Comparative evaluation of gel column agglutination and erythrocyte magnetized technology for red blood cell alloantibody titration

Antibody titration is traditionally performed using a conventional test tube (CTT) method, which is subjected to interlaboratory variations because of a lack of standardization and reproducibility. The aim of this study is to compare newer methods such as get column technology (GCT) and erythrocyte magnetized technology (EMT) for antibody titration in terms of accuracy and precision. Patient serum samples that contained immunoglobin G (IgG) red blood cell (RBC) alloantibodies of a single specificity for Rh or K anitgens were identified during routine transfusion service testing and stored. Titration and scoring were performed separately by and stored. Titration and scoring were performed separately by different laboratory personnel on CTT, GCT, and EMT. Testing was performed a total of three times on each sample. Results were analyzed for accuracy and precision. A total of 50 samples were tested. Only 20 percent of samples tested with GCT shoed titers identical to CTT, whereas 48 percent of samples tested with EMT showed titers identical to CTT. Overall, the mean of th titer difference from CTT was higher using GCT (+0.31) compared with that using EMT (+0.13). Precision shown by CTT was 30 percent, EMT was 76 percent, and GCT was 92 percent on repeat testing. GCT showed higher titer values in comparison with CTT but was found to be the most precise. EMT titers were comparable to CTT, and its precision was intermediate. Further studies to validate this method are required.

A micro-rheological method for determination of blood type

The measurement of time and distance can be used for determining agglutination in small (nL) samples of liquid. We demonstrate the use of this new scheme of detection in typing and subtyping blood in a simple microfluidic system that monitors the speed of flow of microdroplets. The system (i) accepts small samples of liquids deposited directly onto the chip, (ii) forms droplets on demand from these samples, (iii) merges the droplets, and (iv) measures their speed in a microchannel. A sequence of measurements on different combinations of blood and antibodies can thus be used to determine blood type with the estimated probability of mistyping being less than 1 in a million tests. In addition, in the agglutinated samples, red blood cells concentrate at the rear of the droplets yielding an additional vista for detection and suggesting a possible mechanism for separations.

A low cost and high throughput magnetic bead-based immuno-agglutination assay in confined droplets

Although passive immuno-agglutination assays consist of one step and simple procedures, they are usually not adapted for high throughput analyses and they require expensive and bulky equipment for quantitation steps. Here we demonstrate a low cost, multimodal and high throughput immuno-agglutination assay that relies on a combination of magnetic beads (MBs), droplets microfluidics and magnetic tweezers. Antibody coated MBs were used as a capture support in the homogeneous phase. Following the immune interaction, water in oil droplets containing MBs and analytes were generated and transported in Teflon tubing. When passing in between magnetic tweezers, the MBs contained in the droplets were magnetically confined in order to enhance the agglutination rate and kinetics. When releasing the magnetic field, the internal recirculation flows in the droplet induce shear forces that favor MBs redispersion. In the presence of the analyte, the system preserves specific interactions and MBs stay in the aggregated state while in the case of a non-specific analyte, redispersion of particles occurs. The analyte quantitation procedure relies on the MBs redispersion rate within the droplet. The influence of different parameters such as magnetic field intensity, flow rate and MBs concentration on the agglutination performances have been investigated and optimized. Although the immuno-agglutination assay described in this work may not compete with enzyme linked immunosorbent assay (ELISA) in terms of sensitivity, it offers major advantages regarding the reagents consumption (analysis is performed in sub microliter droplet) and the platform cost that yields to very cheap analyses. Moreover the fully automated analysis procedure provides reproducible analyses with throughput well above those of existing technologies. We demonstrated the detection of biotinylated phosphatase alkaline in 100 nL sample volumes with an analysis rate of 300 assays per hour and a limit of detection of 100 pM.

