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  • Immunohematology

 

Article | 18-October-2020

Large-scale use of red blood cell units containing alloantibodies

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

Immunohematology, Volume 16 , ISSUE 3, 120–123

Article | 27-December-2020

Resolution of discrepant typings observed in paternity testing

Discrepant results in phenotyping the red blood cells (RBCs) of a child and his alieged parents were attributable to a contaminating antibody, anti-Bgb (HLA B-17), in typing reagents (anti-C and -CW). This case demonstrates the necessity for using reagents from at least two sources for paternity testing.

Mary Lou Guizzo, Nancy Lang

Immunohematology, Volume 5 , ISSUE 2, 57–59

Review | 01-December-2019

Warm autoadsorption with enzyme-treated red blood cells

Patients demonstrating warm autoantibody specificity present serologic challenges for laboratory staff performing antibody identification in the blood bank. Autoantibody can be removed from plasma or serum by adsorption onto autologous red blood cells (RBCs) provided the patient has not been transfused in the previous 3 months. The adsorption process can be enhanced by enzyme pretreatment of autologous RBCs.

Farai Tsimba-Chitsva, Susanne Bishop, Kelly Kezeor

Immunohematology, Volume 28 , ISSUE 3, 88–90

Case report | 27-December-2020

A case report: unusual Gerbich antibody in a patient with sickle cell anemia

A patient whose red blood cells (RBCs) typed as Ge:2,3 produced an alloantibody to a high-frequency antigen in the Gerbich system. This antibody was shown to be nonreactive with Ge: -2, -3 RBCs using adsorption-elution studies. A monocyte monolayer assay (MMA) suggested that transfusion of Ge:2,3 RBCs to this patient would have reduced in vivo survival.

Michael I. Gorman, Bobbye Woody

Immunohematology, Volume 5 , ISSUE 2, 55–57

Article | 22-November-2020

Glycine-EDTA treatment to prepare Ko red blood cells: preservation of high-frequency antigens

Reactivity of high-incidence antigens after glycine-EDTA treatment of red blood cells (RBCs) to prepare artificial Ko RBCs was investigated. The treatment had little or no effect on Yta, JMH, Yka, Kna, and McCa. Hy antigen-positive-treated RBCs reacted less well with anti-Hy when compared to nontreated cells. Glycine-EDTA treatment to prepare Ko RBCs offers an advantage over AET treatment because it preserves some high-frequency antigens that AET treatment does not.

Jana Julleis, Cindy Sapp, Ram Kakaiya

Immunohematology, Volume 10 , ISSUE 2, 64–65

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

Review | 01-December-2019

EDTA glycine acid treatment of red blood cells

IgG dissociation is necessary when a sample is direct antiglobulin test (DAT) positive and antigen testing using blood grouping serum reactive by the antiglobulin test is performed. Exposure of IgG-coated red blood cells (RBCs) to a low pH of 3.0 with EDTA glycine acid successfully dissociates the IgG, rendering the RBCs DAT negative 82 to 85 percent of the time. The procedure takes one minute or less and leaves RBC antigens intact and able to be typed except for those antigens in the Kell

Joanne Kosanke

Immunohematology, Volume 28 , ISSUE 3, 95–96

Article | 22-January-2021

Freezing and recovering rare red blood cells using glycerol

Principle According to the AABB Standards for Immunohematology Reference Laboratories, an accredited immunohematology reference laboratory (IRL) must maintain an appropriate inventory of reagent red blood cells (RBCs) for testing. This inventory should include RBCs negative for high-prevalence antigens, such as Kpb, Jsb, and Vel, as well as rare phenotypes, such as PP1Pk, Rhnull, and Kiddnull, which are not readily available in commercial panel cells.1 When such rare RBC phenotypes are

B. Eades

Immunohematology, Volume 36 , ISSUE 3, 85–88

Article | 16-October-2019

Utility of chloroquine diphosphate in the blood bank laboratory

Chloroquine diphosphate (CDP) is a helpful tool in the blood bank for two main applications. The most common application is to render direct antiglobulin test–positive red blood cells (RBCs) free from membrane-bound IgG; these treated RBCs can then be used for autologous adsorption and/or to determine the patient’s RBC phenotype. Another common use of CDP is to remove human leukocyte antigens (HLAs) from RBCs to help identify or exclude the presence of antibodies to HLAs expressed

Thandar Aye, Patricia A. Arndt

Immunohematology, Volume 34 , ISSUE 3, 98–102

Article | 16-October-2019

Rouleaux and saline replacement

Rouleaux is a phenomenon that commonly occurs in patients who have an increased number of circulating protein macromolecules. It is a benign, in vitro reaction that appears microscopically as red blood cells (RBCs) line up against each other; many liken the RBC aggregation to “stacked coins.” This unexpected reactivity may cause confusion in direct agglutination testing such as reverse blood typing and crossmatching. Saline replacement is the established method to resolve rouleaux

Kayla L. Waider

Immunohematology, Volume 34 , ISSUE 3, 91–92

Article | 17-November-2020

Elimination of a requirement for Vel-negative red blood cells and successful transfusion following chromium-51 survival study

A 42-year-old woman presented with anemia and complex serologic test results that included a requirement for Vel-negative red blood cells (RBCs). Rare Vel-negative units were located and transfused, but her anemia worsened. As further serologic evaluation was inconclusive, an in vivo recovery study with Vel-positive RBCs was performed. Normal 24-hour recovery of these cells resulted in removal of the Vel-negative antigen restriction and successful transfusion of the patient. Resolution of the

Richard J. Davey, Jo Lynn Procter

Immunohematology, Volume 11 , ISSUE 2, 39–42

Article | 30-November-2020

Loss and reappearance of RhO(D) antigen on the red blood cells of an individual with acute myelogenous leukemia

Complete loss of Rho(D) antigen from red blood cells (RBCs) of individuals with hematologic disorders, though not frequent, has been reported. This case reports the loss of D antigen on the RBCs of a patient with acute myelogenous leukemia and its reappearance when he was in remission. Loss of D antigen expression coincided with worsening clinical and cytogenetic disease. At the time of D antigen loss, the patient also had cytogenetic abnormalities in the bone marrow cells. When he was in

Kala Mohandas, Vesna Najfeld, Harriet Gilbert, Penny Azar, Donna Skerrett

Immunohematology, Volume 10 , ISSUE 4, 134–135

case-report | 25-June-2021

Anti-A1Leb: a mind boggler

The Lewis blood group system (Le) is unique because it is the only system in which the antigens are not synthesized by red blood cells (RBCs); rather, the antigens are passively adsorbed onto the RBC membrane.1 Le antigens are soluble carbohydrate moieties formed by tissue cells and secreted by body secretions like saliva, where they appear as glycoproteins; in plasma, however, they appear as glycolipids. The Le phenotype depends on ABH secretor status of an individual, although FUT2 and FUT3

A. Gupta, K. Chaudhary, S. Asati, B. Kakkar

Immunohematology, Volume 37 , ISSUE 2, 69–71

Review | 09-October-2019

How to recognize and resolve reagentdependent reactivity: a review

Reagent-dependent reactivity can be described as agglutination of red blood cells (RBCs) in serologic testing that is not related to the interaction of RBC antigens and antibodies that the test system is intended to detect. In other words, reagent-dependent reactivity results in false-positive agglutination reactions in serologic testing. These false-positive reactions can cause confusion in antigen typing and RBC antibody detection and identification procedures, and may result in delays in

Gavin C. Patch, Charles F. Hutchinson, Nancy A. Lang, Ghada Khalife

Immunohematology, Volume 32 , ISSUE 3, 96–99

Article | 09-November-2020

Practical method for determination of the U status of S–s– erythrocytes

Red blood cells (RBCs) lacking S and s blood group antigens are classified as S–s–U– or S–s–U+var but the classification may vary due to the characteristics of anti-U and to the technique used. Tests on RBCs known to lack glycophorin B (GPB) or to possess an altered form of GPB showed that polyethylene glycol-indirect antiglobulin testing or MicroTyping Systems (MTS)-gel techniques can be used as a simple and reliable way to detect RBCs with variant forms of GPB

