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Report | 01-December-2019

Prevalence of clinically significant red blood cell alloantibodies in pregnant women at a large tertiary-care facility

More than 50 red blood cell (RBC) alloantibodies are known to cause hemolytic disease of the fetus and newborn (HDFN). Although Rh immune globulin (RhIG) prophylaxis has significantly reduced the incidence of pregnancies complicated by anti-D, the need to detect and monitor maternal alloantibodies capable of causing HDFN is still a concern. The prevalence and specificity of these alloantibodies were determined. In this retrospective study, the prevalence and specificities of unexpected RBC

Heather M. Smith, Rosetta S. Shirey, Sandra K. Thoman, Jay B. Jackson

Immunohematology, Volume 29 , ISSUE 4, 127–130

Case report | 01-December-2019

A case of masquerading alloantibodies:  the value of a multitechnique approach

) revealed the presence of four alloantibodies: anti-M and anti-E reacting at immediate spin, 37°C, and IAT plus anti-Fya and anti-Jkb reacting at IAT.

Paula M.S. Wennersten, Laurie J. Sutor

Immunohematology, Volume 30 , ISSUE 3, 117–120

Article | 18-October-2020

Large-scale use of red blood cell units containing alloantibodies

the 4-month period. This savings was achieved despite some additional costs incurred, including costs of data entry and additional testing on patients’ samples. We concluded that large-scale use of RBC units from donors with alloantibodies is safe and likely to have a minimal impact on a busy transfusion service’s workload and costs. Furthermore, nationwide use of such units would help alleviate projected blood shortages.

Martha R. Combs, Donald H. Bennett, Marilyn J. Telen

Immunohematology, Volume 16 , ISSUE 3, 120–123

Article | 16-February-2021


The International Society of Blood Transfusion (ISBT) currently recognizes 36 blood group systems, which contain a total of 322 antigens.1 Table 1 shows the current blood group systems and the number of antigens within each system. The information presented during the Workshop on the Clinical Significance of Red Blood Cell Alloantibodies was collated data from the main review resources available, including Human Blood Groups by Daniels,2 The Blood Group Antigen Factsbook by Reid et al.,3 and

N.M. Thornton, S.P. Grimsley

Immunohematology, Volume 35 , ISSUE 3, 95–101

Article | 28-April-2020

The incidence of red cell alloantibodies underlying panreactive warm autoantibodies

A recognized hazard of administering blood transfusions to patients with panreactive warm autoantibodies is that alloantibodies may be masked. Studies have shown the incidence of underlying alloantibodies to be 30 to 40 percent. Adsorption procedures can be used to remove autoantibodies and allow detection and identification of underlying alloantibodies. This study contains data from 126 patients referred to the Red Cell Immunohaematology laboratory at the National Blood Service, Newcastle upon

Martin Maley, David G. Bruce, Roderick G. Babb, Angus W. Wells, Mark Williams

Immunohematology, Volume 21 , ISSUE 3, 122–125

Case report | 14-December-2020

Case reports: red blood cell autoantibodies mimicking alloantibodies

The phenomenon of autoantibodies mimicking alloantibodies is rare and challenging. This report describes several unusual cases of mimicking autoantibodies and reviews the literature.

Ronald E. Domen, Ann Clarke

Immunohematology, Volume 7 , ISSUE 4, 98–101

Article | 17-November-2020

A simple screening method to evaluate the presence of alloantibodies with concomitant warm autoantibodies

Autoantibodies are present in the serum of patients with autoimmune hemolytic anemia. Extensive serologic investigation is often needed to determine if alloantibodies are also present. To aid in the investigation, a simple method of serum dilution is described. The serum dilution method was compared to allogeneic red blood cell adsorptions in 119 cases tested over a two-year period. In 20 percent of the cases, the same underlying alloantibodies were detected by both the serum dilution method

Ragnhild Øyen, Maria L. Angeles

Immunohematology, Volume 11 , ISSUE 3, 85–87

Report | 12-March-2020

Occurrence of antibodies to low-incidence antigens among a cohort of multiply transfused patients with sickle cell disease

Data from an immunohematology reference laboratory were compiled retrospectively to determine the occurrence of the formation of alloantibodies to low-incidence antigens associated with the African American population (AA-LIAs) among patients with sickle cell disease (SCD). The AA-LIAs under study were V, VS, Jsa, and Goa. The records from 137 recurrently transfused patients with SCD were selected on the basis of transfusion activity from the 2009 calendar year. We found that 13 patients (9.49

Pamela Jackson

Immunohematology, Volume 27 , ISSUE 4, 143–145

Review | 16-October-2019

A review of in vitro methods to predict the clinical significance of red blood cell alloantibodies

Sandra J. Nance

Immunohematology, Volume 34 , ISSUE 1, 11–15

Article | 22-January-2021

Routine indirect antiglobulin testing of blood donors—a further step toward blood safety: an experience from a tertiary care center in northern India

The primary goal of blood transfusion services is to provide the safest and most effective blood components to patients in need.1,2 This goal pertains to achieving the expected clinical outcomes and safeguarding against transfusion-transmitted infections. In addition, the blood and blood components should be free of alloantibodies directed against the recipient’s red blood cell (RBC) antigens, thereby minimizing the risk of adverse transfusion reactions. This risk is more relevant in plasma

S. Malhotra, G. Negi, D. Kaur, S.K. Meinia, A.K. Tiwari, S. Mitra

Immunohematology, Volume 36 , ISSUE 3, 93–98

Article | 16-October-2019

Use of the prewarm method for detecting clinically significant alloantibodies in the presence of cold autoantibodies

interfere with standard testing methods by reacting at the 37°C and antihuman globulin test phases. When using the PW method, it is important to identify underlying, potentially clinically significant alloantibodies during pretransfusion testing to ensure the most appropriate component will be selected for transfusion.

Stephanie Dupuis

Immunohematology, Volume 34 , ISSUE 4, 148–150

Article | 16-February-2021

Workshop on the clinical significance of red blood cell alloantibodies organized by the Working Party on Immunohaematology of the International Society of Blood Transfusion

The clinical significance of red blood cell (RBC) alloantibodies is a matter of high concern for all immunohematologists and transfusion medicine specialists. It is essential to have a clear understanding of this concept when advising clinicians or making clinical decisions regarding the selection of suitable blood for transfusion or in an obstetric setting. Immunohematologists frequently face questions from colleagues and clinicians such as, “Is the alloantibody identified clinically relevant

T. Peyrard

Immunohematology, Volume 35 , ISSUE 3, 105–107

Case report | 22-November-2020

Case reports: use of a polyethylene glycol additive to enhance eluate sensitivity

The use of polyethylene glycol additives to enhance the detection of clinically significant alloantibodies in serum has been widely described. This report outlines several cases in which polyethylene glycol additives were added to eluate test systems to enhance the detection of alloantibodies in recently transfused patients.