Modifications influencing Widal test reactivity in a novel microplate assay

Reliability of the Widal tube agglutination test has been the subject of many controversies over the years. This study was performed to assess the effect of certain modifications on the performance of Widal test in a novel microplate assay. Sera from 37 patients (21 males; 16 females) (mean age 28 +/- 7 years) were tested in the Immunology Unit at King Khalid University Hospital, Riyadh. Among them were 26 patients with suspected typhoid fever and 11 had bacteriologically confirmed diagnosis of Salmonella infection. The modifications included either the use of 0.5% bovine serum albumin (BSA), absorption of sera with sheep red blood cells (SRBC) or heat inactivation of sera. Compared with Widal tube agglutination test, microplate assay with SRBC absorption of the sera from patients with suspected typhoid fever was not only associated with enhancement of detection titers for both H (p < or = 0.001) and O (p < or = 0.005) Salmonella agglutinins but also the percentage of reactivity. The presence of BSA augmented detection titers for Salmonella H agglutinins (p < or = 0.02) only. Heat inactivation of sera however was found to be associated with reduction in the detectable titers for both H (p < or = 0.03) and O (p < or = 0.01) agglutinins. Increased titers of Salmonella agglutinins were also evident in 11 patients with confirmed diagnosis of Salmonella infection. The novel microplate agglutination assay using the SRBC absorption was associated with enhancement in Widal test reactivity and appears to be a useful alternative for the diagnosis of Salmonella infection.

Quantitative determination of fibrinogen of patients with coronary heart diseases through piezoelectric agglutination sensor

Fibrinogen can transform fibrin through an agglutination reaction, finally forming fibrin polymer with grid structure. The density and viscosity of the reaction system changes drastically during the course of agglutination. In this research, we apply an independently-developed piezoelectric agglutination sensor to detect the fibrinogen agglutination reaction in patients with coronary heart diseases. The terminal judgment method of determining plasma agglutination reaction through piezoelectric agglutination sensor was established. In addition, the standard curve between plasma agglutination time and fibrinogen concentration was established to determinate fibrinogen content quantitatively. The results indicate the close correlation between the STAGO paramagnetic particle method and the method of piezoelectric agglutination sensor for the detection of Fibrinogen. The correlation coefficient was 0.91 (γ = 0.91). The determination can be completed within 10 minutes. The fibrinogen concentration in the coronary heart disease group was significantly higher than that of the healthy control group (P < 0.05). The results reveal that high fibrinogen concentration is closely correlated to the incurrence, development and prognosis of coronary heart diseases. Compared with other traditional methods, the method of piezoelectric agglutination sensor has some merits such as operation convenience, small size, low cost, quick detecting, good precision and the common reacting agents with paramagnetic particle method.

Measuring electrical and mechanical properties of red blood cells with double optical tweezers

Red blood cell (RBC) aggregation in the blood stream is prevented by the zeta potential created by its negatively charged membrane. There are techniques, however, to decrease the zeta potential and allow cell agglutination, which are the basis of most of antigen-antibody tests used in immunohematology. We propose the use of optical tweezers to measure membrane viscosity, adhesion, zeta potential, and the double layer thickness of charges (DLT) formed around the cell in an electrolytic solution. For the membrane viscosity experiment, we trap a bead attached to RBCs and measure the force to slide one RBC over the other as a function of the velocity. Adhesion is quantified by displacing two RBCs apart until disagglutination. The DLT is measured using the force on the bead attached to a single RBC in response to an applied voltage. The zeta potential is obtained by measuring the terminal velocity after releasing the RBC from the trap at the last applied voltage. We believe that the methodology proposed here can provide information about agglutination, help to improve the tests usually performed in transfusion services, and be applied for zeta potential measurements in other samples.

