identisera Diana(P) (Grifols, Barcelona, Spain). Column agglutination techniques were used, with microtubes containing either microgel (Bio-Rad/Grifols) or glass bead microparticles (Ortho). Results Alloantibody identification was possible in 38 samples, of which identical identification was shown in 33 samples by all methods. The remaining samples showed differences between certain methods, with the gel card system being superior to the glass card system for analyzing stored samples Considering that not all samples were evaluated in all three methods, the concordance rate reached 100% between Bio-Rad and Grifols, 90.5% between Bio-Rad and OCD, 86.5% between OCD and Grifols and 90.5% between all methods. Although differences in sensitivities were seen for specific antibodies, the three methods showed comparable performance for the identification of RBC alloantibodies.
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Affiliation(s)
- Siska Blomme
- Clinical Department of Laboratory Medicine, University Hospitals, Herestraat, 49 3000, Leuven, Belgium.
| | - Emilie De Maertelaere
- Clinical Department of Laboratory Medicine, University Hospitals, St. Pietersnieuwstraat 33, 9000, Ghent, Belgium
| | - Eline Verhoye
- Clinical Departments of Laboratory Medicine, AZ Delta Hospital, Ardooisesteenweg 276, 8800, Roeselare, Belgium
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8
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Sawierucha J, Posset M, Hähnel V, Johnson CL, Hutchinson JA, Ahrens N. Comparison of two column agglutination tests for red blood cell antibody testing. PLoS One 2019; 13:e0210099. [PMID: 30596807 PMCID: PMC6312228 DOI: 10.1371/journal.pone.0210099] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 12/16/2018] [Indexed: 11/25/2022] Open
Abstract
Background Several sensitive methods are available for red blood cell (RBC) antibody screening. Among these, gel and glass card systems have demonstrated comparably good performance in retrospective studies and are widely used in routine patient diagnostics, but their performance in prospective studies has not been sufficiently characterised. Patients and methods Gel card (Bio-Rad DiaMed) and glass bead-based (Ortho Clinical Diagnostics) column agglutination technologies were used to screen for antibodies prospectively (group A) and for antibody identification in stored and fresh samples known to contain RBC antibodies retrospectively (group B). Untreated reagent RBCs and either papain-treated (Bio-Rad) or ficin-treated panel C cells (Ortho) were used for antibody identification. Results RBC-reactive antibodies were detected in 22 of 1000 group A samples, three of which tested positive only by gel card agglutination, and four only by glass bead agglutination (including one false positive each). Group B comprised 202 sera with known antibodies: 33 of these samples contained 36 antibodies detected only by gel card agglutination, whereas 9 samples contained antibodies detectable only by glass bead-based agglutination. Discrepancies mostly involved weak antibodies reactive by enzyme only. Two sera contained antibody mixtures that neither system detected completely. Of note, in antibody differentiation batches one and two, anti-Lua was reactive in 7 of 7 and 1 of 8 samples, respectively. Conclusion Both column agglutination tests for red cell antibodies had equal sensitivity and specificity with unstored samples. In stored samples, weak and enzyme-only antibodies were more frequently detected with the gel card system.