Nancy A. Lang

Immunohematology, Volume 10 , ISSUE 1, 19–21

Review | 01-December-2019

Allogeneic red blood cell adsorption for removal of warm autoantibody

Adsorption studies are usually required to confirm or rule out the presence of underlying alloantibodies in samples containing warm autoantibody. Allogeneic adsorptions are necessary if the patient has been recently transfused. Most commonly, allogeneic adsorptions are performed using a trio of phenotyped reagent red blood cells to rule out clinically significant alloantibodies to common antigens. The adsorbing cells may be used untreated or treated with enzymes or with ZZAP before adsorption

Christina Barron

Immunohematology, Volume 30 , ISSUE 4, 153–155

Article | 15-February-2021

Serologic problems associated with administration of intravenous immune globulin (IVIg)

closely watch the patient for development of a hemolytic event.15,16,19 Rarely, IVIg may contain RBC alloantibodies to antigens other than A or B.20,21 If IVIg is infused in a patient having the corresponding antigen, this may result in a positive IgG DAT. An eluate may reveal an antibody that would resemble an autoantibody, but with a common specificity, such as anti-D or anti-C.22–35 Rarely, passive antibodies to antigens other than A or B can cause hemolytic anemia.14,35 Reports of IVIg containing

D.R. Branch

Immunohematology, Volume 35 , ISSUE 1, 13–15

Article | 16-October-2019

Cold autoadsorption

Cold-reactive autoantibodies can mask the presence of underlying clinically significant alloantibodies in a patient’s plasma or serum. These autoantibodies are problematic when performing laboratory procedures such as ABO typing, red blood cell (RBC) crossmatching, antibody detection testing, and antibody identification. To avert the masking of clinically significant alloantibodies in a patient’s plasma or serum, adsorption studies can be performed at 4°C using autologous RBCs

Ernest M. Ekema

Immunohematology, Volume 34 , ISSUE 4, 158–160

Report | 14-March-2020

Allogeneic adsorptions: a comparison of the traditional method with a modified PEG adsorption method

adsorptions, average time saved, and presence or absence of underlying alloantibodies were compared for the two methods and types of adsorbing RBCs. Modified PEGenhanced adsorptions resulted in a 69 percent decrease in adsorbing time. PEG adsorptions removed all autoantibodies and detected 18 of 19 underlying alloantibodies. The unenhanced method did not remove autoantibodies in two samples and identified only 15 of 19 underlying alloantibodies. As expected, reductions in the number of adsorptions and

Mandy E. Etem, Barbara Laird-Fryer, Marie P. Holub, John J. Hedl, Daniel B. Symington, Dolores Figueroa

Immunohematology, Volume 26 , ISSUE 3, 104–108

Article | 16-October-2019

Warm autoadsorption using ZZAP

The masking of clinically significant alloantibodies by warm autoantibodies presents challenges in pretransfusion testing. The adoption of transfusion practices such as the issuing of “least incompatible” red blood cells (RBCs) without a complete antibody workup is potentially unsafe for patients. Several autoadsorption methods can be used to remove autoantibody reactivity. ZZAP treatment of autologous RBCs is an efficient way to prepare the cells for autoadsorption. Autoadsorbed

Farai M. Tsimba-Chitsva, Amy Caballero, Becky Svatora

Immunohematology, Volume 34 , ISSUE 1, 1–3

Article | 16-October-2019

Adsorption of cold agglutinins with rabbit red blood cells

Cold-reactive autoagglutinins may mask the presence of underlying clinically significant alloantibodies. Adsorption with rabbit red blood cells (RBCs) or stroma can remove cold autoagglutinins found in the patient’s plasma/serum that are directed towards antigens expressed on the surface of rabbit RBCs. By removing these cold autoagglutinins, it is then possible to determine whether any underlying alloantibody reactivity is present. Although this method may also unintentionally adsorb

Adam Cobaugh

Immunohematology, Volume 34 , ISSUE 2, 46–48

Case report | 12-March-2020

Alloimmunization to the D antigen by a patient with weak D type 21

Antibodies of apparent D specificity may be found in D+ patients. We report a D+, multi-transfused Caucasian woman with myelodysplasia who exhibited several alloantibodies. One antibody was a moderately strong (2+) anti-D that persisted for 9 months, until the woman died. Molecular analysis of the patient’s RHD gene identified the rare weak D type 21 (938C>T) allele. D alloantibodies do not occur in patients with most weak D types, but some patients with a weak D phenotype, including

Heather McGann, Robert E. Wenk

Immunohematology, Volume 26 , ISSUE 1, 27–29

Article | 17-February-2021

Elimination of HLA antibodies by platelet adsorption

at 2–8°C for 6 months or until visibly contaminated Adsorption Add one to two volumes of prepared platelet pool to one volume of patient serum Incubate for 60 minutes at 37°C Harvest the adsorbed serum, and test for the presence of reactivity at the phases where initially detected Principle Adsorptions are used to remove antibody reactivity from patient serum to allow for detection of underlying clinically significant RBC alloantibodies to common antigens. The most common adsorption

J. Jung, C. Barron

Immunohematology, Volume 36 , ISSUE 1, 1–3

Report | 01-December-2019

Warm autoantibodies: time for a change

with one full part RBCs, creating three adsorbing tubes. All tubes were incubated for 1 hour with periodic mixing. Adsorbed serum from the three tubes was harvested, combined, and tested for reactivity. Fiftyeight samples were evaluated using both the current method and the 1:3 method. Forty-eight (83%) samples successfully adsorbed using both methods. Twenty (34.5%) samples contained underlying alloantibodies. The 1:3 method demonstrated the same antibody specificities and strengths in all 20