A novel piezoelectric immunoagglutination assay technique with antibody-modified liposome

A simple rapid piezoelectric immunoagglutination assay (PEIA) technique with antibody-modified liposome has been developed for direct quantitative detection of human immunoglobulin G (hIgG). This technique is based on specific agglutination of antibody-coated liposome particles in the presence of the corresponding antigen, which can be monitored by the frequency shift of a piezoelectric device. Compared with conventional piezoelectric assays, this liposome-based PEIA does not require the immobilization of antigen or antibody on the quartz crystal surface, making the developed technique especially useful for rapid and renewable immunochemical determination. To alleviate non-specific adsorption of serum proteins, modification of the quartz crystal surface by different protocols and the composition of the assay medium have been investigated. The results indicate that the background interference can be substantially minimized through modifying the quartz crystal surface with a bovine serum albumin (BSA) layer and introducing an appropriate amount of BSA in the assay medium. The effects of the liposome composition, the liposome concentration and the concentration of poly(ethylene glycol) (PEG) in the assay medium, have also been investigated. The frequency responses of the liposome-based PEIA are linearly correlated to hIgG concentration in the range of 0.05-6 microg mL(-1) with a detection limit of 50 ng mL(-1).

Rapid, Simple, and Sensitive Immunoagglutination Assay with SiO2 Particles and Quartz Crystal Microbalance for Quantifying Schistosoma japonicum Antibodies

Background: The resurgence of the parasitic disease schistosomiasis calls for more efficient diagnostic tests. We developed a rapid, simple, portable, and sensitive immunoagglutination assay that uses SiO2 particles and quartz crystal microbalance (QCM) for quantifying Schistosoma japonicum (Sj) antibodies (SjAb).

Methods: We prepared submicrometer-sized silica particles derivatized with Sj antigens as replacements for traditional latex microspheres to specifically agglutinate in the presence of SjAb targets, and we used the QCM monitor to measure the resulting frequency shifts. We optimized the assay medium by adding poly(ethylene glycol) (PEG) as a response accelerator of immunoagglutination. To minimize or eliminate any nonspecific agglutination or adsorption interferences, we conducted appropriate sealing procedures separately for silica particles and the QCM probe.

Results: The measured frequency changes were linearly related to the SjAb concentrations in infected rabbit serum. The PEG-assisted immunoagglutination system was quantitatively sensitive to SjAb concentrations ranging from ∼0.70 to 32.31 mg/L, with a detection limit of ∼0.46 mg/L. The obtained linear regression equation was: y = 43.61 x + 80.44 (r = 0.9872). Several serum specimens were evaluated with the developed QCM immunoassay and the results were compared with ELISA, validating the feasibility of practical applications.

Conclusions: This novel immunoagglutination-based QCM detection format is rapid, simple to use, and more portable than conventional diagnostic immunoassays, thus offering a promising alternative tool that can be used for point-of-care clinical diagnosis of schistosomiasis, particularly in epidemic situations.

Comparison of three microtube column agglutination systems for antibody screening: DG Gel, DiaMed-ID and Ortho BioVue

The aims of the present study were to evaluate the estimated diagnostic accuracy of a new microtube column agglutination system (DG Gel, Diagnostic Grifols, Barcelona, Spain), to analyse the antibody reactivity and to compare the data with the two well-established DiaMed-ID and Ortho BioVue systems. We collected 3024 consecutive samples from blood donors, transfusion recipients and pregnant women, and 100 samples containing antibodies of known specificity. All these samples were tested in parallel by the three microtube agglutination systems. The estimated sensitivity was 100% for DG Gel and Ortho BioVue and 97.58% for DiaMed-ID. The estimated specificity was 99.93% for Ortho BioVue and 100% for DiaMed-ID and DG Gel. The score mean and range of the antibody titration of DG Gel, DiaMed-ID and Ortho BioVue were 34.31 (5-119), 30.3 (3-121) and 37.38 (3-112), respectively. All three column agglutination systems work well showing a high estimated diagnostic accuracy.

A piezoelectric immunoagglutination assay for Toxoplasma gondii antibodies using gold nanoparticles