Marion E. Reid, Jill R. Storry, Joan Maurer, Sandra T. Nance

Immunohematology, Volume 13 , ISSUE 4, 111–114

Article | 15-February-2021

Albumin-indirect antiglobulin test

Principle Albumin is added to serologic tests to overcome forces keeping red blood cells (RBCs) apart and, in doing so, makes hemagglutination reactions more likely to occur. Use of albumin in antibody detection tests began as early as the 1940s before the advent of the antihuman globulin (AHG) phase of testing, when direct agglutination tests were the only available method for visualizing the antigen-antibody reaction. Initially, the reagent was used in albumin layering1,2 or albumin

J.R. Hamilton

Immunohematology, Volume 35 , ISSUE 2, 63–64

Review | 01-December-2019

Immunosuppressive protocols for transplantation and certain hematologic malignancies can prevent the primary immune response to the D blood group antigen

A review of the published literature on Rh alloimmunization reveals that its incidence varies with the volume of infused D+ red blood cells (RBCs), the probable Rh genotype of the RBCs, and the immune competency of the D– recipient. Among the reports of Rh alloimmunization in different clinical circumstances, we identified five studies in which a combined total of 62 D– recipients of hematopoietic stem cell or solid-organ transplants were transfused with D+ RBCs and none (0%) formed

Adair Seager, S. Gerald Sandler

Immunohematology, Volume 29 , ISSUE 3, 110–114

Case report | 11-March-2020

Persistent complement-dependent anti-AnWj in a lymphoproliferative disorder: a case study and review

AnWj is a high-incidence antigen present on the red blood cells (RBCs) of greater than 99 percent of the general population. A 58-year-old man underwent autologous hematopoietic stem cell transplantation (HSCT) for stage IVa mantle cell lymphoma. This procedure was complicated by failure to engraft, necessitating ongoing support with blood components. After a 2-month period of uneventful transfusion support, the patient experienced increasingly severe reactions with fever and evidence of

George Grigoriadis, Jennifer Condon, Kate Green, Mary Ann Anderson, Marija Borosak, Erica Wood

Immunohematology, Volume 27 , ISSUE 3, 83–88

Article | 14-October-2020

Nondetection of the S antigen due to the presence of sodium hypochlorite

Low concentrations of sodium hypochlorite (chlorine bleach) are known to destroy S antigen on intact fresh red blood cells (RBCs). Sodium hypochlorite is commonly used as a disinfectant. We report nondetection of the S antigen in tube and microplate saline indirect antiglobulin testing (SIAT) with a lot of commercial saline utilized in our donor screening and reference laboratories. Known S+s+ RBCs were found to be nonreactive with anti-S by SIAT in our reference laboratory. Our investigation

Anne Long, Lyne Tremblay, Lucie Richard, Réal Lemieux, Mindy Goldman

Immunohematology, Volume 18 , ISSUE 4, 120–122

Article | 26-October-2020

Precipitation of serum proteins by polyethylene glycol (PEG) in  pretransfusion testing

Polyethylene glycol (PEG) is used as a potentiator of blood group antigen-antibody interactions. Although PEG is known to precipitate immunoglobulins, we could find no reports of this reagent entrapping red blood cells (RBCs) in irreversible clumps. The patient we describe here had hyperglobulinemia with a reversed albumin: globulin ratio and a diffuse immunoglobulin peak on serum protein electrophoresis. During preparation of serologic tests, a precipitate formed that entrapped the RBCs when

Jack Hoffer, William P. Koslosky, Elizabeth S. Gloster, Therese M. Dimaio, Marion E. Reid

Immunohematology, Volume 15 , ISSUE 3, 105–107

Article | 15-February-2021

An update on the H blood group system

E.A. Scharberg, C. Olsen, P. Bugert

Immunohematology, Volume 35 , ISSUE 2, 67–68

Article | 16-October-2019

Dithiothreitol treatment of red blood cells

Principle Dithiothreitol (DTT) is a reducing agent capable of irreversibly cleaving accessible disulfide bonds when the solution pH is >7. DTT treatment of red blood cells (RBCs) will modify the tertiary structure of protein-based erythrocyte membrane antigens if their confirmation depends on disulfide bonds.1 Antigens of the following blood group systems are destroyed or weakened by 0.2 M DTT treatment: KEL, IN, JMH, YT, LU, MER2, KN, DO, CROM, and LW.2,3 Antibodies directed at antigens in

C.B. Bub

Immunohematology, Volume 33 , ISSUE 4, 170–172

Article | 10-November-2020

Glycophorin A-deficient red cells may have a weak expression of C4-bound Ch and Rg antigens

The blood group antigens Ch and Rg are polymorphisms of C4d. Antigen-positive red blood cells (RBCs) treated with proteases type as Ch-, Rg-. Although RBCs treated with sialidase may type Ch+ Rg+, they cannot be coated with C4 by the 10 percent sucrose method. Since studies of complement binding have shown that glycophorin A (GPA) is an important component for the uptake of C4 by RBCs, we tested all available GPA-deficient RBCs for their Ch and Rg status. Using eluates of human anti-Ch and anti

Patricia Tippett, Jill Storry, Phyllis Walker, Yasuto Okubo, Marion Reid

Immunohematology, Volume 12 , ISSUE 1, 4–7

Article | 16-October-2019

Separation of multiple antibodies by adsorption with allogeneic red blood cells

Principle Antibody detection and identification are processes that are commonly performed in the transfusion service before the transfusion of allogeneic red blood cells (RBCs). Antibody identification usually follows the discovery of a positive antibody detection test, or other factors such as ABO serum/cell discrepancy or incompatible crossmatch.1 Antibody identification is a necessary practice in blood banking to determine blood products that are suitable for transfusion to an individual

E.M. Ekema

Immunohematology, Volume 33 , ISSUE 4, 155–158

Article | 16-October-2019

Detecting polyagglutinable red blood cells

Polyagglutination is a condition in which red blood cells (RBCs) are agglutinated by normal adult human sera but not by autologous or newborn sera. Polyagglutination is caused by changes in the RBC membrane that enable patient RBCs to agglutinate with normal human sera; this agglutination can interfere with blood bank testing. Depending on the cause, polyagglutination may or may not be the cause of RBC hemolysis. Lectins and human sera can be used to detect polyagglutinable RBCs. Identification

Cami Melland, Connie Hintz

Immunohematology, Volume 34 , ISSUE 3, 113–117

Article | 16-October-2019

Recovery of autologous sickle cells by hypotonic wash

It is important to isolate autologous red blood cells (RBCs) from transfused RBCs in samples from recently transfused patients to ensure that accurate serologic results are obtained. Typically, this isolation can be performed using methods that separate patient reticulocytes from transfused, older donor RBCs. Patients with sickle cell disease (SCD), however, characteristically have RBCs with altered membrane and morphological features, causing their RBCs to take on a sickle-shape appearance

Emily Wilson, Kelly Kezeor, Monica Crosby

Immunohematology, Volume 34 , ISSUE 1, 16–18

Review | 01-December-2019

An update on the GLOB blood group system and collection

The P blood group antigen of the GLOB system is a glycolipid structure, also known as globoside, on the red blood cells (RBCs) of almost all individuals worldwide. The P antigen is intimately related to the Pk and NOR antigens discussed in the review about the P1PK blood group system. Naturally occurring anti-P is present in the serum of individuals with the rare globosidedeficient phenotypes p, P1k, and P2k and has been implicated in hemolytic transfusion reactions as well as unfavorable

Åsa Hellberg, Julia S. Westman, Martin L. Olsson

Immunohematology, Volume 29 , ISSUE 1, 19–24

Article | 16-November-2020

A second example of anti-Esa, an antibody to a high-incidence Cromer antigen

A blood sample contained an antibody to a high-incidence antigen that reacted with all red blood cells (RBCs) tested by the indirect antiglobulin test (IAT). The antibody reacted with papain-, ficin-, and trypsin-treated RBCs, but not with α-chymotrypsin-treated RBCs. This pattern of reactivity suggested the possibility that the antibody was recognizing an antigen in the Cromer blood group system. Tests against RBCs deficient in decay-accelerating factor (which carries the Cromer antigens

Marion E. Reid, Roselyn Marfoe, Anita Mueller, Patricia A. Arndt, Laima Sausais, Peggy Spruell

Immunohematology, Volume 12 , ISSUE 3, 112–114

Article | 29-December-2020

Immunoglobulin A (IgA) levels in blood products and plasma derivatives

lgA was measured by radial immunodiffusion and enzyme-linked immunosorbent assay techniques. Blood products which consistently contained IgA less than 0.05 mg/dL (the present definition for IgA deficiency used by the American Red Cross Rare Donor Registry) were from IgA-deficient donors, deglycerolized red blood cells (RBCs) prepared with an extra wash cycle, and RBCs washed using a total volume of approximately 1300 mL of 0.9 percent sodium chloride.