J. Ryan Nobles, Clare Wong

Immunohematology, Volume 29 , ISSUE 1, 5–10

Article | 17-November-2020

Application of the proteolytic enzyme papain in routine platelet serology

The use of proteolytic enzymes is well established in red cell serology. These enzymes modify some antigen structures and remove sialic acid from the red cell membrane. Enzyme-sensitive structures have also been identified on the platelet membrane. The effect of papain, a proteolytic enzyme used widely in red cell serology, on the detection of various platelet alloantibodies was examined to determine its usefulness in platelet serology. Antisera with the specificities anti-HPA-la, -2b, -3a, -4a

John A.G. Lown, Brian J. Dale

Immunohematology, Volume 11 , ISSUE 4, 140–142

Report | 14-March-2020

The significance of a positive DAT in thalassemia patients

Suzanne A. Arinsburg, Donna L. Skerrett, Dorothy Kleinert, Patricia J. Giardina, Melissa M. Cushing

Immunohematology, Volume 26 , ISSUE 3, 87–91

Case report | 26-October-2019

Suspected acute hemolytic transfusion reaction mediated by anti-Dia

Ashwini Bennett, Ray K. Boyapati, Frank S. Hong

Immunohematology, Volume 31 , ISSUE 4, 163–165

Article | 30-November-2019

Inhibition of blood group antibodies by soluble substances

Background When performing pretransfusion testing, serologic results may indicate the presence of one or more alloantibodies. There are many methods that can be used to identify and separate specificities.1 One such method is based on the principle of inhibition. The ability to specifically inhibit one antibody may help identify that antibody and allow other antibody specificities to also be identified. Inhibition can aid in the identification of an antibody to an antigen that shows variable

K.M. Byrne, C.M.C. Mercado, T.N. Nnabue, T.D. Paige, W.A. Flegel

Immunohematology, Volume 35 , ISSUE 1, 19–22

Letter to Editor | 14-October-2020

Letter to the Editors Re: Use of red blood cell units containing alloantibodies

John C. Staley, Martha R. Combs, Donald H. Bennett, Marilyn J. Telen

Immunohematology, Volume 17 , ISSUE 2, 58–58

Case report | 31-December-2020

A Case Report: Identification of Multiple Alloantibodies in a Patient's Serum

Michael Gorman, Susan S. Todoroff, Jeanmarie Celich

Immunohematology, Volume 3 , ISSUE 4, 58–59

Report | 16-March-2020

The polymorphism nt 76 in exon 2 of SC is more frequent in Whites than in Blacks

Akiko Fuchisawa, Christine Lomas-Francis, Kim Hue-Roye, Marion E. Reid

Immunohematology, Volume 25 , ISSUE 1, 18–19

Article | 01-April-2020

Management of pregnancy complicated by anti-hrB/anti-HrB

Anti-hrB and anti-HrB are rare alloantibodies found predominantly in people of BlackAfrican descent. It has been assumed that strongly reacting examples of anti-hrB may cause hemolytic transfusion reactions,but precise information is limited. Anti-HrB is a clinically significant antibody and may cause hemolytic transfusion reactions and HDN. Selection of blood for transfusion support for patients with these alloantibodies, and especially with anti-HrB, imposes a special challenge in the United

Nay Win, Malcolm Needs, Louise Tillyer

Immunohematology, Volume 23 , ISSUE 4, 143–145

Report | 01-December-2019

Should blood donors be routinely screened for irregular antibodies?

Alloantibody reactivity is approximately 0.3 percent in blood donors worldwide. The present study established total alloantibody and clinically significant alloantibody (CSAA) frequencies in all Colombian Red Cross National Blood Bank donors (almost all donors were Colombian). The probability of these alloantibodies reacting with a specific antigen in the general population was also determined, focusing on male CSAA data because routine practice in this blood bank is to discard female plasma

Michel Andrés García, Leonardo Bautista, Fernando Palomino

Immunohematology, Volume 28 , ISSUE 2, 60–66

Review | 01-December-2019

Cold acid elution (ELU Kit II)

antibody recovery in most cases, such as recovery of alloantibodies and warm-reactive autoantibodies. Studies have compared methods such as xylene, chloroform, digitonin acid, dichloromethane, citric acid, and Immucor Elu-Kit II (cold acid elution). The ELU-Kit II has been shown to be quick and effective at eluting a wide range of alloantibodies as well as autoantibodies without the use of hazardous chemicals or costly reagent preparation time that some methods use. It is for these reasons that the ELU

Monica Hinrichs, Monica A. Keith

Immunohematology, Volume 30 , ISSUE 3, 113–116

Review | 26-October-2019

Kell and Kx blood group systems

, and alloantibodies to Kell antigens can cause transfusion reactions and hemolytic disease of the fetus and newborn. Kell alloantibodies in pregnancy are known to suppress erythropoiesis, which can result in serious disease despite low amniotic bilirubin levels and low antibody titers. Late-onset anemia with reticulocytopenia is thought to be attributable to the continual suppression of erythropoiesis from residual alloantibody in the infant. Alloimmunization to XK protein is rare, and expressed

Gregory A. Denomme

Immunohematology, Volume 31 , ISSUE 1, 14–19

Review | 16-October-2019

A brief overview of clinical significance of blood group antibodies

Manish J. Gandhi, D. Michael Strong, Barbee I. Whitaker, Evangelia Petrisli

Immunohematology, Volume 34 , ISSUE 1, 4–6

Article | 30-November-2020

Hemolytic transfusion reactions due to anti-e+f detectable only by nonstandard serologic techniques

A patient was transfused with a total of 14 units of red blood cells (RBCs) over 33 days (January 14 to February 15) at two hospitals. Febrile transfusion reactions were noted on three occasions, and hemoglobinuria was seen twice. Alloantibodies were not detected in a sample dated February 14, following a transfusion reaction, and this sample was referred to the North London Blond Transfusion Centre. Further samples were also obtained from before and after all transfusions at both hospitals

Alan Devenish, Lesley A. Kay

Immunohematology, Volume 10 , ISSUE 4, 120–123

Article | 17-November-2020

Analysis ofthe routine use of polyethylene glycol (PEG) as an enhancement medium

This study compared the performance of polyethylene glycol (PEG) and low-ionic saline solutions (LISS) as enhancement media for routine use in a large transfusion service. A PEG additive solution (PEG plus LISS) was compared to a LISS additive (LISS plus polymers) and to an albumin-indirect antiglobulin test (A-IAT). Fifty serum samples containing clinically significant alloantibodies and fifty samples without alloantibodies were tested. Following an acute hemolytic transfusion reaction (HTR