The serologic detection of anti-Toxoplasma gondii immunoglobulins plays a key role in the clinical diagnosis of Toxoplasmosis. In this paper, a simple, rapid and highly sensitive agglutination-based piezoelectric immunoassay has been firstly developed for directly detecting anti-T. gondii immunoglobulins in infected rabbit serum (IRS) and infected rabbit blood (IRB). The proposed technique is based on that the specific agglutination of antigen-coated gold nanoparticles, averaging 10nm in diameter, in the presence of the corresponding antibody causes a frequency change that is monitored by a piezoelectric device. In contrast to the commonly used piezoelectric assays, it possesses an attractive advantage in that the immobilization of antibody or antigen on the crystal is unnecessary. Use of a newly prepared sensing probe which was modified by a plasma-polymerized film (PPF) of n-butyl amine and further by a heparin layer resulted in a response-enhanced immunoagglutination and a high compatibility of the probe with biological samples. An appropriate reagent consisting of 1% normal rabbit serum (NRS) and 0.1% bovine serum albumin (BSA) for diluting the analytes were verified in counteracting the background interference of assay. Moreover, an optimization of assay medium composition with the addition of poly(ethylene glycol) (PEG) serving as immunoagglutination rate and sensitivity enhancer was investigated in detail. It is found that the developed immunoagglutination assay system is sensitive to dilution ratio of anti-T. gondii antibody as low as 1:5500. Analytical results of several specimens obtained using the developed technique are in satisfactory agreement with those given by the ELISA method, implying a promising alternative approach for detecting anti-T. gondii antibodies in the clinical diagnosis.

Design and development of an immunosensor for the detection of malaria in field conditions

Eradication of malaria in Southeast Asian countries is still a distant goal, due to the absence of a simple, rapid and inexpensive diagnostic technique. Here, an immunosensor for the photometric detection of malaria, the malaria-detecting immunosensor (MDI), is developed to detect Plasmodium falciparum malarial antibodies in human blood. The method uses the principle of laser light-scattering by latex bead agglutinates in media monitored by a light-detecting device. Agglutination is induced by mixing antigen-coated latex beads with serum antibodies. Immunoreactions are measured in terms of the Tyndall effect in the transmitted beam detected by photodiodes. MDI sensitivity and specificity are compared with the results of enzyme-linked immunoabsorbent assay and laser light-scattering immunoassay techniques, which show that it is a good and sensitive monitoring device.

International collaborative study to evaluate methods for quantification of anti-D in immunoglobulin preparations

BACKGROUND AND OBJECTIVES

The disadvantages of autoanalyser methodology for anti-D potency estimation have prompted the search for an alternative reference method. The aim of this study was to carry out a direct comparison of autoanalyser methodology, competitive enzyme-linked immunoassay (EIA) and flow cytometry.

MATERIALS AND METHODS

The anti-D potencies of nine immunoglobulin preparations were estimated against the World Health Organization (WHO) International Reference Preparation for anti-D immunoglobulin, using the three different assay methods described above, in an international collaborative study involving 18 laboratories.

RESULTS

No significant differences in potency estimates for five of nine samples were identified using the three different methods. For six of nine samples the mean potency estimates obtained using competitive EIA lay between those of the autoanalyser and flow cytometry. Flow cytometry gave the lowest estimates for seven of nine samples. The range of intralaboratory variability, expressed as percentage geometric coefficients of variation (% gcv) and excluding extreme values, was as follows: autoanalyser (eight laboratories), 0.4-17.0; competitive EIA (12 laboratories), 2.6-34.8; and flow cytometry (eight laboratories), 2.9-30.0. The range of interlaboratory variability (expressed as % gcv) was: autoanalyser (eight laboratories, eight samples), 10.8-17.6; competitive EIA (12 laboratories, nine samples), 10.3-17.3; flow cytometry (nine laboratories, eight samples), 6.2-16.1.

CONCLUSIONS

The study did not show clear superiority of one method over the others. Both competitive EIA and flow cytometry are acceptable alternatives to autoanalyser methodology for polyclonal anti-D potency estimation. For monoclonal anti-D, further work is necessary to determine the most appropriate method for potency testing.

