Download - Antibody Screening / Detection & Antibody Identification S. Nasizadeh, APCP DiaMed Switzerland
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Antibody Screening / Detection
& Antibody Identification
S. Nasizadeh, APCP
DiaMed Switzerland
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“Direct Transfusion”
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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%
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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
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Clinically Significant Antibodies
Rhesus (D, C, c, E, e)
Kel (K)
Kidd (Jka, Jkb)
Duffy (Fya, Fyb)
s
Anti-A & -B
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Clinically Relatively SignificantAntibodies Lewis (Lea, Leb)
M
N
S
HI
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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
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Antibody screening procedure
• Two cell pooled (only for donors)
• Two cells (not pooled)
• Three cells (recommended)
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Antibody ScreeningAntibody Screening
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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.
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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
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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
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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
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Disadvantages of cross matching
• Missing of some weak antibodies
• Compatible XM may still cause hemolytic reactions
• Time consuming in cases of incompatibility
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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)
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Antibody screening
Requires :
- Training interpretation skills
- Time
- Tomans
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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
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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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