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Affiliation(s)
- Jonas Sawierucha
- Institute for Clinical Chemistry and Laboratory Medicine, Transfusion Medicine, University Hospital Regensburg, Regensburg, Germany
| | - Marion Posset
- Institute for Clinical Chemistry and Laboratory Medicine, Transfusion Medicine, University Hospital Regensburg, Regensburg, Germany
| | - Viola Hähnel
- Institute for Clinical Chemistry and Laboratory Medicine, Transfusion Medicine, University Hospital Regensburg, Regensburg, Germany
| | - Christian L. Johnson
- Institute for Clinical Chemistry and Laboratory Medicine, Transfusion Medicine, University Hospital Regensburg, Regensburg, Germany
| | | | - Norbert Ahrens
- Institute for Clinical Chemistry and Laboratory Medicine, Transfusion Medicine, University Hospital Regensburg, Regensburg, Germany
- * E-mail:
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Yang L, Yu Y, Ma C, Wang H, Dai J, Duan H, Fu Z, Wu P, Wang D, Yu X. Development of RBC Membrane Antigen Arrays for Validating Blood Grouping Reagents. J Proteome Res 2018; 17:3237-3245. [PMID: 30114910 DOI: 10.1021/acs.jproteome.8b00370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Antibody reagents have been remained as a standard approach to characterize blood group (BG) antigens in clinic. The specificity and cross-reactivity of these BG antibodies are routine detected using the gel microcolumn assay (GMA). However, the GMA is neither specific nor sensitive, thus increasing the risk of improperly matched RBC transfusions. In this work, we describe a bead-based RBC membrane antigen array to detect BG antibody-antigen binding with ∼700-fold higher sensitivity and dynamic range than the GMA. RBC membrane antigen arrays were fabricated using fragmented RBC membranes highly enriched in BG panel antigens. The arrays were then used to screen the interactions of 15 BG reagents to three antigen panels. The majority of the antibody reactions (i.e., 86.7%; 39/45) aligned with those obtained with the GMA. The six cross-reactive, nonspecific antibody reactions identified only by our arrays (i.e., 13.3%; 6/45) were confirmed by agglutination inhibition and genotyping assays. These results demonstrate that our RBC membrane antigen array has great potential in screening BG antibodies and improving the safety of RBC transfusions.
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Affiliation(s)
- Lu Yang
- Department of Blood Transfusion , Chinese PLA General Hospital , Beijing , 100853 , China
| | - Yang Yu
- Department of Blood Transfusion , Chinese PLA General Hospital , Beijing , 100853 , China
| | - Chunya Ma
- Department of Blood Transfusion , Chinese PLA General Hospital , Beijing , 100853 , China
| | - Hongye Wang
- State Key Laboratory of Proteomics, Beijing Proteome Research Center, National Center for Protein Sciences (PHOENIX Center, Beijing) , Beijing Institute of Lifeomics , Beijing , 102206 , China
| | - Jiayu Dai
- State Key Laboratory of Proteomics, Beijing Proteome Research Center, National Center for Protein Sciences (PHOENIX Center, Beijing) , Beijing Institute of Lifeomics , Beijing , 102206 , China
| | - Hu Duan
- State Key Laboratory of Proteomics, Beijing Proteome Research Center, National Center for Protein Sciences (PHOENIX Center, Beijing) , Beijing Institute of Lifeomics , Beijing , 102206 , China
| | - Zhonglin Fu
- State Key Laboratory of Proteomics, Beijing Proteome Research Center, National Center for Protein Sciences (PHOENIX Center, Beijing) , Beijing Institute of Lifeomics , Beijing , 102206 , China
| | - Ping Wu
- State Key Laboratory of Proteomics, Beijing Proteome Research Center, National Center for Protein Sciences (PHOENIX Center, Beijing) , Beijing Institute of Lifeomics , Beijing , 102206 , China
| | - Deqing Wang
- Department of Blood Transfusion , Chinese PLA General Hospital , Beijing , 100853 , China
| | - Xiaobo Yu
- State Key Laboratory of Proteomics, Beijing Proteome Research Center, National Center for Protein Sciences (PHOENIX Center, Beijing) , Beijing Institute of Lifeomics , Beijing , 102206 , China
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10
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Mayer B, Müller J, Candela-García MJ, Manteau AC, Weinstock C, Pruß A. Evaluation of the New Lateral Flow Card MDmulticard® Basic Extended Phenotype in Routine Clinical Practice. Transfus Med Hemother 2018; 45:341-346. [PMID: 30498412 DOI: 10.1159/000486606] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 01/03/2018] [Indexed: 11/19/2022] Open