[Evolving methods in immunohematology]

The immunogenic nature of erythrocyte polymorphism is in variance with the incompatible transfusion. Indeed, the fixing of an antibody on the corresponding antigen generally condemns the cell concerned with its destruction. Therefore, in order to ensure the immunohemolytic safety of the transfusions, it is necessary to avoid an in vivo encounter between antigens and antibodies, whose feasibility study in vitro is a determining element. Because of the requirement standards of such analyses and the preoccupation with the continuous improvement of transfusion safety, the evolution of the methods used in immunohematology is a constant concern for all those involved in the process. Thus, during the last few years, new technologies have been introduced which aim at improving performance and sometimes implementing alternatives to agglutination. This improvement is not limited to the search for an overall increase in specificity-sensitivity; it also takes into account the capability to detect "the clinically significant" as well as the limitations of human reliability, which justifies the introduction of automation and computerization. The whole of these methodological evolutions associated with that of the performance of reagents, legitimate the need to reconsider the realization of erythrocyte typing and the search for anti-erythrocyte antibodies.

Standardisation of subjectively scored HIV immunoassays: developing a quality assurance program to assist in reproducible interpretation of results using an anti-HIV particle agglutination assay as a model

Immunoassays such as particle agglutination assays, rapid tests and western or line blots are scored or read subjectively. These readings display intra- and inter-reader variability, as well as intra- and inter-laboratory variability. In the present study the consistency of scoring was assessed between readers both within and between two groups of scientists using the Serodia anti-HIV particle agglutination assay as an example of an assay scored subjectively. An anti-HIV positive sample in eight serial dilutions made to yield a full range of results expected for the assay was presented 12 times (96 test wells). Each dilution was placed randomly in a plate and tested with the Serodia anti-HIV particle agglutination assay then photographed. Participants in the two groups each scored the photographed plate independently and twice, 2 h apart. Each well was assigned a status (the consensus result of the four most experienced Australian readers) and each participant's results were compared with this status. The average percentage of wells assessed as 'correct' for the Group A participants was 86% (range 56-98%) and for the Group B participants was 67% 'correct' (range 46-88%). In general, strongly positive and negative wells were scored 'correctly'. The highest variations between scores were seen in the borderline positive dilutions +/- region. A quality assessment program based on the method used to obtain these results will be instituted in order to improve the consistency of scoring assays read subjectively.

[The rapid identification of bacteria by agglutination on a slide of antibody-sensitized erythrocytes]

The method for the identification of Brucella (genus) and shigellae (species) by using slide agglutination of antibody erythrocytic immune reagents is substantiated. Such reagents, obtained from polyclonal nonadsorbed immune sera, ensure high specificity of taxon identification. The use of the proposed method may greatly accelerate bacteriological analysis.

Identification of oxacillin-susceptible and oxacillin-resistant Staphylococcus aureus using commercial latex agglutination tests

Four hundred thirteen Staphylococcus sp. were identified by Staphaurex, Staphaurex Plus, and BACTiStaph kits using tube coagulase as reference. Among 222 coagulase-positive isolates, 56 were oxacillin-resistant Staphylococcus aureus. All tests were accurate in distinguishing between coagulase-positive and -negative staphylococci with sensitivities and specificities > or = 97% and only nine discrepancies.

Feasibility of Helicobacter pylori identification by a slide agglutination test

Culture isolation and identification of Helicobacter pylori represents a considerable work load in clinical microbiology. The aim of this study was to test if antibody-mediated bacterial agglutination could be used for rapid identification of H. pylori. Rabbit antiserum against H. pylori strain I and against another strain, H. pylori 330, which was very weakly agglutinated (1+) by anti-H. pylori I serum, were mixed and used in a slide agglutination test. Of 107 consecutive clinical isolates tested, 101 (94%) strains showed 2+ or 3+ reaction using the antiserum mixture, whereas 6 (6%) strains could not be evaluated owing to autoagglutinability. Bacteria of a variety of other species, including Campylobacter spp., showed no agglutination with the antiserum mixture. The results support the notion that reliable identification of the majority of cultured H. pylori strains should be possible in less than 3 min by agglutination testing.

