In 1987 the definition of an Rh-negative donor in the Netherlands was changed from C-, E- as well as Du-negative to D-negative only. The use of 2 different strong anti-D sera without an antiglobulin phase (Du test) was considered sufficient to reveal the clinically important D antigen. In applying this policy, we identified 32 donors in 13,500 consecutive blood donations whose indirect antiglobulin test (IAT) (Du)-positive red cells gave negative reactions with at least 2 out of 11 anti-D sera and whose cells might therefore be typed as Rh(-D-)-negative in routine investigations. IgG anti-D used by a one-stage bromelain technique and anti-D with modified IgG appeared to be relatively insensitive in detecting Du in this study. Polyclonal anti-D in an enhancement medium and monoclonal anti-D scored better, although differences exist between the products of various manufacturers. It is suggested that if IAT (Du) testing is omitted, only anti-D sera with a high index of detectability of cells expressing weak D antigens should be accepted.
Classification of subjects with a partial D antigen is traditionally performed with immune anti-D sera. The development of monoclonal antibodies enables a fine analysis to be made of the specificity of the epitopes that are present or missing in these cases. A systematic search in a Caucasian donor population of 17,500 revealed 8 unrelated male individuals (frequency 0.05%) with a red cell phenotype characteristic of partial D category VI, but without anti-D in their serum. The relation to the 'classic' partial D category VI was investigated and is discussed, as is the observed serological heterogeneity of the partial D category VI group. Clinical consequences for the prevention of immunization of these subjects are mentioned.
Objective: To evaluate the anti-HCV (hepatitic C virus) reactivity for the development of an individual donor counseling strategy which would prevent unnecessary donor deferment without compromising the safety of blood products. Design: All donors, who were repeatedly reactive in the Ortho HCV ELISA as well as the Abbott HCV EIA screening tests were selected for follow-up testing. At follow-up three screening tests (Ortho, Abbott, and UBI HCV EIA) and two confirmation tests (Riba 4 and PCR HCV RNA) were performed. During the counseling interview risk factors and medical history were recorded. Setting: Blood bank Zuid-Limburg, Maastricht, the Netherlands; estimated donor population 17,500. Participants: A total of 54 donors could be completely evaluated. Results: The participants could be divided into five different categories, requiring specific donor information and different blood bank policies. The donors in categories 1 and 2 (n = 11) had false-positive reactions and were kept active. Category 3 and 4 donors (n = 28) showed indeterminate results and were permanently or temporarily excluded. Finally, in category 5 donors (n = 15) a HCV infection could be diagnosed on the basis of either Riba-positive or PCR-positive results. Conclusions: An anti-HCV screening policy should include a careful evaluation and confirmation of antibody reactivity. A strategy is suggested which allows an individual donor counseling, prevents unnecessary donor deferment, and avoids unnecessary fear of seropositivity
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