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| LETTERS TO EDITOR |
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| Year : 2017 | Volume
: 2
| Issue : 1 | Page : 68-69 |
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Variation in antibody detection in pretransfusion practice by different methods
Sadhana Mangwana, Neha Bedi
Department of Blood Transfusion Services, Sri Balaji Action Medical Institute, New Delhi, India
| Date of Web Publication | 22-Mar-2017 |
Correspondence Address:
Sadhana Mangwana
Department of Blood Transfusion Services, Sri Balaji Action Medical Institute, New Delhi
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/GJTM.GJTM_44_16
How to cite this article:
Mangwana S, Bedi N. Variation in antibody detection in pretransfusion practice by different methods. Glob J Transfus Med 2017;2:68-9 |
Sir,
Pretransfusion tests are critical elements in transfusion safety and prevention of hemolytic transfusion reactions. Several methods are available for indirect antiglobulin test (IAT) to identify red cell antibodies and their titration including tube IAT with enhancement reagents, tubeless methods such as solid phase red cell adherence (SPRCA) tests, column agglutination test (CAT), microtiter – plate technique, and not routinely performed molecular tests. Implementation of automated techniques improves the standardization of methods and the quality of achieved results.[1] Since there is no routine method to evaluate the clinical significance of a single antibody, the only practical approach is to screen for the specificities of antibodies that usually lead to the accelerated clearance of antigen-positive red cells.[2]
In our tertiary care facility, SPRCA technology was implemented (Galileo, fully automated immune hematology analyzer) for the routine pretransfusion testing with a combination of semiautomated testing on CAT (Biorad). Considering the recent knowledge about the clinical significance of reactive antibodies and suggestions to perform individual cost-benefit analysis in every institution, we decided to compare the sensitivity of SPRCA (automated) and CAT (manual) to detect clinically significant red cell antibodies in pretransfusion practice.
In a period of 32 months between August 01, 2013, and March 31, 2016, a total of 23,638 samples were tested for antibody screening and cross matching using CAT. In the last 3 months period between January and March 2016, a total of 1048 samples were tested for 3-cell antibody screen on SPRCA using capture RS3 (Galileo Immucor, Norcross, GA, USA) and positive samples were further subjected to identification.
In 29 months between August 2013 and December 2015, seven antibody positive results were found in 22,576 patients using CAT, while SPRCA detected nine antibody positive results out of 1048 which is statistically highly significant (P < 0.001). Of the seven positive patients by CAT, five were of only auto antibodies; both warm and cold and two patients showed a combination of auto- and allo-antibodies (one warm antibody with anti-E, anti-C and other cold antibody with anti-M allo-antibody). After implementing SPRCA, 9 out of 1048 patients showed positive screen in 3-month. Six of nine patients (67%) showed Rh antibodies of which three patients (33%) showed anti-D alloantibodies. Two patients (22%) showed the presence of multiple alloantibodies; one with anti-E, anti-Fy a, and anti-S, while other patient had anti-C and anti-E alloantibodies. Other clinically significant alloantibodies were anti-C, anti-P, and auto antibodies.
Although both the technologies have the advantages of ease of performance, lesser volume, stable results, and reproducibility, SPRCA has higher sensitivity to detect clinically significant antibodies than CAT. Various studies [3],[4] and our experience have shown that SPRCA was able to detect more clinically significant antibodies including anti-Fya, -Jka, -E, and -e; which are capable of hemolytic transfusion reactions. Blood group services should be able to identify the impact of change in methods-automated versus manual or differences in sensitivity and specificity between pooled cells and reagent red cells. Titration studies may be performed to determine the amount of antibodies in antibody identification, separating multiple antibodies, in prenatal studies and ABO incompatible organ transplant patients.[5] Selection of test in transfusion services should not only be cost effective but it must also have technology that is sensitive and specific. Resources should be better directed that benefit the patient. Hence, it is important to select and validate effective pretransfusion test practices.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | |  |
| 1. | Wittmann G, Frank J, Schramm W, Spannagi M. Automation and data processing with the immucor Galileo system in a university blood bank. Transfus Med Hemother 2007;34:347-52.  |
| 2. | Issitt PD, Anstee DJ, editors. Principles of serological methods. In: Applied Blood Group Serology. 4 th ed. Durham, North Carolina: Montgomery Scientific Publications; 1998. p. 43-69. |
| 3. | Weisbach V, Kohnhäuser T, Zimmermann R, Ringwald J, Strasser E, Zingsem J, 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;16:276-84. |
| 4. | Finck RH, Davis RJ, Teng S, Goldfinger D, Ziman AF, Lu Q, et al. Performance of an automated solid-phase red cell adherence system compared with that of a manual gel microcolumn assay for the identification of antibodies eluted from red blood cells. Immunohematology 2011;27:1-5. |
| 5. | Mehta N, Chakraborty IR, Rane M, Ambre V. Verification of column agglutination technology with conventional tube technology for naturally occurring antibody titration. Glob J Transfus Med 2016;1:46-50.Sir, [Full text] |
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