Vicki J. Barrett, James R. Stubbs, Karen Stuardi, Angela Hollis, Leslie Clear

Immunohematology, Volume 11 , ISSUE 1, 11–13

Report | 14-March-2020

Comparison of gel test and conventional tube test for antibody detection and titration in D-negative pregnant women: study from a tertiary-care hospital in North India

Manish K. Thakur, Neelam Marwaha, Praveen Kumar, Subhash C. Saha, Beenu Thakral, Ratti Ram Sharma, Karan Saluja, Hari Krishan Dhawan, Ashish Jain

Immunohematology, Volume 26 , ISSUE 4, 174–177

Case report | 17-November-2020

Case report: a pregnant woman with immune thrombocytopenic purpura and unusual red cell antibodies

Maternal immune thrombocytopenic purpura (ITP) may lead to fetal platelet destruction. This process is mediated by IgG platelet autoantibodies that cross the placenta. In this case, not only were platelet autoantibodies present, but red cell alloantibodies anti-E, anti-M, and anti-He were also present. Anti-E, present as an IgG antibody, crossed the placenta, but did not cause clinical problems in the E+ newborn, other than possible hyperbilirubinemia that was treated by phototherapy.

Carmela R. Nanton, Sharon M. Martin, Lloyd O. Cook, Patricia J. Larison

Immunohematology, Volume 11 , ISSUE 4, 153–155

Article | 14-October-2020

Detection of granulocyte antibodies by flow cytometry without the use of pure granulocyte isolates

blood cells (RBCs) were lysed and remaining leukocytes tested against sera at 4oC. Binding of human alloantibodies to the screening cells was determined by flow cytometric analysis using phycoerythrin-conjugated antibody to human immunoglobulin. Forward and side scatter were used to analyze granulocytes separately from other leukocytes. The assay was validated by testing granulocytes with reference alloantibodies directed to NA1, NA2, 5b, and Mart antigens. Samples from 32 patients were tested, and

Karen M. Kiekhaefer, Karen M. Cipolone, Jo L. Procter, Kazuhiko Matsuo, David F. Stroncek

Immunohematology, Volume 17 , ISSUE 3, 70–75

Article | 31-December-2020

An Example of Mild Hemolytic Disease of the Newborn Caused by Anti-Cob

A woman whose serum contained multiple alloantibodies delivered a full-term infant with mild hemolytic disease of the newborn. The direct antiglobulin test performed on the cord cells was positive with monospecific anti-IgG. An acid elution performed on the cord cells yielded anti-Cob. These findings were consistent with the presence of anti-Cob in the maternal serum. Neonatal clinical findings showed a mildly affected infant who demonstrated a moderate rise in total bilirubin and slight

Nancy B. Steffey, Mary A. Lieb

Immunohematology, Volume 3 , ISSUE 1, 9–10

Article | 17-February-2021

Clinical impacts of DNA-based typing and provision of antigen-matched red blood cell units for chronically transfused patients with thalassemia

Chronic transfusion in patients with thalassemia is often complicated by red blood cell (RBC) alloantibodies to the lacking antigens on the patients’ RBCs. The prevalence of alloantibodies ranges from 4.25 to 37 percent in patients with thalassemia.1–6 Clinically significant alloantibodies can shorten transfused erythrocyte survival due to hemolytic transfusion reactions. To reduce the alloantibody risk, RBC antigen serotyping for Rh (C, c, E, e) and MNS hybrid glycophorins, especially for MNS7

P. Watanaboonyongcharoen, S. Onspun, P. Rojnuckarin

Immunohematology, Volume 36 , ISSUE 4, 137–145

Case report | 01-December-2019

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

from RBCs. Acid eluates from 51 peripheral blood (PB) and 7 cord blood (CB) samples were evaluated by both an automated SPRCA instrument and a manual GMC assay. The concordance rate between the two systems for peripheral RBC samples was 88.2 percent (45 of 51), including cases with alloantibodies (n = 8), warm autoantibodies (n = 12), antibodies with no identifiable specificity (n = 2), and negative results (n = 23). There were six discordant cases, of which four had alloantibodies (including anti

Rachel H. Finck, Rebecca J. Davis, Shih-Mao Teng, Dennis Goldfinger, Alyssa F. Ziman, Qun Lu, Shan Yuan

Immunohematology, Volume 27 , ISSUE 1, 1–5

Article | 14-October-2020

PEG adsorption of autoantibodies causes loss of concomitant alloantibody

Use of polyethylene glycol (PEG) to promote adsorption of autoantibodies is reported to give good recovery of concomitant alloantibodies. In initial experiments, PEG and ZZAP (Ficin and DTT) adsorption procedures were compared for removal of autoantibody and recovery of alloantibody. Postadsorption studies (n = 11) were performed and hemagglutination scores compared. In subsequent studies, equal volumes of alloantibody containing sera, PEG, and antigen-negative red blood cells (RBCs) were used

W. John Judd, Louann Dake

Immunohematology, Volume 17 , ISSUE 3, 82–85

Article | 09-November-2020

The use of polyethylene glycol (PEG) to enhance the adsorption of autoantibodies

The use of polyethylene glycol (PEG) to enhance the adsorption of warm autoantibodies on red blood cells (RBCs) was evaluated in our laboratory in an effort to reduce the time and cost associated with routine differential adsorptions. Sera from 19 patients with warm autoantibodies were tested. Fourteen of these sera contained alloantibodies or additional autoantibody specificities underlying the dominant autoantibody. The sera were differentially adsorbed using equal volumes of serum, reagent

Christina L. Barron, Mary Beth Brown

Immunohematology, Volume 13 , ISSUE 4, 119–122

Review | 09-October-2019

A Caucasian JK*A/JK*B woman with Jk(a+b–) red blood cells, anti-Jkb, and a novel JK*B allele c.1038delG

antisera. Nevertheless, in RBC genotyping (BioArray HEA BeadChip, Immucor, Warren, NJ) performed in our transfusion service on all patients with alloantibodies, her Kidd typing was JK*A/JK*B based on the Jka/Jkb single nucleotide polymorphism in exon 9 (c.838G>A, p.Asp280Asn). Genomic analysis and cDNA sequencing of her JK*B allele revealed a novel singlenucleotide deletion of c.1038G in exon 11, predicting a frameshift and premature stop (p.Thr346Thrfs*5) after translation of nearly 90 percent of