Abstract
Background Transfusion emergencies and critical situations require specifically designed devices to simplify and optimize the standard procedures. In addition, matching antigens over and above ABO-Rh-K would be beneficial. Methods Routine blood samples were collected in four immunohematology centers and tested with the new MDmulticard Basic Extended Phenotype for the simultaneous detection of the Duffy, Kidd, and Ss antigens, according to the principle of the lateral flow. Results were compared with those obtained using routine serology methods. Discrepancies were analyzed by molecular techniques/genotyping. Results 310 samples were tested (167 donors; 75 patients; 28 subjects with positive direct antiglobulin test (DAT); 15 newborns; 25 previously transfused patients). The 285 samples with non-mixed-field reaction yielded 1,710 antigen results with 8 discrepancies (0.47%) six of which in DAT-positive subjects: three false-positive (Fya) for MDmulticard, and two false-positive (Fya) plus three false-negative (Fyb) for the reference methods (MDmulticard PPA for donors/patients/newborns: 99.82%; negative percent agreement: 100%; sensitivity: 100%; specificity: 99.39%, positive predictive value: 99.75%; negative predictive value: 100%). The MDmulticard detected mixed-field in 15 antigen reactions from 13 transfused patients, undetected by the comparative method, with the opposite result in 8 antigens (5 patients). Conclusion The MDmulticard Basic Extended Phenotype met the criteria prescribed for the testing of donor, patient, DAT-positive, and newborn samples in transfusion laboratory routine.
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Affiliation(s)
- Beate Mayer
- Institute of Transfusion Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Julia Müller
- German Red Cross Blood Service Baden-Württemberg - Hesse, Institute for Clinical Transfusion Medicine and Immunogenetics, Ulm, Germany
| | | | | | - Christof Weinstock
- German Red Cross Blood Service Baden-Württemberg - Hesse, Institute for Clinical Transfusion Medicine and Immunogenetics, Ulm, Germany
| | - Axel Pruß
- Institute of Transfusion Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Bäckman S, Ångerman-Haasmaa S, Jousi M, Siitonen S, Salmela K. ABO and D typing and alloantibody screening in marrow samples: relevance to intraosseous blood transfusion. Transfusion 2018; 58:1372-1376. [DOI: 10.1111/trf.14557] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 01/05/2018] [Accepted: 01/22/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Sari Bäckman
- Meilahti Hospital Blood Bank, Department of Clinical Chemistry, Helsinki University Hospital Laboratory (HUSLAB), and the Department of Emergency Medicine and Services; Helsinki University Hospital; Helsinki Finland
| | - Susanne Ångerman-Haasmaa
- Meilahti Hospital Blood Bank, Department of Clinical Chemistry, Helsinki University Hospital Laboratory (HUSLAB), and the Department of Emergency Medicine and Services; Helsinki University Hospital; Helsinki Finland
| | - Milla Jousi
- Meilahti Hospital Blood Bank, Department of Clinical Chemistry, Helsinki University Hospital Laboratory (HUSLAB), and the Department of Emergency Medicine and Services; Helsinki University Hospital; Helsinki Finland
| | - Sanna Siitonen
- Meilahti Hospital Blood Bank, Department of Clinical Chemistry, Helsinki University Hospital Laboratory (HUSLAB), and the Department of Emergency Medicine and Services; Helsinki University Hospital; Helsinki Finland
| | - Katja Salmela
- Meilahti Hospital Blood Bank, Department of Clinical Chemistry, Helsinki University Hospital Laboratory (HUSLAB), and the Department of Emergency Medicine and Services; Helsinki University Hospital; Helsinki Finland