Susan M. Fox, Linda M. Stavely-Haiber

Immunohematology, Volume 4 , ISSUE 1, 5–9

Article | 09-October-2019

Applications of selected cells in immunohematology in a developing country: case studies

When an antibody is detected, its specificity should be determined and its likely clinical significance should be assessed. When one antibody has been identified, it becomes necessary to confirm the presence of additional significant antibodies to ensure that compatible blood is provided to the patient. To perform this confirmation, specific reagent red blood cells (RBCs) are selected; these are called selected cells. Though the most common use of selected cells is for antibody confirmation

Ravi C. Dara Dara, Aseem Kumar Tiwari, Dinesh Arora, Subhasis Mitra, Geet Aggarwal, Devi Prasad Acharya, Gunjan Bhardwaj

Immunohematology, Volume 33 , ISSUE 1, 27–35

Article | 30-November-2020

First example of Rh:-32,-46 red cell phenotype

The red cells of a white male blood donor typed as Rh:-1, -2, -3, w4, w5, 6, -17, w19, -31, -32, -34, and -46. Although the donor has no history of transfusion, his serum contains an alloantibody that is weakly reactive with most red blood cells (RBCs) tested. Only Rhnull and D-- RBCs are nonreactive. Reactivity is enhanced with ficin- or papain-treated RBCs and is unaffected by AET or DTT treatment of the RBCs. Previously described Rh:-46 RBCs have been of deletion types D--, D•&bull

Jill Storry, Michael Gorman, Nancy I. Maddox, Ella Toy, Peter D. Issitt, Delores M. Mallory

Immunohematology, Volume 10 , ISSUE 4, 130–133

Article | 30-November-2020

Autoimmune hemolysis following transfusion: a mimicking autoanti-D in a D- patient with alloanti-D

An 80-year-old group O, D- (rr) female with anti-C, -D, -E, and -Fya received four units of crossmatch-compatible red blood cells (RBCs). The direct antiglobulin test (DAT) was negative. Two weeks later, jaundice, dark urine, a 16% drop in hematocrit (Hct), a 20% reticulocyte count, and absent haptoglobin occurred. During the next month, her DAT was positive with anti-IgG and -C3d. Acid eluates, which repeatedly showed anti-D specificity, were nonreactive with enzyme-treated D- RBCs. Adsorption

Walter H. Dzik, Joyce Blank, Paula Lutz, Thomas G. Hirose, Christine Lomas-Francis, Marilyn Moulds

Immunohematology, Volume 10 , ISSUE 4, 117–119

Article | 14-December-2020

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

Because the sensitivity of antibody detection testing may be reduced when pooled reagent red blood cells (RBCs) are used, the American Association of Blood Banks (AABB) prohibits the use of pooled reagent RBCs when performing pretransfusion antibody detection testing. This restriction imposed upon the use of pooled reagent RBCs is based, at least in part, on the belief that pooled reagent RBCs are less likely to detect clinically significant antibodies than are sets of unpooled reagent RBCs

Ira A. Shulman, Roland Nakayama, Cintia Calderon

Immunohematology, Volume 7 , ISSUE 1, 16–19

Case report | 29-December-2020

A case report: cold hemagglutinin disease in a pancreatic and renal transplant patient

A 33-year-old white male, 30 days postpancreatic transplant, with a history of juvenile onset diabetes mellitus and previous renal transplant, appeared to have cold hemagglutinin disease (CHD). He was being treated for acute organ rejection and had received two units of red blood cells (RBCs) on postoperative day 11, at which time no serum antibodies were detectable. On postoperative day 30, serum studies showed an autoanti-I with a titer of 512 in 30 percent albumin at 4°C and a maximum

Catherine Y. Beiting, Kathleen S. Larimore

Immunohematology, Volume 4 , ISSUE 4, 85–87

Report | 06-November-2019

Drug-induced immune hemolytic anemia: the last 30 years  of changes

Drug-induced immune hemolytic anemia (DIIHA) is a rare condition that occurs primarily as a result of drug-induced antibodies, either drug-dependent or drug-independent. Drugdependent antibodies can be detected by testing drug-treated red blood cells (RBCs) or untreated RBCs in the presence of a solution of drug. Drug-independent antibodies react with untreated RBCs (no drug added) and cannot be distinguished from warm autoantibodies.  Many changes have occurred during the last 30 years

Patricia A. Arndt

Immunohematology, Volume 30 , ISSUE 2, 44–54

Article | 14-October-2020

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

In the United States, the Food and Drug Administration mandates that red blood cells (RBCs) for antibody detection possess the following antigens: C, D, E, c, e, M, N, S, s, P1, Lea , Leb , K, k, Fya, Fyb, Jka, and Jkb. Although not required, it is generally agreed that homozygosity for C, D, E, c, e, Fya, and Jka is also preferable.There is no requirement for low-frequency antigens to be present.However, manufacturers of antibody detection RBCs receive requests for these RBCs to possess Cw

George Garratty

Immunohematology, Volume 18 , ISSUE 3, 71–77

Review | 14-October-2020

The Cromer blood group system: a review

DAF protein. The red blood cells (RBCs) of people with the Cromer null phenotype, Inab, lack DAF. Antibodies to Cromer antigens are rarely encountered although there is evidence that the antibodies may cause accelerated destruction of transfused RBCs. There is no risk of hemolytic disease of the newborn associated with Cromer system antibodies because the placenta is a rich source of fetally derived DAF, which is thought to adsorb the antibodies.

Jill R. Storry, Marion E. Reid

Immunohematology, Volume 18 , ISSUE 4, 95–103

Article | 14-October-2020

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

The enzyme test is used to detect certain antibodies or facilitate antibody identification. This study compares antibody reactivity with bromelin-treated red blood cells (RBCs) and untreated RBCs using a newly developed solid-phase immunoassay. The reactivity of irregular antibodies was tested by a magnetic-mixed passive hemagglutination assay (M-MPHA). In addition, antibody reactivity was tested with dried stroma of bromelin-treated RBCs and untreated RBCs (M-MPHA-Dry). Rh antibodies were

Toyohiro Tamai, Toshio Mazda

Immunohematology, Volume 17 , ISSUE 1, 17–21

Article | 03-November-2020

Warm autoimmune hemolytic anemia associated with an IgM autoanti-Ge

A 28-year-old male with a prior history of Hodgkin’s disease and a recent upper respiratory tract infection presented with autoimmune hemolytic anemia (AIHA). The patient’s red blood cells (RBCs) were spontaneously agglutinated after room temperature and 37°C washes. Dithiothreitol-treated RBCs reacted strongly with anti-C3 and were nonreactive with anti-IgG, -IgM, and -IgA; they reacted with anti-IgM (κ light chains only) by flow cytometry. The patient’s serum was

Thom S. Sererat, Douglas W. Veidt, Patricia A. Arndt, George Garratty

Immunohematology, Volume 14 , ISSUE 1, 26–29

Article | 06-December-2020

A weak B antigen with serologic reactivity between B1 and B2 red blood cells found in a Chinese family