Automated reading and processing of quantitative IgG, IgM, IgA, and IgE isotypic agglutination results in microplates. Development and application in parasitology-mycology

Microplate agglutination techniques represent a simple and commonly used approach for the quantitative or qualitative isotypic analysis of specific antibodies. However, they require optical reading by the investigator and are thus prone to an important degree of variability. In order to solve some of the problems associated with the variability of optical readings, we have used an automatic reader scanning each of the 96 wells of a standard microplate in 32 different locations. The inherent advantages of the automatic reader were further maximized by coupling it to a dedicated computer running customized software designed to process data coming on-line from the spectrophotometer. This approach has been applied to the diagnosis of human toxoplasmosis and candidosis. Suspensions of Toxoplasma gondii tachyzoites or of sensitised erythrocytes were used for the determination of IgG antibodies or the quantification of IgM, IgA, or IgE specific isotypes. This procedure allows the simple and reproducible collection of objective results. Moreover, it permits a reduction in cut-off values and direct interpretation of results with automatic conversion of scores into titer, units, index, or into any other scale appropriate for standardization purposes.

Immediate HbA1c results. Performance of new HbA1c system in pediatric outpatient population

OBJECTIVE

This study compared the performance of a new device that uses an IA to measure HbA1c in 9 min with a 1-microliter capillary blood sample with AC and CE methods in both nondiabetic and diabetic pediatric patients.

RESEARCH DESIGN AND METHODS

Two hundred seven pediatric subjects (103 nondiabetic, 104 with insulin-dependent diabetes mellitus) had HbA1c measured with the IA method and compared with total GHb values determined by AC and HbA1 by the CE method with the same whole-blood capillary aliquot. Glucose values were also obtained from the same blood samples.

RESULTS

Correlations and regression analyses show excellent correspondence between the three assays. The correlation between the AC and CE methods is 0.98 (P less than 0.001) with a slope of 1.615 +/- 0.0125 and intercept of 4.00 +/- 0.20. The correlation between the IA and AC methods is 0.99 (P less than 0.001) with a slope of 0.608 +/- 0.007 and intercept of 1.326 +/- 0.066. The correlation between the IA and CE methods is 0.97 (P less than 0.001), with a slope of 0.983 +/- 0.018 and intercept of 1.122 +/- 0.153. The average difference and average percentage difference between methods were also significant (P less than 0.001), reflecting the differences in GHb components measured. There was a significant correlation (P less than 0.001) between each method and glucose values (IA r = 0.72, AC r = 0.70, CE r = 0.73). Within-run precision for IA ranged from 1.7 to 3.5% and between-run precision 2.7 to 4.1%.

CONCLUSIONS

Study results suggest that the IA method gives extremely accurate and reliable values over the clinical range of interest. The instrument is small, portable, easy to use, and provides information within 9 min for both physicians and patients.

[Expert research on sera yielding false-positive results for HIV antibodies during screening]

The significance of different serological methods and assay systems for the verification of false positive cases of HIV infection has been analyzed on the basis of materials obtained in arbitration studies. As demonstrated by this analysis, the use of such highly specific and sensitive systems as Huma-Lab, Enzygnost, Serodia and Erythrorecombinant has made it possible to obtain a reliable result as early as at the first stage of expert diagnosis in the enzyme immunoassay and the agglutination test. The methods of radioimmunoprecipitation and indirect immunofluorescence have permitted a more precise differentiation of doubtful results than that achieved by immune blotting.

[The characteristics of a Russian-made kit for the serological identification of streptococci groups A, B and C]

The first Soviet kits for the serological identification of streptococci, groups A, B, and C, on the basis of the coagglutination test were developed. Each kit was intended for 35-40 determinations. The optimum concentration of streptococci during their identification by means of the reagents making up the kit was about 1.6 x 10(9) cells/ml. The specificity of the reagents in comparison with the results of the identification of streptococci by reference methods was 97.3 +/- 0.9%. The reagents making up the kits can be presumably used for solving a number of practical problems in the epidemiological surveillance of streptococcal infection.

[A method for the passive agglutination of polymer dispersions for the diagnosis of legionellosis]

The method of synthetizing dispersions of gelatin-modified polyacrolein microspheres 1.5-2.5 micrograms in diameter, used as a solid-phase carrier for the preparation of immunodispersion diagnostica, has been developed. The possibility of using immunodispersion diagnosticum in the passive agglutination test with hyperimmune rabbit sera has been demonstrated. High activity and specificity of immunodispersion diagnosticum, combining methodological simplicity and rapidity characteristic of agglutination, has been shown.