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Garg S, Saini N, Bedi RK, Basu S. Comparison of micro column technology with conventional tube methods for antibody detection. J Lab Physicians 2017; 9:95-99. [PMID: 28367023 PMCID: PMC5320888 DOI: 10.4103/0974-2727.199627] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 09/13/2016] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Conventional tube technique (CTT) has been the mainstay for antibody detection in pretransfusion testing. There have been rapid technological advances in blood banking and methodology of crossmatch has been modified to improve the sensitivity of these tests and to enable automation. This study was done to compare the efficacy of three crossmatch techniques: CTT, tube low-ionic-strength-saline indirect antiglobulin test (tube LISS-IAT), and micro column technology (MCT) used in the blood bank serology laboratory. MATERIALS AND METHODS In this prospective study, 150 samples from patients who had received two or more transfusions on two different occasions (with at least 72 h between two transfusions) were subjected to cross match by three different techniques - CTT, LISS-IAT, and MCT. RESULTS A total of 16 cases with antibodies were identified in 150 patients. Out of 16 cases, 14 were clinically significant (anti-c = 5, anti-K = 4, anti-E = 2, anti-S = 2, anti-Jka = 1) and 2 nonclinically significant antibody cases (anti-Lea). MCT detected all the 14 clinically significant antibody cases and no case of nonclinically significant antibody. Tube LISS-IAT detected 14 antibody cases including 2 cases of non-clinically significant antibody but failed to detect 1 case of anti-c and the only case of anti-Jka. CTT detected only 10 antibody cases including 2 cases of non-clinically significant antibody and but failed to detect 3 cases of anti-c, 1 case of anti-K, 1 case of anti-E, and the only case of anti-Jka. CONCLUSION MCT was found to be most efficacious when compared to CTT and tube LISS-IAT in detecting clinically significant red cell antibodies; although MCT missed 2 cases of Lea antibody which were detected by CTT and LISS-IAT.
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Affiliation(s)
- Sachin Garg
- Department of Transfusion Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Nishant Saini
- Department of Transfusion Medicine, Government Medical College and Hospital, Chandigarh, India
| | - Ravneet Kaur Bedi
- Department of Transfusion Medicine, Government Medical College and Hospital, Chandigarh, India
| | - Sabita Basu
- Department of Transfusion Medicine, Tata Medical Center, Kolkata, West Bengal, India
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Hill BC, Hanna CA, Adamski J, Pham HP, Marques MB, Williams LA. Ficin-Treated Red Cells Help Identify Clinically Significant Alloantibodies Masked as Reactions of Undetermined Specificity in Gel Microtubes. Lab Med 2016; 48:24-28. [DOI: 10.1093/labmed/lmw062] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
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14
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Kay B, Poisson JL, Tuma CW, Shulman IA. Anti-Jkathat are detected by solid-phase red blood cell adherence but missed by gel testing can cause hemolytic transfusion reactions. Transfusion 2016; 56:2973-2979. [DOI: 10.1111/trf.13782] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 07/15/2016] [Accepted: 07/17/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Brian Kay
- Los Angeles County + USC Medical Center and Keck School of Medicine of USC; Los Angeles California
| | - Jessica L. Poisson
- Los Angeles County + USC Medical Center and Keck School of Medicine of USC; Los Angeles California
| | - Christopher W. Tuma
- Los Angeles County + USC Medical Center and Keck School of Medicine of USC; Los Angeles California
| | - Ira A. Shulman
- Los Angeles County + USC Medical Center and Keck School of Medicine of USC; Los Angeles California
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15
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A new approach to detection of incomplete antibodies using hydrogel chromatography medium. Transfus Apher Sci 2015; 53:337-41. [PMID: 26099667 DOI: 10.1016/j.transci.2015.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 06/09/2015] [Accepted: 06/11/2015] [Indexed: 11/23/2022]
Abstract
In assays for incomplete antibody detection, several washing steps are required to remove unbound globulins which may cause false negatives. Here, we present an improved approach employing hydrogel chromatography medium (HCM) in the detection of incomplete antibodies. After a rapid single-step centrifugation, incomplete antibodies, attached to red blood cells (RBCs), were separated from the reaction mixture using HCM and sedimentation. This method obviates the need for multiple centrifugation steps found in conventional Tube-Coombs tests. The HCM-Coombs tests may have a wide range of applications for incomplete antibody detection.