During a serologic study on red cell samples from individuals representing three generations of a Chinese family, an unusual pattern of reactivity was noted in a sample from a daughter of an A1B2 individual. The results of direct ABO grouping, titration, and adsorption studies demonstrated that the red blood cells (RBCs) from the proposita and two of the proposita's uncles (1) expressed more B antigen than group B2 RBCs but less than group B1 RBCs; (2) expressed the B1 antigen but at a

Gongliang Zhang, Yiging Wang, Jie Zheng, Alice Lee, Robert J. Eckrich, Delores M. Mallory, Tsung Dao Lee

Immunohematology, Volume 9 , ISSUE 1, 11–14

Report | 26-October-2019

Proposed criterion for distinguishing ABO mosaics from ABO chimeras using flow cytometric analysis

“A” or “B” antigen-negative and -positive red blood cells (RBCs) were set such that group O RBCs were classified as 99 percent negative and group A or B RBCs as 99 percent positive, the percentages of RBCs in the middle region of six chimeras and 23 mosaics (12 A mosaics and 11 B mosaics) were 0.1–0.6 percent and 7.0–19.0 percent, respectively. This result suggested that ABO mosaics and chimeras can be unambiguously differentiated when the cutoff point of the

Akira Oda, Nobuki Matsuyama, Mizuko Hirashima, Hiroyuki Ishii, Keiko Kimura, Harumichi Matsukura, Fumiya Hirayama, Keisei Kawa, Yasuo Fukumori

Immunohematology, Volume 31 , ISSUE 1, 24–28

Report | 06-November-2019

How we investigate drug-induced immune hemolytic anemia

antibodies are investigated by testing drug-treated red blood cells (RBCs) or by testing RBCs in the presence of a solution of drug. Drug-independent antibodies are serologically indistinct from idiopathic warm autoantibodies and cannot be defined or excluded by serologic testing. Nonimmunologic protein adsorption, caused by some drugs, is independent of antibody production but may also cause immune hemolytic anemia. Serologic methods for testing for drug antibodies are presented, and observations from

Regina M. Leger, Patricia A. Arndt, George Garratty

Immunohematology, Volume 30 , ISSUE 2, 85–94

Article | 06-December-2020

Reactive lysis - a phenomenon of delayed hemolytic transfusion reactions

A 62-year-old female with Gaucher's disease demonstrated alloanti-c on pretransfusion testing. She was transfused with five units of c-negative red blood cells (RBCs) preoperatively and intraoperatively. The hemoglobin (Hb) level was slightly lower initially, but was markedly lower on day 10 posttransfusion. Serologic results indicated a delayed hemolytic transfusion reaction (DHTR) due to alloanti-s, -Fya, and -Jkb, present both on the RBCs and in the serum. As late as day 35

Deborah L. Greene, Sanobar Khan

Immunohematology, Volume 9 , ISSUE 3, 74–77

Review | 01-December-2019

Cold acid elution (ELU Kit II)

Elution is a procedure for recovery of antibody attached to intact, immunoglobulin-coated red blood cells (RBCs) by disrupting the antigen–antibody bonds. The recovered antibody is collected in an inert diluent and is referred to as an eluate. Testing of an eluate may be desired to identify antibody(ies) coating the RBCs of patients with a positive direct antiglobulin test. Many types of elution procedures have been developed and described; however, an acid elution is suitable for

Monica Hinrichs, Monica A. Keith

Immunohematology, Volume 30 , ISSUE 3, 113–116

Article | 30-November-2020

An example of anti-LWa in a 10-month-old infant

patient’s red blood cells (RBCs) typed as B, D-, LW(a-), K-, Fy(a-). Due to the age and clinical status of the child, 51Cr survival studies were not performed. One pediatric unit of D-, K-, Fy(a-) blood was transfused uneventfully; the expected increment of hemoglobin was achieved. Repeat testing 3 months later showed a weakly positive DAT, the patient’s RBCs typed as LW(a+), and anti-LWa was detected only by a two-stage papain technique. These results suggest that the patient had a

Alan Devenish

Immunohematology, Volume 10 , ISSUE 4, 127–129

Review | 26-October-2019

Kell and Kx blood group systems

The Kell and Kx blood group systems are expressed as covalently linked molecules on red blood cells (RBCs). The Kell blood group system is very polymorphic, with 35 antigens assigned to the system. The expression of Kell glycoprotein on RBCs is not critical to the erythrocyte function. However, the expression of Kx is critical to normal morphology, and null mutations are associated with the McLeod neuroacanthocytosis syndrome. The immunogenicity of the K antigen is second only to the D antigen

Gregory A. Denomme

Immunohematology, Volume 31 , ISSUE 1, 14–19

Article | 10-November-2020

The second example of Lu:-7 phenotype: serology and immunochemical studies

We describe the second example of red blood cells (RBCs) with the Lu:–7 phenotype in a 37-year-old Latino female (SA). Her RBCs were nonreactive with anti-Lu7 (Mrs. GA) but were reactive with all other antibodies to high-prevalence antigens tested, including those in the Lutheran blood group system. No Lu:–7 RBCs were available for testing. SA’s serum was nonreactive by the indirect antiglobulin test against (1) recessive and dominant Lu(a–b–) RBCs and (2) trypsin

Marion E. Reid, Jack L. Hoffer, Ragnhild Øyen, Edith Alicea-Tossas, Manijeh Sadjadi, Gladys M. Messina

Immunohematology, Volume 12 , ISSUE 2, 66–68

Report | 09-November-2020

Report on anti-Dib encountered in two Hong Kong Chinese

Two cases of anti-Dib, a rarely encountered antibody, were identified in serum samples referred by hospital blood banks during the past 13 months. Case 1 is a 4l-year-old female who required blood for elective surgery. Case 2 is a premature infant suffering from mild neonatal jaundice on day 2 after birth. The anti-Dib in both cases exhibited marked dosage effect. The titer/score against Di(a+b+) and Di(a-b+) red blood cells (RBCs) in case 1 was 8/10 and 32/32, respectively, and in case 2, 4/18

C.K. Lin, K.H. Mak, N.K. Chan, C.M.Y. Yuen, A. Devenish, H.B. Chan, K.L. Au, S.C. Szeto

Immunohematology, Volume 13 , ISSUE 1, 17–19

case-report | 25-June-2021

B subgroup detection in a small hospital transfusion service

have subgroups that are often distinguished by decreased amounts of A or B antigens on red blood cells (RBCs). A and B subgroup phenotypes can be identified based on the quantity of A or B antigens carried on RBCs and A or B substances present in secretions (for individuals who have the secretor phenotype). The most common subgroups are A1 and A2 (in Europeans, 80% of all group A and AB individuals are A1 and 20% are A2).2 Blood group A appears to have more subgroup variations than group B. In

E. Elardo, N. Elbadri, C. Sanchez, V. Powell, M. Smaris, Y. Li, J. Jacobson, T. Hilbert, T. Hamilton, D.W. Wu

Immunohematology, Volume 37 , ISSUE 2, 89–94

Report | 01-December-2019

Transfusion of D+ red blood cells to D– individuals in trauma situations

To conserve D– red blood cells (RBCs), our facility developed a policy for transfusion of D+ units to D– patients, particularly in trauma situations. To our knowledge, this is the first study looking at D-mismatched RBC transfusion in trauma patients. We developed guidelines for the transfusion of D-mismatched RBCs. Patients were followed by antibody screening and direct antiglobulin testing. Twenty-six patients were identified, and 57.7 percent of the cases were the result of

Amanda Tchakarov, Rhonda Hobbs, Yu Bai

Immunohematology, Volume 30 , ISSUE 4, 149–152

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 | 20-December-2020

Two cases of autoantibodies that demonstrate mimicking specificity in the Duffy blood group system