Glenn Ramsey, Ricardo D. Sumugod, Paul F. Lindholm, Jules G. Zinni, Jessica A. Keller, Trina Horn, Margaret A. Keller

Immunohematology, Volume 32 , ISSUE 3, 91–95

Review | 14-October-2020

In vitro cellular assays and other approaches used to predict the clinical significance of red cell alloantibodies: a review

Regina M. Leger

Immunohematology, Volume 18 , ISSUE 3, 65–70

Article | 01-April-2020

A confusion in antibody identification:anti-D production after anti-hrB

It is well known that certain combinations of alloantibodies are frequently found together. Patients with sickle cell disease (SCD) are mostly of African ancestry, and they may make anti-hrB. A transfusion of hrB– blood is often achieved by using e– (R2R2) RBCs; it is generally believed that hrB– patients readily make anti-E or a “broad-spectrum” anti-Rh34 (-HrB). We describe two multiply transfused D+ patients with SCD and a history of anti-hrB who subsequently

Christine Lomas-Francis, Rosyln Yomtovian, Claire McGrath, Phyllis S. Walker, Marion E. Reid

Immunohematology, Volume 23 , ISSUE 4, 158–160

Article | 15-February-2021

Albumin-indirect antiglobulin test

method used in antibody identification studies. The increased tendency for 37°C agglutination when using albumin may allow recognition of antibody specificity before the AHG phase. This step is especially helpful when multiple alloantibodies are present; Rh system antibodies are most likely to react at this test phase. Newly developing antibodies may show increased reactivity in 37°C tests when compared with AHG tests using anti-IgG. Conversely, warm autoantibodies generally have decreased reactivity

J.R. Hamilton

Immunohematology, Volume 35 , ISSUE 2, 63–64

Article | 17-February-2021

A prospective, observational study for optimization of antibody screening in pretransfusion compatibility testing

decision tree was prepared in accordance with British Committee for Standards in Haematology guidelines.19 Figure 1 illustrates the institutional algorithm for the pretransfusion compatibility testing. If an autoantibody was present, a complete serologic evaluation was performed to rule out or rule in the presence of underlying single or multiple alloantibodies. If no underlying alloantibody was identified, either a “best-matched” (defined as an RBC unit for which reaction strength was less than that

P. Pandey, D. Setya, R. Srivastava, M.K. Singh

Immunohematology, Volume 36 , ISSUE 1, 19–28

Article | 16-October-2019

Low-ionic-strength saline solution–antiglobulin test (LISS-AGT)

suspended in LISS. Modifications of the method led to development of the commercially prepared LISS additive solutions in use today. The LISS-AGT can be used effectively to detect alloantibodies of all major blood groups in antibody detection, antibody identification, and crossmatching procedures.

LeeAnn Walker

Immunohematology, Volume 34 , ISSUE 2, 57–60

Review | 12-March-2020

Granulocyte serology: current concepts and clinical signifcance

Applying serologic procedures to the detection of RBC and lymphocyte antigens has facilitated the identification of granulocyte antigens with established clinical significance, which are now classified in the human neutrophil antigen system. Granulocyte alloantibodies and autoantibodies have been implicated in a variety of clinical conditions including alloimmune neutropenia, autoimmune neutropenia, febrile and severe pulmonary transfusion reactions, drug-induced neutropenia, refractoriness to

Mary E. Clay, Randy M. Schuller, Gary J. Bachowski

Immunohematology, Volume 26 , ISSUE 1, 11–21

Review | 02-May-2020

Review: the Kell, Duffy, and Kidd blood group systems

After the discovery (over 50 years ago) that the IAT could be applied to the detection of antibodies to blood group antigens, there was a rapid increase in the identification of alloantibodies that caused transfusion reactions or HDN. After Rh, antibodies in the Kell, Duffy, and Kidd blood group systems were the next in clinically significant antibodies to be revealed. Much of what has been learned about these blood groups since the journal Immunohematology issued its first edition has to do

Constance M. Westhoff, Marion E. Reid

Immunohematology, Volume 20 , ISSUE 1, 37–49

Article | 14-October-2020

Low-incidence MNS antigens associated with single amino acid changes and their susceptibility to enzyme treatment

MNS antigens are carried on glycophorin A (GPA), glycophorin B (GPB), or their variants. Antigens at the N-terminus of GPA are sensitive to cleavage by ficin, papain, and trypsin but are resistant to α-chymotrypsin. Antigens at the N-terminus of GPB are sensitive to cleavage by ficin, papain, and α-chymotrypsin but are resistant to trypsin treatment. These characteristics have been used to aid in the identification of blood group alloantibodies. Recent molecular analyses have

Marion E. Reid, Jill Storry

Immunohematology, Volume 17 , ISSUE 3, 76–81

Article | 14-December-2020

Indicators of clinically significant red cell antibodies produced by sensitized lymphocytes in liver transplant patients

transplant recipients. We therefore propose an antibody screen on all potential liver donors and titration of unexpected alloantibodies; titration of ABO antibodies of liver donors who demonstrate minor ABO-incompatibilities with their recipients; and, when needed, transfusion of group O RBCs to recipients of livers from donors with minor ABO-incompatibility who have antibody scores > 60.

BeverIy E.W. Calhoun, M. Pothiawala, G. Musa, B. Baron

Immunohematology, Volume 7 , ISSUE 2, 37–39

Article | 10-April-2021

A fatal case of acute hemolytic transfusion reaction caused by anti-Wra: case report and review of the literature

A. Espinosa, L.J. Garvik, N. Trung Nguyen, B. Jacobsen

Immunohematology, Volume 37 , ISSUE 1, 20–24

Original Paper | 09-October-2019

Modeling alloantibody formation to highincidence red blood cell antigens in immune responders using genotypic data  

HIA (12.5% of all, 13.8% of those with a documented exposure). Two of these four patients (50%) had made an alloantibody to another antigen. The odds of forming an antibody to an HIA were not related to the total number of transfusions (p = 0.47), the total number of alloantibodies (p = 0.61), or diagnosis of sickle cell disease (p = 0.77) in simple logistic regression. Adjustment for the other two variables in a multiple logistic regression was also not significant for each variable (p = 0.6, p

Patricia A.R. Brunker, Keerthana Ravindran, R. Sue Shirey

Immunohematology, Volume 33 , ISSUE 1, 9–14

Report | 11-March-2020

Should we be screening for anti-Jsa?