[A new method for the rapid diagnosis of acute streptococcal infection]

The work deals with the development of the rapid method of the identification of acute streptococcal infection on the basis of the coagglutination test. The rapid method of the extraction of group-specific polysaccharide antigen from the cell walls of group A streptococci is proposed. The data on the use of native sera and their fractions in the development of coagglutination diagnostica have been described and analyzed. The advantages of the new method of the diagnosis of acute streptococcal infection in comparison with the traditional microbiological method are shown.

[A comparative evaluation of the sensitivity of different methods for the serological diagnosis of leptospirosis]

In this work the comparative evaluation of the sensitivity and serological specificity of the microcapsular agglutination (MCA) test, the passive hemagglutination (PHA) test and the microagglutination (MA) test are presented. In the MCA test leptospiral antigens, adsorbed on synthetic carrier capsules produced by Japan Lyophilization Laboratory, were used and the PHA test was made with the use of polyvalent erythrocyte diagnosticum. The study of blood serum samples from 46 leptospirosis patients revealed that the values of antibody titers in the PHA and MCA tests were 5.5-8.1 times higher than the traditional MA test. In the MCA and PHA tests antileptospiral antibodies could be detected as early as on days 1-3 of the disease when the results of the MA test were negative or very low. The maximum values of antibody titers in the MCA and PHA tests were detected on days 11-15 of the disease and in the MA test, on days 21-25. The MCA and PHA tests are genus-specific and permit the detection of antileptospiral antibodies irrespective of the serogroup of the infective agent. In the study of the blood sera of 40 patients with diseases of nonleptospiral etiology the MCA and MA tests yielded false positive results in 7.5% and the PHA test, in 12.5% of cases in titers below the diagnostic level. These data are indicative of high sensitivity and specificity of the serological tests used in this study.

New developments in particle-based tests and immunoassays

Latex agglutination tests were invented in 1957. Thirty years later, new tests are still being devised and applied to new analytes. Reproducibility and readability continue to improve. Qualitative tests have now evolved to quantitative particle immunoassays: agglutination is detected by spectrophotometers or nephelometers, in tubes or 96-well plates. These same particles are now also being used in particle capture ELIST and ELISA (enzyme linked immunosorbent tests and assays) where particles are caught upon a filter and act as supports for sandwich tests (those "+/-" or "blue-dot" tests). These also can be quantified, as in the Abbott IM x assay system. Dyed microspheres now function as the color tags in over-the-counter sandwich-type pregnancy tests. In the future, results from assays using this technology could be read on reflectometers (strip readers). Currently, magnetic particles are used in solid phase radioimmunoassays and DNA probes.

[Value of agglutination tests for the rapid identification of isolated streptococci in medical microbiology]

The clinical need for rapidly and correctly differentiating pathogenic streptococci into Lancefield groups prompted the development of rapid agglutination techniques by the direct colony method. Pastorex Streptogroupe (Diagnostics Pasteur, France) and Streptex (Wellcome Diagnostics, USA) were tested on 90 streptococcal isolates and compared with the identification obtained by conventional procedures. No cross-reactions were observed with any of the 33 strains of enterococci and of the seven strains representative of other genus among Gram-positive bacteria. When combined with colonial morphology and hemolytic reaction, both Pastorex and Streptex were specific tests for identifying beta-hemolytic streptococci, with Pastorex being slightly faster.

Rapid transfer of small volumes of serum into microplates

A method has been devised to transfer small volumes of serum, as an adjunct to larger volume sampling, into microplates. The Costar Transplate 96 machine is used routinely in our laboratory for transferring serum samples into reaction wells for anti-HIV screening. Using this additional method a mean of 4 microliters of serum was transferred, within acceptable limits of error (coefficient of variation, c.v., 16%).