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Roback JD, Barclay S, Moulds JM, Denomme GA. A multicenter study on the performance of a fully automated, walk-away high-throughput analyzer for pretransfusion testing in the US population. Transfusion 2015; 55:1522-8. [PMID: 25753019 DOI: 10.1111/trf.13053] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 01/18/2015] [Accepted: 01/18/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Moving to automation is a major focus of transfusion centers. Erytra (Grifols) is a walk-away analyzer with high-performance and -throughput capacity for pretransfusion testing. Efficiency and performance of Erytra with its cards and reagents were evaluated in comparison to Food and Drug Administration (FDA)-approved reference methods. STUDY DESIGN AND METHODS A total of 5279 blood samples (46% patients; 54% donors) were obtained from US blood establishment facilities. Samples were analyzed with Erytra and results were compared with the routine FDA-licensed automated platforms used by the clinical study sites. A total of 25,217 tests were performed (15,322 ABO/D/reverse typing; 4916 Rh phenotypes, 669 K typing, 838 antibody screens, 759 antibody identifications, 250 cross-matches, 244 ABO compatibilities by immediate-spin cross-match, and 219 direct antiglobulin tests [DATs]). RESULTS Global agreement between Erytra and the comparison platforms was 99.66%, with 99.82% positive percent agreement (95% lower confidence bound [LCB], 99.75%) and 99.50% negative percent agreement (95% LCB, 99.37%). There were 85 discrepancies (0.34%), including cross-matches (n = 13), antibody screens (n = 10), antibody identifications (n = 21), and DATs (n = 5), whereas an excellent concordance was obtained in blood grouping determinations (ABO/D/C/E/c/e/K, 0.04%-0.22% discrepancies). Analysis of the discrepancies showed that Erytra provided the correct result in 51 of them (60%), with only five false negatives (one O patient transplanted with A, one mixed-field reaction in a very weak D, one anti-Vel, two A2rr). Erytra results were 100% reproducible in a series of 3760 repetition tests. CONCLUSION Grifols' Erytra analyzer showed reliable efficacy compared with equivalent FDA-licensed reagents and FDA-cleared instruments.
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Affiliation(s)
- John D Roback
- Department of Pathology and Laboratory Medicine, Emory University Hospital, Atlanta, Georgia
| | - Sheilagh Barclay
- Department of Pathology and Laboratory Medicine, Emory University Hospital, Atlanta, Georgia
| | | | - Gregory A Denomme
- Diagnostic Laboratories, BloodCenter of Wisconsin, Milwaukee, Wisconsin
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Chang C, Brown M, Davies L, Pointon L, Brown R, Barker D. Evaluation of Erytra® fully automated analyser for Routine Use in Transfusion Laboratory. Transfus Med 2013; 24:33-8. [PMID: 24188135 DOI: 10.1111/tme.12073] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Accepted: 07/31/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate efficiency and performance of Erytra® analyser in comparison to the reference platform of the NBT immunohaematology laboratory (Bio-Rad ID-System). BACKGROUND Moving to automation or semi-automation is a major focus of transfusion centres. The Erytra® (Grifols) is a new fully automated walk-away analyser with high volume processing capacity for pre-transfusion testing, designed to be used with the unique 8-column DG Gel® cards. STUDY DESIGN AND METHODS A total of 2201 immunohaematological tests (1041 ABO/D grouping, 1041 antibody screening, 51 antibody identification, 45 newborns (ABO/D and DAT) and 23 crossmatches were performed on 1160 donor/patient whole blood samples. Erytra®'s performance was assessed by means of a stress test replicating the routine work of a hospital laboratory. RESULTS Concordant results between the Erytra® and the reference method were obtained in 2195 (99·73 %) of the tests. There were only three discrepancies out of 6246 reactions (0·05%) in ABO/D grouping, all in the reverse group which did not mislead to group identification. Of the 1041 samples screened for antibody presence, Erytra® detected all the relevant antibodies [9 not detected weak prophylactic anti-D were determined to be clinically nonsignificant (<0·1 IU mL(-1) )] while Bio-Rad ID-System missed one anti-e and one anti-Jk(a) . Concordance for D grouping, crossmatching and newborns was 100%. Results of the simulated stress test exercise highlighted the capacity of Erytra® for absorbing into 4 h workloads equivalent to 24 h of routine. CONCLUSIONS Grifols' Erytra® analyser showed reliable high sensitivity, velocity and capacity to cope with high workload in the immunohaematology laboratory routine.