Two transfused Caucasian patients presented with possible delayed transfusion reactions. Both patients demonstrated an anti-Fya (Fy1) plus anti-Fyb (Fy2) pattern of reactivity in their sera. The patients’ red blood cells (RBCs) were Fy:1,-2,3. Both had positive direct antiglobulin tests (DAT) with anti-IgG and -C3d. The serum antibodies reacted with the patients’ RBCs drawn when the DATs were negative. Both patients’ serum samples showed reactivity with Fy:1,-2 (1+), Fy:-1,2

Teresa Y. Harris

Immunohematology, Volume 6 , ISSUE 4, 87–91

Article | 20-December-2020

Du phenotyping by the rosette technique when the direct antiglobulin test is positive

The rosette technique provides a simple rapid and accurate procedure for Du phenotyping of red blood cells (RBCs) with a positive direct antiglobulin test (DAT) due to antibodies other than those of the Rh system. We used Sebring and Polesky’s rosette technique to test RBCs with positive DATs. Characteristic microscopic agglutination was observed for the Du phenotype which was dif­ferent from the mixed-field agglutination seen as positive rosettes in feto-maternal hemorrhage (FMH

Jochewed Werch, Carolyn Todd, Marilyn K. Moulds

Immunohematology, Volume 6 , ISSUE 2, 44–46

Case report | 09-October-2019

Hemolytic transfusion reaction attributable to anti-Dia  

In situations when a patient's antibody detection test is negative, many institutions have moved from an indirect antiglobulin test (IAT) crossmatch to an electronic crossmatch system. Here we report a case of an acute hemolytic transfusion reaction attributable to anti-Dia in a patient with a negative antibody detection test. A 22-year-old female patient with a diagnosis of β thalassemia and sickle cell anemia commenced a routine exchange transfusion of 5 units of red blood cells

Arthur J. Joyce, Kelli M Quantock, Ray Banh, Yew-Wah Liew

Immunohematology, Volume 33 , ISSUE 1, 6–8

Case report | 26-October-2019

Blocked D phenomenon and relevance of maternal  serologic testing

A blood requisition for double-volume exchange transfusion was received for a 2-day-old male child born to a 29-yearold multiparous female (P2002) referred to our institute having neonatal jaundice with encephalopathy; no maternal sample was received. The neonatal blood sample was typed as group A, D–, and the direct antiglobulin test (DAT) was strongly positive (4+) using the gel method. Mono-specific DAT showed the presence of IgG antibodies on neonatal red blood cells (RBCs). Acid

Ashish Jain, Vijay Kumawat, Neelam Marwaha

Immunohematology, Volume 31 , ISSUE 3, 116–118

Article | 14-October-2020

Antibody screening in 37°C saline. Is it safe to omit it using the indirect antiglobulin (gel) test?

Pretransfusion tests must detect antibodies that can shorten the life of red blood cells (RBCs). Some studies have demonstrated the existence of clinically significant antibodies detected at 37°C in saline that are not detected by the indirect antiglobulin test (IAT) when the conventional tube test is used. Our aim was to determine whether these antibodies, detected with a 37°C saline tube test, are also detected when a sensitive column gel agglutination method is used. The 2373

José A. Duran, Manuel Figueiredo

Immunohematology, Volume 18 , ISSUE 1, 13–15

Report | 01-December-2019

Warm autoantibodies: time for a change

Routine adsorption procedures to remove autoantibodies from patients’ serum often require many hours to perform. This timeconsuming process can create significant delays that affect patient care. This study modified the current adsorption method to reduce total adsorption time to 1 hour. A ratio of one part serum to three parts red blood cells (RBCs; 1:3 method) was maintained for all samples. The one part serum was split into three tubes. Each of these three aliquots of serum was mixed

J. Ryan Nobles, Clare Wong

Immunohematology, Volume 29 , ISSUE 1, 5–10

Case report | 14-October-2020

Discrepancies in Rh(D) typing of sensitized red blood cells using monoclonal/polyclonal anti-D reagents: case report and review

Instructions included with monoclonal Rh(D) typing reagents do not require routine use of an Rh control as immunoglobulin-coated red blood cells (RBCs) rarely yield falsely positive results with low protein reagents. However, the American Association of Blood Banks (AABB) Technical Manual recommends a concurrent control be performed on patients’ RBCs that type as group AB, D+. Proficiency testing surveys presented sensitized AB, D– RBCs, which resulted in a positive direct

Beverly J. Padget, Judith L. Hannon

Immunohematology, Volume 17 , ISSUE 1, 10–13

Article | 18-October-2020

A successful delivery of a baby from a D––/ D–– mother with strong anti-Hr0

, fetal cells were direct antiglobulin test positive and the blood type was group O, D+ (CDe). We performed plasma exchanges in the mother; however, the titer of antibody rebounded to its initial level after the third plasma exchange. At 26 weeks gestation, cord blood Hb decreased to 7.1 g/dL and three intrauterine transfusions were performed using the mother’s washed red blood cells (RBCs). At 34 weeks gestation, a live baby was delivered by cesarean section. The infant was hydropic with

Dong Hee Whang, Hee Chung Kim, Mina Hur, Jung Hwan Choi, Joong Shin Park, Kyou Sup Han

Immunohematology, Volume 16 , ISSUE 3, 112–114

Article | 26-October-2020

Anti-Lu9: the finding of the second example after 25 years

:-1,2,6,9 antibody-screening red blood cells (RBCs) using either a low-ionic-saline additive solution or polyethylene glycol for enhancement. Lu:6,9 RBCs were reactive with the serum when ficin- or EDTA/glycine-acid-treated, but nonreactive when trypsin- or α-chymotrypsin-treated. Six known examples of Lu:9 RBCs were reactive with the GR serum. His serum did not contain anti-Lua, anti-HLA-B7 (-Bga) or antibodies to 34 low-incidence antigens tested. We have identified the second example of anti-Lu9

Kayla D. Champagne, Marilyn Moulds, Jo Schmidt

Immunohematology, Volume 15 , ISSUE 3, 113–116

Article | 26-October-2020

EDTA/glycine-acid versus chloroquine diphosphate treatment for stripping Bg antigens from red blood cells

EDTA/glycine-acid (EGA) has been reported to remove IgG-bound antibodies from red blood cells (RBCs) and to denature Kell system and Era antigens. EGA-treated RBCs were tested in parallel with chloroquine diphosphate (CDP)-treated RBCs to evaluate whether EGA would remove Bg antigens from RBCs as efficiently as CDP. Fifty-seven serum/plasma samples containing known Bg antibodies were tested with untreated Bg+ RBCs, EGA-treated Bg+ RBCs, and CDP-treated Bg+ RBCs by an indirect antiglobulin test

Kayla D. Champagne, Peggy Spruell, Jane Chen, Leslie Voll, Gloria Schlanser

Immunohematology, Volume 15 , ISSUE 2, 66–68

Article | 03-November-2020

Rapid screening of platelet donors for PlA1 (HPA-1a) alloantigen using a solid-phase microplate immunoassay

effectiveness of a solid-phase microplate immunoassay for this purpose. Platelet-rich donor plasmas were tested using the Capture-P® kit (Immucor, Norcross, GA). Platelet monolayers in microtiter wells were incubated with anti-PlA1, washed, and exposed to red blood cells (RBCs) precoated with anti-human IgG. Adherence of RBCs in a diffuse pattern across the well surface indicated the attachment of anti-PlA1 to PlA1-positive platelets whereas sedimentation of unattached RBCs into a central pellet

Jo L. Procter, Faye E. Vique, Ed Alegre, Junichi Honda, Kazuhiko Matsuo, Diane Reid

Immunohematology, Volume 14 , ISSUE 4, 141–145

Case report | 09-November-2020

Case report: reporting anti-G as anti-C+D may have misleading clinical implications

Four months after a D– male was transfused with four units of D– red blood cells (RBCs), the results of a standard pretransfusion antibody screen and alloantibody identification panel detected anti-C+D in his serum. This report was interpreted by his physician to be evidence of alloimmunization to the D antigen, which triggered concern that the patient had been transfused previously with D+ RBCs as the result of an error in blood typing or personal identification. After a review of

