Does decreasing the incubation period used in the antibody screen affect its sensitivity?
antibody screen
antibody titre
column agglutination technology
incubation period
solid phase red cell adherence assay
Journal
Transfusion medicine (Oxford, England)
ISSN: 1365-3148
Titre abrégé: Transfus Med
Pays: England
ID NLM: 9301182
Informations de publication
Date de publication:
Oct 2023
Oct 2023
Historique:
revised:
13
07
2023
received:
23
12
2022
accepted:
09
09
2023
medline:
12
10
2023
pubmed:
20
9
2023
entrez:
20
9
2023
Statut:
ppublish
Résumé
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. 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. 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.
Sections du résumé
BACKGROUND
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
METHODS
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
CONCLUSIONS
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.
Substances chimiques
Antibodies
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
379-389Subventions
Organisme : Curtin Medical School
Informations de copyright
© 2023 The Authors. Transfusion Medicine published by John Wiley & Sons Ltd on behalf of British Blood Transfusion Society.
Références
ISBT. Red cell immunogenetics and blood group terminology. Accessed April 1, 2023 https://www.isbtweb.org/working-parties/red-cell-immunogenetics-and-blood-group-terminology/
Zalpuri S, Zwaginga JJ, Le Cessie S, Elshuis J, Schonewille H, Van Der Bom JG. Red-blood-cell alloimmunization and number of red-blood-cell transfusions. Vox Sang. 2012;102:144-149.
Redman M, Regan F, Contreras M. A prospective study of the incidence of red cell allo-immunisation following transfusion. Vox Sang. 1996;71:216-220.
Pulte D, Kay J, Harach M, Le N, Herman J. Red cell alloimmunization in sickle cell disease: benefit of extended crossmatching in adults. Blood. 2012;120:4761.
Davies SC, McWilliam AC, Hewitt PE, Devenish A, Brozovic M. Red cell alloimmunization in sickle cell disease. Br J Haematol. 1986;63:241-245.
Jansuwan S, Tangvarasittichai O, Tangvarasittichai S. Alloimmunization to red cells and the association of alloantibodies formation with splenectomy among transfusion-dependent β-thalassemia major/HbE patients. Indian J Clin Biochem. 2015;30:198-203.
Hussein E, Desooky N, Rihan A, Kamal A. Predictors of red cell alloimmunization in multitransfused egyptian patients with β-thalassemia. Arch Pathol Lab Med. 2014;138:684-688.
Taylor C, Navarrete C, Contreras M. Immunological complications of blood transfusion. Transfus Altern Transfus Med. 2008;10:112-126.
Strobel E. Hemolytic transfusion reactions. Transfus Med Hemother. 2008;35:346-353.
Barankewitsch P. Red blood cell alloantibody frequency in a Western Australian population. Accessed April 26, 2018 https://www.blood.gov.au/system/files/documents/2015-session-1-9-paul-barankewitsch-red-cell-alloantibody-frequency-in-a-western-australian-population-consent-yes_1.pdf
White J. Pre-transfusion testing. ISBT Sci Ser. 2009;4:37-44.
Fung MK, Grossman BJ, Hillyer CD, Westoff CM. Technical Manual. 18th ed. American Association of Blood Banks (AABB); 2014.
Hughes-Jones N, Gardner B, Telford R. The effect of pH and ionic strength on the reaction between anti-D and erythrocytes. Immunology. 1964;7:72-81.
Moore HC, Mollison PL. Use of a low-ionic-strength medium in manual tests for antibody detection. Transfusion. 1976;16:291-296.
Nance S, Garratty G. A new potentiator of red blood cell antigen-antibody reactions. Am J Clin Pathol. 1987;87:633-635.
Bromilow IM, Adams KE, Hope J, Eggington JA, Duguid JKM. Evaluation of the ID-gel test for antibody screening and identification. Transfus Med. 1991;1:159-161.
Lapierre Y, Rigal D, Adam J, et al. The gel test: a new way to detect red cell antigen-antibody reactions. Transfusion. 1990;30:109-113.
Weisbach V, Kohnhäuser T, Zimmermann R, et al. Comparison of the performance of microtube column systems and solid-phase systems and the tube low-ionic-strength solution additive indirect antiglobulin test in the detection of red cell alloantibodies. Transfus Med. 2006;16:276-284.
Weisbach V, Ziener A, Zimmermann R, Glaser A, Zingsem J, Eckstein R. Comparison of the performance of four microtube column agglutination systems in the detection of red cell alloantibodies. Transfusion. 1999;39:1045-1050.