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Affiliation(s)
- C Chang
- Pathology Department, Blood Transfusion Laboratory, Southmead Hospital, Bristol, UK
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Abstract
There have been rapid technological advances in blood banking in South Asian region over the past decade with an increasing emphasis on quality and safety of blood products. The conventional test tube technique has given way to newer techniques such as column agglutination technique, solid phase red cell adherence assay, and erythrocyte-magnetized technique. These new technologies are adaptable to automation and major manufacturers in this field have come up with semi and fully automated equipments for immunohematology tests in the blood bank. Automation improves the objectivity and reproducibility of tests. It reduces human errors in patient identification and transcription errors. Documentation and traceability of tests, reagents and processes and archiving of results is another major advantage of automation. Shifting from manual methods to automation is a major undertaking for any transfusion service to provide quality patient care with lesser turnaround time for their ever increasing workload. This article discusses the various issues involved in the process.
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Affiliation(s)
- Meenu Bajpai
- Transfusion Medicine, Institute of Liver and Biliary Sciences, Vasant Kunj, New Delhi, India
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Ching E. Solid Phase Red Cell Adherence Assay: A tubeless method for pretransfusion testing and other applications in transfusion science. Transfus Apher Sci 2012; 46:287-91. [DOI: 10.1016/j.transci.2012.03.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Nadarajan VS, Laing AA, Saad SM, Usin M. Prevalence and specificity of red-blood-cell antibodies in a multiethnic South and East Asian patient population and influence of using novel MUT+Mur+ kodecytes on its detection. Vox Sang 2011; 102:65-71. [PMID: 21592136 DOI: 10.1111/j.1423-0410.2011.01507.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVES Appropriate screening for irregular red-cell antibodies is essential for ensuring transfusion compatibility and for antenatal management of mothers at risk of haemolytic disease of the foetus and newborn. Screening for all relevant antibodies is, however, limited by screening cells that do not express antigens present in the patient and donor population. Technology to artificially incorporate antigens into red cells is currently available and may be an option for customizing screening cells. MATERIALS AND METHODS We sought to identify retrospectively the changing patterns of alloantibody prevalence in our multiethnic population on change of screening cells. Antibody screening records of 143 501 patients tested from 2004 to 2010 were retrieved and divided into two groups: period-1 (2004-2008) and period-2 (2009-2010). During period-1, standard screening cells were used while in period-2, MUT+Mur+ KODE(™) transformed red cells (kodecytes) were used. RESULTS Four per cent of samples tested during period-2 were positive on antibody screening compared to 3·2% in period-1. Specific antibodies, excluding anti-D, were identified in 1·66% and 1·52% of patients in period-2 and -1, respectively. When confined to antibodies of clinical significance only, period-2 showed higher alloantibody prevalence of 1·16% as compared to 0·66% in period-1. Antibodies to glycophorin variants of MNS (vMNS) were more commonly detected while antibodies to Lewis antigens declined during period-2. CONCLUSION Antibodies to vMNS antigens are common in South and East Asian populations and are often missed when using standard screening cells. Use of specifically engineered screening cells to express red-cell antigens artificially is beneficial in detecting the diverse alloantibodies present in our population.
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Affiliation(s)
- V S Nadarajan
- Department of Pathology, University Malaya, Kuala Lumpur, Malaysia.
