|LETTERS TO EDITOR
|Year : 2020 | Volume
| Issue : 1 | Page : 101-103
Naturally occurring anti-S antibody in a blood donor: Screening using panel cells
Ankur Goyal, Seema Dua, Satyam Arora
Department of Transfusion Medicine, Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida, Uttar Pradesh, India
|Date of Submission||13-Jan-2020|
|Date of Decision||01-Feb-2020|
|Date of Acceptance||20-Feb-2020|
|Date of Web Publication||17-Apr-2020|
Department of Transfusion Medicine, Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Goyal A, Dua S, Arora S. Naturally occurring anti-S antibody in a blood donor: Screening using panel cells. Glob J Transfus Med 2020;5:101-3
Naturally occurring antibodies are preimmune antibodies generated in the absence of exogenous antigenic stimulation. These antibodies are broadly reactive, with low affinity and germline-like in nature. Environmental factor/genetic factors such as exposure to bacteria, dust, or pollen that are similar to red cell antigens play an important role and can trigger these antibody formations. It is not necessary that sensitization such as transfusion or pregnancy may be present in these cases. Antibody to S antigen (Anti-S) is rarely found as a naturally occurring antibody.
A 22-year-old first-time male donor, a farmer by occupation, donated blood at our center. All mandatory criteria for donation (as per the guidelines) were within the acceptable limits. There was no significant predonation history like transfusion or drug intake, etc., His blood group was O Rh (D) positive (conventional tube method) with no reaction in pooled O cells and auto control. As per our protocol, all donors are subjected to indirect coomb's test using three cells panel (Bio-Rad, ID-Dia cells), which was positive. The specificity of the antibody was identified to be against S (capital) antigen using ID-Dia panel cells. The 3-cell and 11-cell panels were tested using (BioRad) Liss/Coombs cards [Table 1]. The panel cells showed typical dosage phenomenon with heterozygous Ss phenotype cell.
The alloantibody was of immunoglobulin G nature (no reaction at room temperature) and titer was 1:16. The phenotype of the donor was “S-s+”. Prevalence of S and s antigens in Indian blood donor population is reported to be 54.80% and 88.7%, respectively.,
Clinically significant Anti-S antibody, i.e., reactive at 37°C and binding to complement, may be associated with severe complications such as hemolytic transfusion reactions and hemolytic disease of the fetus and newborn (HDFN). The first HDFN case was reported by Levine et al. in 1952. The HDFN due to anti-S generally causes mild hemolytic jaundice in newborns, but in severe cases, fetal/neonatal deaths have also been reported. The blood components prepared (fresh frozen plasma and random donor platelet) from this donation were discarded, except for packed red blood cell which was issued. The donor was informed of this rare finding and was advised to inform the blood center, about it if he donates again in future.
A study from AIIMS, New Delhi has reported a prevalence of 0.09% (17 out of 18,112 donors) for alloantibodies in blood donors when screening using panel cells. Recently, Malhotra et al. have also reported the detection of naturally occurring anti-S alloantibody in combination with anti-N in a donor. Our case report highlights that there is a need for comprehensive antibody screening in blood donors using panel cells, as the use of pooled O cells may miss the identification of such clinically significant alloantibodies. Comprehensive screening holds more importance while providing blood and blood components in the neonatal or pediatric age group of patients, as even platelets concentrate, prepared from such donations, may cause severe transfusion reactions.
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Conflicts of interest
There are no conflicts of interest.
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