Background and aims Antibody titration by the manual method has certain limitations. The aim of this study was to compare the manual conventional test tube technique (CTT) with semi-automated, column agglutination technique (CAT) and fully automated haemagglutination/solid-phase red cell adherence (HA/SPRCA) technology in measuring antibody titres of anti-A and anti-B isoagglutinins of blood group O blood donors. The median IgM and IgG antibody titres with 1+, 2+ and 3+ end-points were determined for each technology, and the agreement and correlation between results of the 3 technologies were evaluated.Materials and methods This was a prospective, observational study conducted from October 2018 to March 2020. All consecutive O group blood donors, who donated blood at the Department of Transfusion Medicine at a tertiary healthcare centre, were included in the study. All samples were consecutively tested by CTT, CAT and HA/SPRCA, and the results were recorded and compared.Results A total of 2005 donors were included. Inter-observer variation was observed in 295 (14.71%) samples by the CTT and in 51 (2.54%) by the CAT. There was 43.4% and 40.3% agreement of anti-A IgM and IgG titres between CAT (2+ strength) and CTT (1+ strength), respectively. The agreement for anti-B IgM and IgG titres between CAT (2+ strength) and CTT (1+ strength) was 43.6% and 32%, respectively. While a strong correlation was found between CTT (1+ strength) and CAT (1+, 2+ strengths) for both IgM and IgG measurements of anti-A and anti-B isoagglutinins, the correlation between CTT (1+ strength) and HA/SPRCA (1+, 2+ strengths) was found to be weak. The median IgM titres for anti-A and anti-B were lower than the median IgG titres. ConclusionThe antibody titration levels were higher with CAT than with CTT, and those of HA/SPRCA were lower than those of CTT. Transfusion services need to decide which method would provide higher benefit to their patient population.
ABO antigens play an important role in solid organ transplantation. Desensitization for ABO incompatibility offers patients awaiting transplant a larger donor pool. The aim of this study was to assess outcome of desensitization using the institutional preconditioning protocol in ABO‐incompatible solid organ transplants. A retrospective analysis of ABO‐incompatible solid organ transplants between October 2015 and June 2018, at a tertiary healthcare center was performed. The preconditioning regimen consisted of immunosuppression and therapeutic apheresis (TA). Pre‐ and post‐TA titers were performed, until a target titer of 8 or below was achieved, at which transplant was performed. Follow‐up data till 1 year was analyzed. A total of 50 ABO‐incompatible solid organ transplantations, including 14 liver transplants and 36 renal transplants were analyzed. The median baseline anti‐A and anti‐B titers were 192 and 256, respectively. A total of 150 therapeutic plasma exchange (TPE) procedures were performed for renal transplant recipients; 19 TPE and eight immunoadsorption procedures (five preoperative and three intraoperative) were performed for liver transplant recipients. Five (10%) patients experienced minor adverse events. Biopsy revealed antibody‐mediated rejection was observed in three cases in the immediate posttransplant phase and in three (6.67%) cases over 1 year. There was one death due to transplant‐associated thrombotic microangiopathy. Graft survival for renal transplant was 100% and death‐censored graft survival for liver transplant was 100%. Despite difficulties, ABO‐incompatible transplants can be performed without antibody‐mediated rejection with the use of an appropriate protocol.
BACKGROUND:Erycard 2.0 is a “point-of-care” device that is primarily being used for patient blood grouping before transfusion.MATERIALS AND METHODS:Erycard 2.0 was compared with conventional slide technology for accuracy and time taken for ABO and Rh forward grouping result with column agglutination technology (CAT) being the gold standard. Erycard 2.0 as a device was also evaluated for its stability under different storage conditions and stability of result till 48 h. In addition, grouping of hemolyzed samples was also tested with Erycard 2.0. Ease of use of Erycard 2.0 was evaluated with a survey among paramedical staff.RESULTS:Erycard 2.0 demonstrated 100% concordance with CAT as compared with slide technique (98.9%). Mean time taken per test by Erycard 2.0 and slide technique was 5.13 min and 1.7 min, respectively. After pretesting storage under different temperature and humidity conditions, Erycard 2.0 did not show any deviation from the result. The result did not change even after 48 h of testing and storage under room temperature. 100% concordance was recorded between pre- and post-hemolyzed blood grouping. Ease of use survey revealed that Erycard 2.0 was more acceptable to paramedical staff for its simplicity, objectivity, and performance than conventional slide technique.CONCLUSION:Erycard 2.0 can be used as “point-of-care” device for blood donor screening for ABO and Rh blood group and can possibly replace conventional slide technique.
Estimation of residual leukocytes in blood components after leukodepletion is crucial for assessment of quality. Flow cytometry (FC) and Nageotte hemocytometer are the most widely accepted methods for counting residual white blood cells (rWBCs) in leucocyte-depleted (LD) blood components. The objective of this study was to compare use of Nageotte counting chamber and FC for quality control of leukodepleted red cell units. A prospective, observational study was conducted in the department of Transfusion Medicine. A total of 80 whole blood donations from healthy donors were subjected to testing by FC and Nageotte hemocytometer for estimation of rWBC in duplicate. Additionally, ten personnel attempted a survey for ease of use of FC. Number of rWBC detected by flow cytometer were between 1 WBC/lL and 28 WBCs/lL whereas that detected by Nageotte's chamber were between 0 WBC/ lL (lowest) and 5 WBCs/lL. Coefficient of variation was found to be 87.36% by Nageotte hemocytometer method and 43.26% by FC. Linear regression analysis did not show any correlation (R-squared = 0.01, p = 0.13) between the two methods which signifies that the two methods cannot be used interchangeably. Pearson's correlation coefficient showed a weak relation between results obtained by the two methods. Inter-observer variation was found to be significant with use of Nageotte hemocytometry. Survey for ease of use of FC indicated acceptability of FC with favorable scores. Flow cytometric technique provides a reproducible and objective tool for counting rWBC in leukodepleted blood components compared with the Nageotte hemocytometer.
Background and aims Although desensitization is well established, concerns about graft outcome, patient survival and rejection still exist. The present study aims at comparing outcomes of renal transplant recipients across simultaneous ABO and human leukocyte antigen (HLA) incompatibility barriers to those with ABO or HLA incompatibility alone. Materials and methods This was a retrospective study conducted from October 2015 to December 2018. All patients with a clinical diagnosis of chronic kidney disease, who were prospective HLA incompatible (HLAi) and/or ABO incompatible (ABOi) renal transplant recipients were included. A total of 400 cases including 36 ABOi transplants, 154 HLAi transplants, 10 simultaneously ABO and HLA incompatible transplants, and 200 ABO (ABOc) and HLA (HLAc) compatible kidney transplants from living donors were included. Results There were significantly more number of blood transfusions, previous transplants and pregnancies in HLAi transplant recipients relative to the ABOi or the control group. Mean number of therapeutic plasma exchange procedures per patient and mean plasma volume processed per procedure were slightly higher in the ABOi + HLAi category. The incidence of graft dysfunction due to suspected antibody‐mediated rejection during first year was highest in the ABOi + HLAi group, followed by ABOc + HLAi and ABOi + HLAc, lowest in the ABOc + HLAc category. Mean time to first episode of graft dysfunction was significantly shorter with incompatible transplants. There were no kidney transplant recipient deaths in the study. Conclusion Patient outcome and graft outcomes observed with incompatible transplants were not worse than those observed with compatible transplants.
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