Archiaus L. Mosley, Jr., Mary Beth Trich, Nanette C. Thomas, S. Gerald Sandler

Immunohematology, Volume 13 , ISSUE 2, 58–60

Article | 17-November-2020

Acute hemolysis due to passively transfused high-titer anti-B causing spontaneous in vitro agglutination

during the exchange consisted first of one unit of group B, D+, AS-1 packed red blood cells (RBCs), resuspended in group AB fresh frozen plasma (FFP), followed by one unit of group O, D-, CPDA-1 RBCs resuspended in group AB FFP. During the second infusion, the infant displayed an increase in temperature and hemoglobinuria, characteristics consistent with an acute intravascular hemolytic transfusion reaction. Clerical errors and hemolysis due to polyagglutinable infant RBCs were ruled out. Further

Gregg Boothe, Mark E. Brecher, Mamie B. Root, Judy Robinson, Nancy R. Haley

Immunohematology, Volume 11 , ISSUE 2, 43–45

Article | 17-November-2020

Loss of the Knops blood group system antigens from stored blood

Complement receptor type one (CR1) is a polymorphic glycoprotein, present on red blood cells (RBCs), that carries the Knops blood group system antigens. Since Knops system antigens can vary in strength, we investigated whether CR1 deteriorated upon storage, thus affecting Knops blood group system antigen reactivity. Units of whole blood were collected in CPDA-1 and evaluated at day 0 and day 35 for antigen strength, using routine serologic techniques. CR1 was quantitated by an enzyme-linked

Joann M. Moulds, L. Lee Brown, Elizabeth Brukheimer

Immunohematology, Volume 11 , ISSUE 2, 46–50

Article | 30-November-2020

Successful transfusion in the presence of anti-K4 (anti-Kpb)

A 71-year-old group A, D+ female, with anti-K4(-Kpb), -E, and -S was admitted for her second coronary artery surgery. Four units of autologous red blood cells (RBCs) were transfused perioperatively, and four units of homologous K:-4, E-, S- RBCs were transfused over the next 24 hours. Ten units of fresh frozen plasma and 28 units of platelets were also transfused. Continued bleeding necessitated calling donors from other states in Australia and from the International Panel of Donors of Rare

Julie M Watt, Peter N. Moffatt, Suzanne Y. Chatfield, Wendy A. Grimm, Jennifer A. Bryant

Immunohematology, Volume 10 , ISSUE 3, 87–89

Article | 06-December-2020

Six monoclonal antibodies to the CD59 antigen

CD59 defines an N-glycosylated glycoprotein expressed on various hemopoietic cells. It is anchored to the cell membrane by a glycosylpbospbatidylinositol linkage and restricts the action of homologous complement. Monoclonal antibodies 2/24, 182, Fib75.1, BRIC 229, MEM-43, and YTH 53.1 were compared by immunoblotting against normal erythrocyte ghosts. All six stained a diffuse band of 17-25 kDa, but BRIC 229 also detected bands at 35 and 80 kDa. 2/24 reacts with all red blood cells (RBCs) tested

Jennifer A. Bryant, Anne Fletcher, Fang Fang Yuan

Immunohematology, Volume 9 , ISSUE 3, 68–73

Article | 14-October-2020

Acute hemolytic transfusion reaction caused by anti-Coa

Coa is a high-frequency blood group antigen in the Colton blood group system expressed on red blood cells (RBCs) of approximately 99.8 percent of random persons. Anti-Coa has been reported to cause delayed hemolytic transfusion reactions, hemolytic disease of the newborn, and accelerated clearance of RBCs in vivo. Acute hemolytic transfusion reactions (AHTRs) have not previously been reported. A 58-year-old man was hospitalized for vascular surgery. Initial blood bank evaluation revealed anti

Randal B. Covin, Karen S. Evans, Richard Olshock, Hannis W. Thompson

Immunohematology, Volume 17 , ISSUE 2, 45–49

Article | 06-December-2020

Anti-Uz found in mother's serum and child's eluate

A saline-reactive antibody, anti-Uz, that reacted stronger with S+ than with S- red blood cells (RBCs) and failed to react with U- or ficin-treated RBCs has been previously reported. We describe an antibody of similar specificity in the postpartum serum of an untransfused woman and the eluate from her fourth child's cord RBCs. The mother's RBCs typed S-s+U+, He+(weak), and appeared to have normal glycophorin A and B content, as determined by immunoblotting. The direct antiglobulin test

Sandra M. Read, Mary M. Taylor, Marion E. Reid, Mark A. Popovsky

Immunohematology, Volume 9 , ISSUE 2, 47–49

Review | 09-October-2019

The Vel blood group system: a review

The blood group antigen Vel has been one of immunohematology’s greatest enigmas: the variation in antigen strength from one individual to another, the property of anti-Vel to readily hemolyze Vel+ red blood cells (RBCs), and the difficulty to screen for sufficient numbers of Vel– blood donors had made Vel a tough nut to crack. In 2013, a small, previously unknown protein called small integral membrane protein 1 (SMIM1) was identified on the RBC by three independent research groups

Jill R. Storry, Thierry Peyrard

Immunohematology, Volume 33 , ISSUE 2, 56–59

Case report | 01-December-2019

Molecular RH blood group typing of serologically D–/CE+ donors: the use of a polymerase chain reaction–sequence-specific primer test kit with pooled samples

The known presence of RHD blood group alleles in apparently D– individuals who are positive for C or E antigens leads to an appropriate investigation for the RHD gene on the red blood cells (RBCs) of D– blood donors, thus preventing their RBCs from immunizing D– recipients. Ready-to-use polymerase chain reaction–sequence-specific primer (PCR-SSP) typing kits are available and allow single-sample results. The need to perform this testing on a large number of donors

Donatella Londero, Mauro Fiorino, Valeria Miotti, Vincenzo de Angelis

Immunohematology, Volume 27 , ISSUE 1, 25–28

Article | 14-October-2020

A gel microtyping system for diagnosis of paroxysmal nocturnal hemoglobinuria

Paroxysmal nocturnal hemoglobinuria (PNH), an acquired stem cell defect, is underdiagnosed because of its atypical symptoms in some patients and because available methods, which are time consuming and complicated, are not widely used. The hemolysis of PNH red blood cells (RBCs) is attributed to their enhanced susceptibility to complement lysis caused by a deficiency in glycosylsphosphatidylinositol (GPI)-anchored complement regulatory membrane proteins, especially membrane inhibitor of reactive

Barbara Zupanska, Irena Bogdanik, Hanna Pyl

Immunohematology, Volume 18 , ISSUE 1, 9–12

Article | 14-October-2020

MIMA-9, a valuable antibody for screening for rare donors

, McLeod, or Ge:–3 red blood cells (RBCs), was used in MTS gel cards containing anti-mouse IgG as the second antibody to test 1134 K– donors. Among the 1134 donors tested, we found one Kp(a+b–) and one Ge:–2,–3,4 donor. If random donor samples had been used instead of preselecting for K–, we would have expected to identify two K+k– donors. One reagent (MIMA-9) can be used to simultaneously screen for K+k–, Kp(a+b–), K0, McLeod, and Ge:–3 RBCs

Edith Tossas, Ragnhild Øyen, Gregory R. Halverson, Harry Malyska, Marion E. Reid

Immunohematology, Volume 18 , ISSUE 2, 43–45

Article | 14-October-2020

Warm autoimmune hemolytic anemia with mimicking anti-c and -E specificities

An 18-month-old male was admitted to a hospital with a hemoglobin of 4.1 g/dL and a reticulocyte count of 53 percent. There was no history of prior transfusion. Serologic evaluation revealed the presence of both a positive direct antiglobulin test (DAT) and an indirect antiglobulin test (IAT). The patient’s red blood cells (RBCs) typed as group A, C–D–E–c+e+ (cde/cde). Evaluation of the IAT revealed the presence of anti-c and anti-E. All other major antibodies were ruled

