antibody screening / detection & antibody identification s. nasizadeh, apcp diamed switzerland
TRANSCRIPT
Antibody Screening / Detection
& Antibody Identification
S. Nasizadeh, APCP
DiaMed Switzerland
“Direct Transfusion”
SHOT REPORT: IBCT Vs TTD
• ABO incompatibilities 9.5%• RhD incompatibilities 6.3%• Other blood group antigens 6.3%• TOTAL IBCT 22.1%
• HIV 0.17%• HBV 0.17%• HAV 0.17%• Malaria 0.17%• Bacterial contamination 0.51%• TOTAL TTDs 1.19%
Compatibility Testing
Ab screening
Indirect Antiglobulin Test
2 or 3 red blood cells
To detect ANY clinically significant Ab
Ab identification
Indirect Antiglobulin Test
11 reagent panel cells
To detect THE clinically significant Ab
Clinically Significant Antibodies
Rhesus (D, C, c, E, e)
Kel (K)
Kidd (Jka, Jkb)
Duffy (Fya, Fyb)
s
Anti-A & -B
Clinically Relatively SignificantAntibodies Lewis (Lea, Leb)
M
N
S
HI
Unexpected Antibodies (Non-A, Non-B)
Found in:
• Chronically transfused patients
• Pregnancy
• Transplants
• Needle sticking
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Clinically Significant Antibodies.
• Clinically significant antibodies in vitro are detected by the indirect antiglobulin technique (IAT) at a strict 37ºC.
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Antibody Screening
• The antibody screen is a
serological technique designed
to detect the presence of ANY
clinically significant
antibody(ies) present in
patient’s blood sample.
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Antibody Screening, Indications
For detection of irregular antibodies (non-ABO)
• Pre-transfusion tests
• Antenatal screening
• Donor units
• HDN
Antibody screening procedure
• Two cell pooled (only for donors)
• Two cells (not pooled)
• Three cells (recommended)
Antibody ScreeningAntibody Screening
Antibody Screening
• Allow the early detection of antibodies.
• Enable laboratories to phenotype available units, or obtain appropriate antigen negative blood from their Blood Centre.
• Negate the need for serological crossmatching if the screen is negative. C/T ratio = 2/1
VERY IMPORTANT
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Antibody Identification
• If the Antibody Screen is reactive, the
antibody specificity must be determined.
• So safe blood can be administered to the
Recipient.
• 11 reagent panel cells are to be used for
identification.
Antibody Identification
• The antibody identification is a
serological technique designed to
determine the TYPE of the
clinically significant antibody(ies)
present in patient’s blood sample.
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Antibody IdentificationAntibody Identification
Antibody Identification.
• When an antibody is detected in the antibody screen, crossmatch compatible blood should not be issued until:
– The antibody has been positively identified
and
– If the antibody is clinically significant, units
phenotyped and found antigen negative for the
appropriate antibody have been obtained.
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Antibody Exclusion
• Antibody exclusion is an important part of antibody investigative work and should always be performed.
• It is essential that when one antibody has been identified, the potential presence of another, masked, antibody has not been overlooked.
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Antibody Screening / Identification
Di aMed- I D Ant i gen - Tabl e Set I - I I 4515. 45. 01 Exp. dat e : 31. 05. 99
Rh- hr Kel l Duff y Ki dd Lewi s P MNS Lut h. Xg Speci al ag Resul t s
D C E c e Cw K k Kpa Kpb J sa J sb Fya Fyb J ka J kb Lea Leb P1 M N S s Lua Lub Xga AHG ENZ1 + + 0 0 + 0 0 + 0 + 0 + + 0 0 + + 0 + + + + + 0 + + - N/ T
2 + 0 + + 0 0 + + 0 + 0 + + + + 0 0 + 0 + 0 + 0 0 + 0 2+ N/ T
Di aMed- I D Ant i gen - Tabl e Set I D- Di aPanel 4517- 63- 01 Exp. dat e : 31. 05. 99
Rh- hr Kel l Duff y Ki dd Lewi s P MNS Lut h. Xg Speci al ag Resul t s D C E c e Cw K k Kpa Kpb J sa J sb Fya Fyb Jka J kb Lea Leb P1 M N S s Lua Lub Xga AHG ENZ
1 + + 0 0 + + + + 0 + 0 + + 0 0 + 0 + + + + + + 0 + + -
2 + + 0 0 + 0 0 + + + 0 + + + + 0 + 0 0 + + 0 + 0 + 0 2+s
3 + 0 + + 0 0 0 + 0 + 0 + 0 + 0 + 0 + + + 0 + 0 0 + + -
4 0 + 0 + + 0 + + 0 + 0 + + + + 0 0 0 + + + 0 + + + + 2+
5 0 0 + + + 0 0 + 0 + 0 + + 0 + + 0 + + + 0 + + 0 + 0 2+
6 0 0 0 + + 0 + + 0 + 0 + + 0 + + 0 + 0 0 + + + 0 + + 2+
7 0 0 0 + + 0 0 + 0 + 0 + 0 + 0 + + 0 0 0 + 0 + + + + -
8 + 0 0 + + 0 0 + 0 + + 0 0 0 + + 0 + + + + 0 + 0 + + 2+s
9 0 0 0 + + 0 0 + 0 + 0 + + + + + 0 + + + 0 + 0 0 + + 2+s
10 + + + 0 + 0 0 + 0 + 0 + 0 + + + + 0 0 0 + 0 + 0 + + 2+
11 + + + 0 0 0 0 + 0 + 0 + + + + + + 0 + + + 0 + 0 + + 2+
12 Aut ocont r ol 0
Antibody Specificity (confirmation)
• Current pre-transfusion guidelines state:
‘The specificity of the antibody should only be assigned when it is reactive with at least two examples of reagent red cells carrying the antigen and non-reactive with at least two examples of reagent red cells lacking the antigen’ .
• In order to meet this criteria, more than one identification panel may be necessary.
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Advatages of cross matching (XM)
• Easy,
• Routinely applied in all blood banks
• Relatively cheap
Disadvantages of cross matching
• Missing of some weak antibodies
• Compatible XM may still cause hemolytic reactions
• Time consuming in cases of incompatibility
Advantages of antibody screening
• Detection of weak antibodies (homozygous cells)
• Preparation and testing of blood at leisure• Batch and mass testing• Automation• Substitution of cross matching (in optimal
conditions)
Antibody screening
Requires :
- Training interpretation skills
- Time
- Tomans
Price / Time comparison
• XM
• RT + 37 AHG (2 tubes)--- 2x• Repeat incompatibles, e-g 4 units --- 8x
• 4 x 30 min= 120 min
• Ab Screen
• 2 x 37 C tubes (2x)
• Or 3 x 2 (AHG +ENZ)= 6x
• 30 min
Tests Are Performed to Provide Compatible Blood
With the Minimum Delay.
• The red cells will have the maximum survival following the transfusion.
• The donor’s blood will not cause an adverse reaction.
• Serological compatibility cannot guarantee that an antibody will not cause a transfusion reaction.
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