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Increased detection of clinically significant antibodies and decreased incidence of delayed haemolytic transfusion reaction with the indirect antiglobulin test potentiated by polyethylene glycol compared to albumin: a Japanese study. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2011; 9:311-9. [PMID: 21251459 DOI: 10.2450/2010.0057-10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 07/02/2010] [Accepted: 09/13/2010] [Indexed: 11/21/2022]
Abstract
BACKGROUND The indirect antiglobulin test (IAT) can be potentiated by agents such as polyethylene glycol (PEG-IAT) and albumin (Alb-IAT). PEG-IAT is generally regarded as superior to Alb-IAT for the detection of clinically significant red blood cell (RBC) antibodies. However, supporting data come from Caucasian-dominant populations. Non-Caucasian populations should be investigated as well. MATERIAL AND METHODS In this single-centre, retrospective, sequential study, Alb-IAT was used from 1989 to 1996 (8 years) and PEG-IAT from 1997 to 2008 (12 years). Pre-transfusion RBC alloantibody detection rates and specificity, post-transfusion alloantibody production, and the incidence of delayed haemolytic transfusion reaction were assessed and compared for the two periods. RESULTS Although overall RBC alloantibody detection rates were comparable, PEG-IAT more frequently detected clinically significant antibodies such as anti-E, anti-Fy(b), and anti-Jk(a), and less frequently detected insignificant antibodies such as anti-Le(b) and anti-P(1). New alloantibodies emerged comparably during the two periods. Delayed haemolytic transfusion reaction was less frequent during the PEG-IAT period (0.30% versus 0.12%, p<0.05). CONCLUSION PEG-IAT was superior in the detection of clinically significant antibodies, reduced the detection of insignificant antibodies, and prevented delayed haemolytic transfusion reaction better than Alb-IAT among Japanese transfusion recipients in this retrospective survey of limited power.
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Taylor J, Hyare J, Stelfox P, Williams M, Lees R, Maley M. Multi-centre evaluation of pre-transfusional routine tests using 8-column format gel cards (DG Gel®). Transfus Med 2010; 21:90-8. [PMID: 21118316 DOI: 10.1111/j.1365-3148.2010.01054.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- J Taylor
- Pathology Department, Birmingham Heartlands Hospital, Blood Transfusion Laboratory, Birmingham, UK.
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Frame T, Sinor LT. In reply. Transfusion 2010. [DOI: 10.1111/j.1537-2995.2010.02813.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Hoppe C, Klitz W, Vichinsky E, Styles L. HLA type and risk of alloimmunization in sickle cell disease. Am J Hematol 2009; 84:462-4. [PMID: 19484735 DOI: 10.1002/ajh.21442] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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A rewarding fresh look at routine blood group data. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2008; 6:182-3. [PMID: 19112731 DOI: 10.2450/2008.0043-08] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Stochastic modeling of human RBC alloimmunization: evidence for a distinct population of immunologic responders. Blood 2008; 112:2546-53. [DOI: 10.1182/blood-2008-03-146415] [Citation(s) in RCA: 144] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
AbstractRed blood cell (RBC) transfusion is unique as a common large-scale intravenous introduction of foreign tissue and provides a valuable opportunity to study human immunologic response to intravenous foreign antigen. Patients receiving RBC transfusions are at risk of forming alloantibodies against donor RBC antigens, and valid estimates of alloimmunization risk are clinically important, but little is known about the factors governing this risk or, more generally, about determinants of human response to intravenous antigen. Here, we mine large electronic patient databases enabling us to model RBC alloimmunization as a stochastic process. We identify a subgroup of transfusion recipients that has a dramatically increased risk of alloimmunization that appears to be genetically determined because it is independent of common disease states, patient age, or the number of alloantibodies already formed, and only weakly dependent on transfusion count.
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Bouix O, Ferrera V, Delamaire M, Redersdorff JC, Roubinet F. Erythrocyte-magnetized technology: an original and innovative method for blood group serology. Transfusion 2008; 48:1878-85. [DOI: 10.1111/j.1537-2995.2008.01790.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Wittmann G, Frank J, Schramm W, Spannagl M. Automation and Data Processing with the Immucor Galileo® System in a University Blood Bank. Transfus Med Hemother 2007. [DOI: 10.1159/000107936] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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