We analyzed our historic patient database at North Shore University Hospital and determined both the overall frequency of anti-Jsa and the frequency at which it was detected in combination with other alloantibodies to red blood cell (RBC) antigens. Screening cells used currently are negative for Jsa. Our data suggest that anti-Jsa would not be detected in 30 to 40 percent of patients in which it is the sole antibody present. Since 1996 the antibody was only detected when other antibodies were

Nancy M. Nikolis, Fouad Boctor, William Andrew Heaton, James Martone

Immunohematology, Volume 27 , ISSUE 3, 104–106

Article | 30-November-2020

A comparison of the monocyte J monolayer assay with 51chromium red cell recovery for determining the clinical significance of red cell alloantibodies

Richard J. Davey, Susan S. Esty, Jenny F. Chin, Delores Mallory

Immunohematology, Volume 10 , ISSUE 3, 90–94

Article | 16-November-2020

Empirical evaluation of the transfusion medicine tutor

Previous research during the development of Antibody IDentification Assistant (AIDA) revealed that many medical technology students and other laboratory personnel have serious difficulties in determining the specificity of blood group alloantibodies, especially weak or multiple antibodies. Based on these previous results, AIDA was modified to provide a teaching environment for medical technology students. We report the results of a rigorous, objective evaluation of the resultant system, the

Jodi Heintz Obradovich, Philip J. Smith, Stephanie Guerlain, Sally Rudmann, Patricia Strohm, Jack Smith, John Svirbely, Larry Sacks

Immunohematology, Volume 12 , ISSUE 4, 169–174

Article | 14-December-2020

The sensitivity of antibody detection testing using pooled versus unpooled reagent red cells

. Little data, however, have been published to support this contention. In the present study, the data show a decreased sensitivity for antibody detection when pooled reagent RBCs are used. This reduced sensitivity could result in failure to detect some clinically significant RBC alloantibodies, which might result in the occurrence of overt hemolytic transfusion reactions, especially if an indirect antiglobulin test is not performed at the time blood is crossmatched.

Ira A. Shulman, Roland Nakayama, Cintia Calderon

Immunohematology, Volume 7 , ISSUE 1, 16–19

Article | 14-October-2020

Screening for RBC antibodies - what should we expect from antibody detection RBCs

George Garratty

Immunohematology, Volume 18 , ISSUE 3, 71–77

Review | 20-March-2020

MNS blood group system: a review

The MNS blood group system is second only to the Rh blood group system in its complexity. Many alloantibodies to antigens in the MNS system are not generally clinically significant although antibodies to low-prevalence and high-prevalence MNS antigens have caused hemolytic disease of the fetus and newborn. The MNS antigens are carried on glycophorin A (GPA), glycophorin B (GPB), or hybrids thereof, which arise from single-nucleotide substitution, unequal crossing over, or gene conversion

Marion E. Reid

Immunohematology, Volume 25 , ISSUE 3, 95–101

Review | 20-March-2020

Recognition and management of antibodies to human platelet antigens in platelet transfusion–refractory patients

Platelet transfusion refractoriness is a problem for parous and multiply transfused patients, placing them at higher risk for morbidity and mortality when posttransfusion count increments are significantly lower than expected. Although nonimmune causes of transfusion refractoriness are very common, HLA alloantibodies are the most important of the less frequent immune factors responsible for inadequate count increments. As universal leukoreduction decreases the occurrence of HLA antibody

Ralph R. Vassallo

Immunohematology, Volume 25 , ISSUE 3, 119–124

Article | 14-October-2020

Serologic aspects of treating immune thrombocytopenic purpura using intravenous Rh immune globulin

infusions of IV RhIG in D+ ITP patients, the direct and indirect antiglobulin tests become transiently positive, reflecting passively transferred anti-D and other alloantibodies that were present in the infused IV RhIG. These consistent and predictable serologic findings contrast with the inconsistent and weak anti-D reactivity observed when D– women are treated with relatively small doses of intramuscular RhIG for Rh immunoprophylaxis. The pathophysiology of ITP and the effect of infusing IV RhIG

Can M. Savasman, S. Gerald Sandler

Immunohematology, Volume 17 , ISSUE 4, 106–110

Article | 14-October-2020

Evaluation of a new solid-phase immunoassay for alloantibody detection using bromelin-treated and untreated red blood cells

detected with enzyme-treated intact RBCs and untreated RBCs by M-MPHA. The slight increase in reactivity using M-MPHA was not seen using dried RBC stroma (M-MPHA-Dry). All donor-derived IgG alloantibodies, which were detected by either a conventional tube enzyme test or an indirect antiglobulin test, were detected by M-MPHA without using enzyme-treated RBCs. Both M-MPHA and M-MPHA-Dry can be used for antibody detection without using enzyme-treated RBCs and are also useful for antibody identification.

Toyohiro Tamai, Toshio Mazda

Immunohematology, Volume 17 , ISSUE 1, 17–21

Article | 10-November-2020

Leukocyte reduction of red cells when transfusing patients with autoimmune hemolytic anemia: a strategy to decrease the incidence of confounding transfusion reactions

Autoimmune hemolytic anemia (AIHA) presents a difficult challenge to clinicians and blood bankers alike. Autoantibodies in the serum significantly complicate serologic evaluation, and necessitate performing procedures such as adsorptions to eliminate the possibility of underlying alloantibodies. In many instances the blood that is issued may be phenotypically similar but remains crossmatch incompatible, generating a considerable degree of anxiety among the clinical staff who are responsible for

Jeanne A. Lumadue, Rosetta Sue Shirey, Thomas S. Kickler, Paul M. Ness

Immunohematology, Volume 12 , ISSUE 2, 84–86

Article | 14-December-2020

Antibody detection using pooled sera and a solid phase system

serum) was added to each microwell. In parallel tests of 888 donor pools and of 70 stored sera containing known alloantibodies, results with SP were comparable to results with RP. After implementation of SP for donor antibody detection, 1,135 donor pools were tested. Results with SP appeared satisfactory when compared to previous records. We concluded that the Immucor Capture™-R system can be used for antibody detection using pooled donor sera.