Hsin-Yeh Hsieh, Diana L. Moroney, Deanne E. Naumann, D. Jane Hata, Nancy C. Vosnidou, Rovenna L. Kessinger, Nassir Shahab, Nasrollah Hakami, Daniel S. Smith

Immunohematology, Volume 18 , ISSUE 1, 19–22

Article | 03-November-2020

Comparison of affinity column technology and LISS tube tests

Proteins G and A coated on agarose have been extensively used in affinity chromatography. Protein G will bind to all four subclasses of human IgG and protein A to the subclasses IgG1, IgG2, and IgG4. This IgG binding ability of protein G and protein A has been used in a red cell affinity column technology developed for the detection and identification of IgG red cell antibodies. When serum or plasma is incubated in a microcolumn with red blood cells (RBCs) that express the appropriate antigens

Kayla D. Champagne, Peggy Spruell, Jane Chen, Leslie Voll, Gloria Schlanser, Marilyn Moulds

Immunohematology, Volume 14 , ISSUE 4, 149–151

Article | 09-November-2020

Direct Coombs test-negative autoimmune hemolytic anemia and low-affinity IgG class antibodies

Autoimmune hemolytic anemia, in which the direct antiglobulin test (DAT) is negative or weakly positive, may be due to low-affinity autoantibodies. We describe two such cases. An 8-year-old male presented with weight loss, jaundice, a hemoglobin of 33 g/L, reticulocytes of 306 x 109/L, and haptoglobin of < 0.1 g/L. The DAT was negative. After washing the red blood cells (RBCs) with saline at 4°C, the DAT was positive for IgG and an eluate contained an IgG3 autoantibody, thus confirming a

R.J. Sokol, D.J. Booker, R. Stamps, S. Jalihal, B. Paul

Immunohematology, Volume 13 , ISSUE 4, 115–118

Article | 09-November-2020

Immune hemolytic anemia due to diclofenac

A 37-year-old male presented with severe anemia, mild jaundice, and hemoglobinuria during his second course of diclofenac for gout. The peripheral blood showed microspherocytes and nucleated red blood cells (RBCs). The reticulocyte count was 21 percent and haptoglobin was < 0.1 g/L. A presumptive diagnosis of diclofenac-induced immune hemolysis was made and blood, urine, and drug samples were referred for investigation. Direct antiglobulin testing showed the RBCs to be coated with IgG1, IgG4

S.T. Laidlaw, R. Stamps, D.J. Booker, M.J. Brown, R.J. Sokol

Immunohematology, Volume 13 , ISSUE 1, 9–11

Article | 10-November-2020

A new form of polyagglutination related to Cad

Four phenotypes of Cad (Cad 1–4) have been characterized by a continuum of polyagglutinability and reactivity with lectins, with the strongest Cad+ red blood cells (RBCs) being polyagglutinable because of the presence of anti-Cad (anti-Sda) in most normal sera. Over a period of 7 years, a French male blood donor’s RBCs demonstrated polyagglutinability with 50 percent to 70 percent of normal adult sera. The reactivity was characteristic of anti-Sda (refractile agglutination at 4°

Regina M. Leger, Elfreda J. Lines, Keith Cunningham, George Garratty

Immunohematology, Volume 12 , ISSUE 2, 69–71

Article | 10-April-2021

Acute hemolytic transfusion reaction caused by anti-Yta

M. Raos, N. Thornton, M. Lukic, B. Golubic Cepulic

Immunohematology, Volume 37 , ISSUE 1, 13–17

Article | 31-March-2021

Transfusion support during childbirth for a woman with anti-U and the RHD*weak D type 4.0 allele

Q. Yin, K. Srivastava, D.G. Brust, W.A. Flegel

Immunohematology, Volume 37 , ISSUE 1, 1–4

Case report | 09-October-2019

A LU:-16 individual with antibodies

investigation was requested. This time, an antibody directed at a high-prevalence Lutheran antigen was found in addition to the anti-Lea and -Lub previously observed. Her serum was compatible with three out of five Lu(a−b−) reagent red blood cells (RBCs). One of the incompatible Lu(a−b−) reagent RBCs was known to be In(Lu) (KLF1 mutation). The genetic background of the other reagent RBC was unknown. The LU cDNA sequence analysis revealed the presence of the c.230G>A (Lua), c.679C

Carole Éthier, Cynthia Parent, Anne-Sophie Lemay, Nadia Baillargeon, Geneviève Laflamme, Josée Lavoie, Josée Perreault, Maryse St-Louis

Immunohematology, Volume 33 , ISSUE 3, 110–113

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

IgG antibodies coating red blood cells (RBCs) can be removed by elution procedures and their specificity determined by antibody identification studies. Although such testing is traditionally performed using the tube agglutination assay, prior studies have shown that the gel microcolumn (GMC) assay may also be used with comparable results. The purpose of this study was to compare an automated solid-phase red cell adherence (SPRCA) system with a GMC assay for the detection of antibodies eluted

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

Case report | 14-October-2020

Moderate hemolytic disease of the newborn (HDN) due to anti-Rh17 produced by a black female with an e variant phenotype

The Rh blood group antigen e is of high incidence and has many epitopes. Partial expression may occur, more commonly in black persons. Individuals with e variant phenotypes can make antibodies to epitopes they lack. While some of these antibodies may be specific for an antigen, e.g., hrB, others, like anti-Rh17 (anti-Hro), show broader specificity, compatible only with D– – and Rhnull red blood cells (RBCs). Anti-Rh17 in persons of the D– – phenotype has been reported to

Marla C. Brumit, Gary E. Carnahan, James R. Stubbs, Jill R. Storry, Marion E. Reid

Immunohematology, Volume 18 , ISSUE 2, 40–42

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 | 18-October-2020

Red blood cell diluent composition is important for detection of some anti-E

Commercially prepared 0.8% reagent red blood cells (RBCs) eliminate the need to manually dilute 3 to 5% RBCs for use in gel cards. Ortho-Clinical Diagnostics investigated twelve anti-E samples detected in MTS Anti-IgG gel cards using Ortho 3% reagent RBCs manually diluted to 0.8% in MTS Diluent 2™ (MTS2) that were not detected with commercially prepared Ortho 0.8% reagent RBCs. In gel tests, using additional examples of E-positive RBCs, 22 of 26 antiE were reactive when the cells were

Dania D. Yaskanin, Janice L. Jakway, David J. Ciavarella

Immunohematology, Volume 16 , ISSUE 4, 142–146

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

Article | 20-December-2020

Human leukocyte antigens (HLA) class I (Bg) on red cells studied with monoclonal antibodies

Monoclonal antibodies, capable of detecting monomorphic epitopes on HLA class I polypeptides and beta-microglobulin (ß2-M), have been used by a variety of techniques to ascertain the type of structure detected on red blood cells (RBCs). Hemagglutinatlon with class I monoclonal antibodies confirmed the reported relationship between Bg blood groups and HLA. It also established that the expression of HLA on RBCs which do not have nuclei is not normally strong, hut may be enhanced in patients

Carolyn M. Giles

Immunohematology, Volume 6 , ISSUE 3, 53–58

Article | 31-December-2020

Stimulation of Antibody Following 51Chromium Survival Studies

The survival of red blood cells (RBCs) radiolabeled with 51chromium (51Cr) is a reliable method for predicting transfusion compatibility. Approximately 1.0 ml of 51Cr tagged RBCs is infused into the patient and samples are drawn at predetermined intervals post infusion to determine RBC survival. Red cells used for the study are usually incompatible with the patient's antibody. This antigenic rechallenge may stimulate further antibody production, which could contribute to accelerated