Lui C, Grossman BJ. Antibody of undetermined soecificity: frequency, laboratory features, and natural history. Transfusion. 2013;53:931-938.
Plapp FV, Sinor LT, Rachel JM, Beck ML, Coenen WM, Bayer WL. A solid phase antibody screen. Am J Clin Pathol. 1984;82:719-721.
De Castilho LM, Pellegrino J, Bechelli APP, Le Pennec PY, Mendes NF. Evaluation of recent techniques for detection of red blood cell antibodies in sera of reference samples, patients, pregnant women, and blood donors. J Clin Lab Anal. 1996;10:250-256.
Goodell PP, Mohammed M, Powers AA. Risk of hemolytic transfusion reactions following emergency-release RBC transfusion. Am J Clin Pathol. 2010;134:202-206.
Judd WJ, Walter WJ, Steiner EA. Clinical and laboratory findings on two patients with naturally occurring anti-Kell agglutinins. Transfusion. 1981;21:184-188.
Tegoli J, Sausais L, Issitt PD. Another example of a “naturally-occurring” anti-kl*. Vox Sang. 1967;12:305-307.
Molthan L, Strohm PL. Hemolytic transfusion reaction due to anti-Kell undetectable in low-ionic-strength solutions. Am J Clin Pathol. 1981;75:629-631.
Szymanski IO, Keegan M. Mechanism of enhancement of blood group antibody reactions in low ionic strength. Am J Clin Pathol. 1982;78:360-364.
Dankbar DT, Blake BE, Pierce SR, Beck ML. Comparison of anti-K reactivity using saline and LISS tests (abstract). Transfusion. 1986;26:549.
Shmookler A, Hamad D, Scrape S, Chen J. Acute hemolytic transfusion reaction caused by a red cell antibody that was missed by pretransfusion testing using tube method. Lab Med. 2017;48:258-261.
Michalewska B, Ejduk A, Pniewska K. Acute haemolytic transfusion reaction apparently caused by the 'enzyme-only' anti-E. Vox Sang. 2005;89:61.
de Jonge N, Martens JE, Milani AL, Krijnen JM, van Krimpen C, Ponjee GAE. Haemolytic disease of the newborn due to anti-K antibodies. Eur J Obstet Gynecol. 1996;67:69-72.
Collinet P, Subtil D, Puech F, Vaast P. Successful treatment of extremely severe fetal anemia due to Kell alloimmunization. Obstet Gynecol. 2002;100:1102-1105.
Kay B, Poisson JL, Tuma CW, Shulman IA. Anti-Jka that are detected by solid-phase red blood cell adherence but missed by gel testing can cause hemolytic transfusion reactions. Transfusion. 2016;56:2973-2979.
Malhotra S, Kaur G, Singh L, Basu S, Lehl S. Delayed hemolytic reaction due to anti Jka alloimmunization. Int J Blood Transfus Immunohematol. 2011;1:16-19.
Narayan S, Poles D, et al. On behalf of the serious hazards of transfusion (SHOT) Steering Group. The 2021 Annual SHOT Report. 2022.
Fatalities reported to FDA following blood collection and transfusion aunnual summary for fiscal year. 2020 https://www.fda.gov/media/160859/download
Yamada C, Serrano-Rahman L, Vasovic LV, Mohandas K, Uehlinger J. Antibody identification using both automated solid-phase red cell adherence assay and a tube polyethylene glycol antiglobulin method. Transfusion. 2008;48:1693-1698.
Sancho JM, Pujol M, FernÁndez F, Soler M, Manzano P, Feliu E. Delayed haemolytic transfusion reaction due to anti-M antibody. Br J Haematol. 1998;103:268-269.
Miller NM, Johnson ST, Carpenter E, Naczek CA, Karafin MS. Patient factors associated with unidentified reactivity in solid-phase and polyethylene glycol antibody detection methods. Transfusion. 2017;57:1288-1293.
Garratty G. How concerned should we be about missing antibodies to low incidence antigens? Transfusion. 2003;43:844-847.
Hauser RG, Esserman D, Karafin MS, et al. The evanescence and persistence of RBC alloantibodies in blood donors. Transfusion. 2020;60:831-839.
Boisen LM, Collins AR, Yazer HM, Waters HJ. Pretransfusion testing and transfusion of uncrossmatched erythrocytes. Anesthesiology. 2015;122:191-195.