Malcolm L. Beck, Jill T. Hardman, Alicia M. Briseño

Immunohematology, Volume 7 , ISSUE 3, 73–75

Article | 16-February-2021

Use of trypsin in serologic investigation

trypsin treatment of RBCs in the antibody identification process include the inability to provide rule-outs, panagglutination, and inconsistent reactivity with treated RBCs. If the antibody to the high-prevalence antigen is not destroyed by trypsin, a negative reaction will not be achieved, preventing the rule-outs of common clinically significant alloantibodies. As in all enzyme treatments, treatment can expose enzyme-specific antigens present in most normal sera resulting in panagglutination

A. Novotny

Immunohematology, Volume 35 , ISSUE 4, 145–148

Article | 10-November-2020

Anti-Holley detected in a primary immune response

. Recent scientific information has resulted in the placement of Hy in the Dombrock blood group system. Alloantibodies to Dombrock system antigens have not been associated with severe HDN.

Vicki J. Barrett, M. Margaret O’Brien, John J Moulds, Peggy Spruell, Valerie Jackson, James R. Stubbs

Immunohematology, Volume 12 , ISSUE 2, 62–65

Review | 29-October-2019

Raph blood group system

This review describes the current state of knowledge of the Raph blood group system, which consists of a single antigen, MER2. MER2 was initially classified as a high-incidence antigen in the 901 series of blood groups, formerly known as 901011, but was reclassified as an antigen in the Raph blood group system in 2004. There have been six reports of human alloantibodies to MER2. Three of the subjects were found to have a stop codon in the CD151 gene, which encodes a member of the tetraspanin

Michele Hayes

Immunohematology, Volume 30 , ISSUE 1, 6–10

Article | 14-October-2020

Blood group antigen profile predicted by molecular biology - use of real-time polymerase chain reaction to genotype important KEL, JK, RHD, and RHCE alleles

The most clinically important blood group systems in transfusion medicine, excluding the ABO system, are the RH, Kell, and Kidd systems. Alloantibodies to antigens of these systems may be produced following blood transfusion or during pregnancy and can result in serious hemolytic transfusion reactions and hemolytic disease of the newborn.We developed rapid and robust techniques for RHD, RHCE, KEL, and JK genotyping with the use of a real-time polymerase chain reaction instrument. Two

Fernando Manuel Ferreira Araújo, Christiana Pereira, Fátima Monteiro, Isabel Henriques, Elsa Meireles, Pedro Lacerda, Ana Aleixo, Regina Celeste, Luis M. Cunha-Ribeiro, Maria J. Rodrigues

Immunohematology, Volume 18 , ISSUE 3, 59–64

Report | 12-March-2020

Determination of optimal method for antibody identification in a reference laboratory

autoantibodies, respectively. Solid-phase testing failed to detect 12 examples of anti-K. No identifiable pattern of reactivity was found in 13 samples using gel testing compared with 6 for solid-phase and none for tube methodologies. Hemagglutination tube method was the best choice for our IRL because it missed the fewest number of clinically significant alloantibodies. Benefits also included the ability to use various potentiating factors, incubation times, and temperature phases to enhance antibody

Jennifer R. Haywood, Marilyn K. Grandstaff Moulds, Barbara J. Bryant

Immunohematology, Volume 27 , ISSUE 4, 146–150

Report | 26-October-2019

Comparative evaluation of gel column agglutination and erythrocyte magnetized technology for red blood cell alloantibody titration

Antibody titration is traditionally performed using a conventional test tube (CTT) method, which is subjected to interlaboratory variations because of a lack of standardization and reproducibility. The aim of this study is to compare newer methods such as gel column technology (GCT) and erythrocyte magnetized technology (EMT) for antibody titration in terms of accuracy and precision. Patient serum samples that contained immunoglobulin G (IgG) red blood cell (RBC) alloantibodies of a single

Anju Dubey, Atul Sonker, Rajendra K. Chaudhary

Immunohematology, Volume 31 , ISSUE 1, 1–6

Article | 09-November-2020

Clinical significance of an anti-Dib assessed by flow cytometry

, 7, and 10, the percent of circulating Di(b+) RBCs was determined to be 39, 30, and 11 percent, respectively, compared to an expected 49, 43, and 41 percent based on calculations. The Di(b+) RBCs appear to have been tolerated for about 6 days, then were removed from the circulation. Direct anti-IgG tests were 1–2+ mixed field with all posttransfusion samples. Monocyte monolayer assays (MMAs), which have been reported to predict the clinical significance of alloantibodies, gave borderline

Regina M. Leger, Patricia A. Arndt, Asuncion Co, Lauren O’Brien, George Garratty

Immunohematology, Volume 13 , ISSUE 3, 93–96

Report | 01-December-2019

Seroprevalence of unexpected red blood cell antibodies among pregnant women in Uganda

evidence of agglutination. Nine of the 21 samples demonstrated the presence of clinically significant RBC antibodies with anti-S being the most common, 8 samples demonstrated the presence of benign or naturally occurring antibodies, and 4 had only inconclusive reactivity. This study revealed a relatively high frequency of D and a low frequency of demonstrable clinically significant alloantibodies that may cause hemolytic disease of the newborn or hemolytic transfusion reactions among pregnant women in

Kristina Eipl, Clemensia Nakabiito, Kabali Bwogi, Mahnaz Motevalli, Angela Roots, Lorraine Blagg, J. Brooks Jackson

Immunohematology, Volume 28 , ISSUE 4, 115–117

Article | 14-October-2020

An algorithm to locate hrB – donors for individuals with sickle cell disease

Many African Americans with sickle cell disease (SCD) develop alloantibodies to antigens in the Rh blood group system.Others have shown that from D– individuals, those lacking the high-incidence hrB antigen (> 98% prevalence) may be found among r'r African Americans. We describe an algorithm to locate units for African Americans with SCD and anti-hrB and -D. From 46,539 donations, 5136 listed African American as race. Our primary reference laboratory performed Rh phenotyping (D, C

Richard R. Gammon, Norberto D. Velasquez Jr.