An automated screening test for antibodies to human immunodeficiency virus-1

An automated pretransfusion testing system was applied to HIV antibody screening by a gelatin particle agglutination (HIV-PA) test. The test conditions for the test, such as diluent, plate shape, and incubation time, were applicable not only for the HIV-PA test but also for other routine tests, including those for hepatitis B surface antigen and HTLV-1 antibodies. After a 60-minute incubation, the plates were read automatically and then were assessed visually. Tests with seropositive samples obtained from hemophiliacs and an HIV enzyme immunoassay (EIA) familiarization panel showed that the automated HIV-PA test was more sensitive than the EIA and did not show a false-negative result. Of 11,300 blood donors, 44 were positive by the automated test, and 51 were positive by the EIA. None of the blood donors was confirmed to be seropositive. Using the automated test, a large number of samples could be screened in a relatively short time without a significant increase of nonspecific reactions.

Assessment of the AmnioStat-FLM immunoagglutination test for phosphatidylglycerol in amniotic fluid

One hundred and eight amniotic fluids were assayed by the AmnioStat-FLM (A-FLM) immunological agglutination test for phosphatidylglycerol (PG) and simultaneously measured enzymatically for PG content. Of 52 amniotic fluids found to be PG negative by the A-FLM method, all had enzymatic PG concentrations less than or equal to 1.5 mumol/l. Conversely, of 56 amniotic fluids judged to be either PG positive or weak positive, all but five had enzymatic PG concentrations greater than 1.5 mumol/l. The sensitivity of the A-FLM assay employed clinically for predicting foetal lung maturity was 89% and the specificity was 100%. The overall predictive accuracy of the test could be improved by providing controls at lower, more appropriate PG concentrations. Ninety-one fluids analysed by the A-FLM kit were subsequently tested for the presence of PG by two-dimensional thin-layer chromatography (2D TLC). A 94%-concordance between the methods was found.

Influence of IgG subclasses on automated anti-D (Rho) quantification

Anti-D quantification by both an automated Polybrene method and an automated trypsin-albumin-dextran (TAD) method gave discrepant results in certain cases. These discrepancies, expressed as the polybrene TAD ratio of reactivity (PTR), were related to the IgG subclass of anti-D. Anti-D of the IgG3 subclass showed a higher PTR than IgG1 (0.94 vs 1.65). No difference was shown between G1m(1) and G1m(3) (0.93 and 0.95, respectively) or between G3m(11) and G3m(21) (1.40 and 1.81, respectively) allotypes. The simultaneous use of our automated Polybrene and TAD methods provides information about the anti-D subclass composition.

Gonorrhea card test: an agglutination test for uncomplicated gonorrhea

An antigen extracted and purified from Neisseria gonorrhoeae B370, type 4, was employed to sensitize charcoal particles for use in an agglutination assay of human sera for antibodies that indicate active gonorrheal infection. The screening card test is more sensitive than the fluorescent gonorrheal test-heated (FGT-H), especially in men. A simple one-step absorption improved the specificity without reducing the sensitivity of the test.

[Highly specific agglutinating O- and OK-immunoglobulins for identification of Escherichia in the agglutination test on glass]

Escherichia agglutinating O- and OK-immunoglobulins of class G were obtained by the method of ion exchange chromatography; in studying with live and heated O- and K- cultures of the test strains from the International escherichia collection these immunoglobulins proved to be diagnostically highly specific and useful for the identification of escherichia strains in the express agglutination reaction on glass.

Microantiglobulin test for detecting Salmonella typhimurium agglutinins

A sensitive antiglobulin (AG) test procedure for the demonstration and experimental study of the agglutinin response of chickens infected orally with Salmonella typhimurium is described. A tetrazolium-stained S. typhimurium antigen was employed with microagglutination techniques and equipment for the first time in conducting the AG test. Results with the conventional macroscopy tube agglutination test for S. typhimurium and the 24-hr microtest were comparable; however, the AG test enhanced titers as much as 16 times, and these persisted at a significant level for as long as 4 months. This study is being extended to other Salmonella serotypes and possible field applications of the AG test procedure.