Susan S. Esty, Delores Mallory, Richard J. Davey, Tracy Wahl, Julie Zswisza

Immunohematology, Volume 3 , ISSUE 1, 6–8

Article | 17-February-2021

Blood component administration to multiple myeloma patients treated with daratumumab: suggesting a novel approach with use of 0.1 M dithiothreitol

specifically targets human CD38 antigens, was approved by the U.S. Food and Drug Administration in November 2016 for cases of relapsed and refractory MM.1 CD38 is an integral trans-membrane glycoprotein that is overexpressed in myeloma cells, and the expression is shared by other lineages including red blood cells (RBCs).2 Anti-CD38 mediates via a variety of immune mechanisms that are responsible for its anti-myeloma activity like complement-dependent cellular cytotoxicity, antibody-dependent cellular

P. Pandey, D. Setya, E. Kaul, S. Ranjan, M.K. Singh, A. Shankar

Immunohematology, Volume 36 , ISSUE 4, 157–165

Article | 26-October-2020

Naturally-occurring anti-Jka in infant twins

transfusions. Red blood cells (RBCs) from the patient and her sister typed as Jk(a-b+) by direct hemagglutination and this phenotype was confirmed by negative adsorption and elution studies. Both infants' plasma samples were strongly reactive with 20 examples of Jk(a+) RBCs and nonreactive with 20 examples of Jk(a-) RBCs by SPRCA assays. Anti-Jka was not detected in either twins' plasma by indirect antiglobulin tests by tube method in low-ionic-strength saline solution or polyethylene glycol, or

Dawn H. Rumsey, Sandra J. Nance, Mary Rubino, S. Gerald Sandler

Immunohematology, Volume 15 , ISSUE 4, 159–162

case-report | 25-June-2021

Neonatal testing leading to the identification of Bh (para-Bombay) phenotype in the mother: case report with review of the literature

FUT2 gene.2 As a result, para-Bombay individuals have ABH substances in their secretions and plasma (Type 1 precursor chain) depending on whether or not they inherit ABO genes. ABH substance in the plasma can be adsorbed onto the red blood cells (RBCs), leading to a weak expression of ABH antigens. There are few case reports on the para-Bombay phenotype from India; what makes this case unique is that we identified a para-Bombay phenotype in the mother because of her newborn’s blood type. Case

G. Mohan, A. Vaidya, S. Shastry

Immunohematology, Volume 37 , ISSUE 2, 59–63

Case report | 09-October-2019

Two cases of the variant RHD*DAU5 allele associated with maternal alloanti-D  

allele. Cord blood testing on both infants revealed positive direct antiglobulin test (DAT) results with anti-D eluted from the red blood cells (RBCs) of one of the infants. Despite the positive DAT, neither infant experienced anemia or hyperbilirubinemia. We document two cases of pregnant women whose RBCs expressed a partial D variant and were classified as D+ on the basis of standard serologic testing, resulting in subsequent failure to provide RhIG prophylaxis. Both cases were associated with

Jennifer A. Duncan, Susan Nahirniak, Rodrigo Onell, Gwen Clarke

Immunohematology, Volume 33 , ISSUE 2, 60–63

Report | 01-December-2019

Low risk of hemolysis after transfusion of uncrossmatched red blood cells

Transfusing uncrossmatched red blood cells (RBCs) can be a lifesaving bridge until crossmatched RBCs are available. The risk of using uncrossmatched RBCs is that of hemolysis from unexpected clinically significant antibodies. This study sought to quantify the risk of hemolysis after the transfusion of uncrossmatched RBCs. The records of recipients of uncrossmatched RBCs over approximately 9 months were retrieved from the regional transfusion service. Basic immunohematologic data were recorded

Lisa Radkay, Darrell J. Triulzi, Mark H. Yazer

Immunohematology, Volume 28 , ISSUE 2, 39–44

Case report | 01-December-2019

Possible suppression of fetal erythropoiesis by the Kell blood group antibody anti-Kpa

Antibodies to antigens in the Kell blood group system are usually immunoglobulin G, and, notoriously, anti-K, anti-k, and anti-Kpa can cause severe hemolytic transfusion reactions, as well as severe hemolytic disease of the fetus and newborn (HDFN). It has been shown that the titer of anti-K does not correlate with the severity of HDFN because, in addition to immune destruction of red blood cells (RBCs), anti-K causes suppression of erythropoiesis in the fetus, which can result in severe anemia

Michelle Tuson, Kim Hue-Roye, Karen Koval, Sherwin Imlay, Rajendra Desai, Gayatri Garg, Esam Kazem, Diane Stockman, Janis S. Hamilton, Marion E. Reid

Immunohematology, Volume 27 , ISSUE 2, 58–60

Article | 18-October-2020

Moderate hemolytic disease of the newborn due to anti-Hr0 in a mother with the D––/D–– phenotype

of follow up. An exchange transfusion was excluded due to the lack of a compatible donor and the physical condition of the mother precluded blood donation. The maternal RBCs were D+C–c–E–e–; only G and Rh29 of the Rh system were expressed. Thus, her probable phenotype was D––/D––. Her alloantibody was identified as anti-Hr0 (anti-Rh17) as it reacted with all red blood cells (RBCs) but not her own, other D--– RBCs, and Rhnull RBCs. The results

Barbara Żupańska, B. Lenkiewicz

Immunohematology, Volume 16 , ISSUE 3, 109–111

Article | 03-November-2020

Use of LOR-15C9 monoclonal anti-D to differentiate erythrocytes with the partial DVI antigen from those with other partial D antigens or weak D antigens

Historically, red blood cells (RBCs) with partial D antigens have been defined serologically by their pattern of reactivity with polyclonal and monoclonal anti-D. Although numerous variants have been described in tests with well-characterized monoclonal anti-D, definition remains difficult to ascertain serologically. RBCs of known partial D type were tested with LOR-15C9 (a monoclonal anti-D) and commercial anti-D by the tube indirect antiglobulin test (IAT), by micro typing system IgG gel

Marion E. Reid, Gregory R. Halverson, Francis Roubinet, P.A. Apoil, Antoine Blancher

Immunohematology, Volume 14 , ISSUE 3, 89–93

Article | 03-November-2020

Autoimmune hemolytic anemia caused by warm-reacting IgM-class antibodies

confirmed as IgM by their ability to rebind to normal red blood cells (RBCs) after elution; the absence of small increases in RBC-bound IgG and IgA was shown by a sensitive enzyme-linked antiglobulin test. Patient 1 was a 64-year-old female with non-Hodgkin’s lymphoma, with a hemoglobin of 50 g/L and haptoglobin of < 0.1 g/L. Direct antiglobulin tests were positive for IgM, C3d, and C3c; only IgM was present in an eluate. The serum contained a weak autoantibody at 37°C and tests for

R.J. Sokol, D.J. Booker, R. Stamps, S. Sobolewski, A.P. Haynes

Immunohematology, Volume 14 , ISSUE 2, 53–58

Article | 17-November-2020

A practice guideline and decision aid for blood transfusion

An attempt was made to reduce exposure of patients to blood products by using a point-of-ordering decision support system and strict adherence to a practice guideline, by observing physician behavior in the multidisciplinary intensive-care unit (ICU) of a tertiary-care medical center. Hemoglobin (Hg) level at the time of transfusion, total units of red blood cells (RBCs) per admission, units per patient per ICU day, fraction of patients receiving no transfusions, and incidence of single-unit

Benjamin Littenberg, Howard Corwin, Andrew Gettinger, Joshua Leihter, James P. AuBuchon

Immunohematology, Volume 11 , ISSUE 3, 88–94

Article | 22-November-2020

Cefotetan-induced immune hemolytic anemia due to the drug-adsorption mechanism

), her hematocrit (Hct) decreased from 34.3% to 23.3%. The reticulocyte count was 6.9%. The DAT was 2+ (IgG only), and the serum and an eluate were nonreactive with a panel of standard reagent red blood cells (RBCs). Cefotetan therapy continued and the patient was transfused with two units of RBCs. On day 6 of therapy, the patient experienced an anaphylactoid reaction attributed to sensitivity to cefotetan. Cefotetan therapy was discontinued, the patient was treated with corticosteroids and

Robert J. Eckrich, Susan Fox, Delores Mallory

Immunohematology, Volume 10 , ISSUE 2, 51–54

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