Immunohematology, Volume 18 , ISSUE 3, 82–84

Article | 10-April-2021

Group O blood donors in Iran: evaluation of isoagglutinin titers and immunoglobulin G subclasses

also to determine the cutoff titer value that determines a plasma component to be unsafe.8,9 Unexpected alloantibodies are normally produced through immunization by blood transfusion or pregnancy. Alloantibodies such as anti-M, anti-P1, anti-H, and anti-I can occur without previous RBC exposure. It has been shown that microbial elements or environmental factors are also involved in alloantibody production.10 Alloantibodies are important in transfusion medicine and can cause complications

S. Arabi, M. Moghaddam, A.A. Pourfathollah, A. Aghaie, M. Mosaed

Immunohematology, Volume 37 , ISSUE 1, 5–12

Case report | 16-October-2019

Management of pregnancy sensitized with anti-Inb with monocyte monolayer assay and maternal blood donation

Maternal red blood cell (RBC) alloantibodies can cause hemolytic disease of the fetus and newborn (HDFN). Although much is described about common antibodies associated with HDFN, management of a pregnancy complicated by a maternal rare antibody presents several challenges related to assessment of fetal anemia risk, availability of blood for transfusion to the mother and/or the fetus or newborn if needed, and planning for delivery in the case of maternal hemorrhage. Here we report the laboratory

Raj Shree, Kimberly K. Ma, Lay See Er, Meghan Delaney

Immunohematology, Volume 34 , ISSUE 1, 7–10

Article | 29-December-2020

Assessing the clinical significance of anti-Cra and anti-M in a chronically transfused sickle cell patient

An alloantibody to a high-incidence antigen, asso­ciated with multiple other alloantibodies, made it impossible to supply antigen-negative red blood cells (RBCs) for a chronically transfused sickle cell anemia patient. Anti-Cra, -E, -K, -S, -Fya, -Fyb, as well as anti-M reactive at 37°C and in the antiglobulin phase of testing, were identified in the patient’s serum. An extensive search of rare donor files at the American Red Cross and at the American As­sociation of Blood

Mary B. Leatherbarrow, Sandra S. Ellisor, Patricia A. Collins, Deborah K. Douglas, Robert J. Eckrich, Susan S. Esty, Michael L. Baldwin, Paul M. Ness

Immunohematology, Volume 4 , ISSUE 4, 71–74

Report | 09-October-2019

Distribution of blood groups in the Iranian general population

+ (1392; 40.06%). In the Lutheran and P1PK blood group systems, Lu(a–b+) and P1+ phenotypes were observed in 3292 (94.73%) and 1966 (56.58%) samples, respectively. The Xg antigen was present in 1953 (56.20%) samples versus 1522 (43.80%) samples identified as Xg(a–). Knowledge of the prevalence of RBC antigen phenotypes in a population can be useful in databank creation for providing antigen-negative compatible blood to patients with multiple alloantibodies.

Ehsan Shahverdi, Mostafa Moghaddam, Ali Talebian, Hassan Abolghasemi

Immunohematology, Volume 32 , ISSUE 4, 135–139

Article | 15-April-2020

Molecular characterization of GYPB and RH in donors in the American Rare Donor Program

become immunized to Rh antigens, indicating the units were not truly matched. RH genotyping can identify those patients with SCD who carry RH alleles that encode altered C, e, or D who are at risk for production of “apparent auto” and alloantibodies to Rh antigens. RH genotyping of alloimmunized patients with SCD,partnered with genotyping of donors,can identify compatible units that would also eliminate the risk of further Rh alloimmunization.

Sunitha Vege, Connie M. Westhoff

Immunohematology, Volume 22 , ISSUE 3, 143–147

Article | 14-October-2020

Intravenous Rh immune globulin prevents alloimmunization in D– granulocyte recipients but obscures the detection of an alloanti-K

patient. These results suggest that intravenous RhIG can be used to prevent alloimmunization to D in D– patients receiving large quantities of RBCs from D+ granulocyte transfusions. However, anti-D and other passive antibodies from RhIG prohibit the use of the antiglobulin crossmatch with antigenpositive granulocyte donor samples. It may be important to frequently collect new samples to screen for newly formed alloantibodies when IS crossmatches are used in place of the antiglobulin crossmatch.

D.F. Stroncek, J.L. Procter, L. Moses, C. Bolan, G.J. Pomper, C. Conry-Cantilens, H.L. Malech, H.G. Klein, S.F. Leitman

Immunohematology, Volume 17 , ISSUE 2, 37–41

Report | 29-October-2019

Indirect antiglobulin test-crossmatch using low-ionic-strength saline–albumin enhancement medium and reduced incubation time: effectiveness in the detection of most clinically significant antibodies and impact on blood utilization

; uncrossmatched ones. The objective of this study was to evaluate the performance of a LISS-albumin enhancer to intensify antigen-antibody reaction after 5 minutes of 37°C incubation and compare this performance with that of other enhancers, gel, and conventional tube testing. Second, the study evaluated the impact of this method’s implementation in the C:T ratio (crossmatched to transfused RBC units) of a transfusion laboratory. Ninety serum samples containing alloantibodies of potential clinical

Carla Luana Dinardo, Sílvia Leão Bonifácio, Alfredo Mendrone Júnior

Immunohematology, Volume 30 , ISSUE 1, 1–5

Review | 01-April-2020

Transfusion of multiple units of Js(b+) red blood cells in the presence of anti-Jsb in a patient with sickleβ-thalassemia disease and a review of the literature

Jsb is a high-frequency antigen.Anti-Jsb is a rare alloantibody,and its clinical significance is poorly documented. We report a case in which a 12-year-old boy of Nigerian descent with sickle βthalassemia presented with multiple alloantibodies, including a panagglutinin and acute chest syndrome, necessitating the emergent transfusion of five units of phenotype-similar,crossmatchincompatible RBCs,four of which were given during an exchange transfusion. The patient was later found to have

Shan Yuan, Nadia P. Ewing, Debra Bailey, Marissa Salvador, Shirong Wang

Immunohematology, Volume 23 , ISSUE 2, 75–80

Article | 16-October-2019

Assessment of common red blood cell pretreatments to yield an accurate serologic antigen phenotype compared with genotype-predicted phenotype

Red blood cell (RBC) phenotyping is valuable for transfusion management of multiply transfused patients, including the determination of the risk of forming alloantibodies. Extended phenotype matching is most commonly used in situations where there is a need to avoid sensitization in a nontransfused patient1 or to avoid further alloimmunization in a patient who has already been sensitized.2–5 Phenotyping of patients in these situations is often hindered by the presence of circulating donor cells

T. Horn, J. Hamilton, J. Kosanke, V.W. Hare, W. Kluver, W. Beres, S. Nance, M.A. Keller

Immunohematology, Volume 33 , ISSUE 4, 147–151

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