Clinical value of an antibody-dependent cell-mediated cytotoxicity assay in the management of Rh D alloimmunization

Discriminating complement‐mediated acute transfusion reaction for type O+ red blood cells transfused into a B+ recipient with the complement hemolysis using human erythrocytes (CHUHE) assay

“…6 These methodologies measure antibody binding but do not directly assess antibody-initiated classical complement activation and hemolysis. Supplemental methodologies to evaluate immune reactivity have been described, such as the monocyte monolayer assay (MMA) 7 and antibodydependent cellular cytotoxicity (ADCC), 8,9 but these do not directly measure complement activation and are not widely available in most blood bank and transfusion services sites. Measurement of antibody binding alone is insufficient to assess the risk of complement activation caused by some immunoglobulin (Ig) classes and IgG subclasses activating complement robustly and others activating complement only minimally or not at all.…”

Intrauterine transfusion and non-invasive treatment options for hemolytic disease of the fetus and newborn – review on current management and outcome

“…In most countries, a critical titer around 16, varying from 8 to 32, is used as a cut off for fetal monitoring [8,10], although this value has a false-positive rate of 77% for predicting fetal anemia [6].…”

“…If antibodies are detected in pregnancy, the risk of HDFN is estimated using maternal serum testing for antibody levels (quantification or titers) and, mainly in the Netherlands, antibody-dependent cell-mediated cytotoxicity (ADCC) assays for RhD-immunizations [6][7][8][9]. In most countries, a critical titer around 16, varying from 8 to 32, is used as a cut off for fetal monitoring [8,10], although this value has a false-positive rate of 77% for predicting fetal anemia [6].…”

Hemolytic Disease of the Fetus and Newborn: Modern Practice and Future Investigations

“…In one study, for example, fetal anemia correlated positively with the amount of maternal IgG1 anti-D, and negatively with the amount of IgG3 anti-D bound to fetal RBCs 17 . In addition to antibody titers, some countries also use in vitro antibody dependent cellular cytotoxicity (ADCC) biological assays to predict alloantibody activity 18,19 The importance of antibody glycosylation patterns on FcγR binding avidity on clinical outcomes is increasingly being appreciated, in multiple biologic systems 20 . Recent studies have described a significant association between such antibody glycosylation patterns and fetal outcomes.…”