Comparative study of two automated pre-transfusion testing systems (microplate and gel column methods) with standard tube technique

Abstract

Aims: Clinically significant antibodies may become undetectable and still provoke transfusion reactions. Hemolysis has been reported among transfusion recipients with anti-Kidd that was undetectable by gel column but detectable by other methods. Methods: We compared two automated technologies - microplate (MP) and gel column (GC) methods - with manual methods in ABO/RhD typing, irregular antibody screening, identification, titration, and detection threshold of mixed-field agglutination. Results: Automated systems agreed generally with tube results in 98% or more of ABO forward and RhD groupings, but showed weaker reactions in ABO reverse testing against A1 (K=0.88 with MP and K=0.77 with GC) and B cells (K=0.66 with MP and K=0.68 with GC) and failed to detect some anti-A (2 of 273 samples with MP) and anti-B (2 of 273 with MP and 1 of 272 with GC). MP missed 2 (anti-E and –Fyb) of 8 antibodies and GC missed 5 (2 anti-E and 1 each of -Fyb, -Jka and –Lea) of 10 antibodies, which manual PEG-IAT detected. Among 11 known alloantibodies, MP detected 7 antibodies at higher dilution than tube PEG-IAT, whereas GC showed lower scores in 7 samples than tube PEG-IAT and missed 2 clinically significant antibodies (anti-C and anti-Fyb). Conclusion: Automated systems, comparable to manual tube technique for forward grouping of ABO and RhD, are less sensitive in ABO reverse testing. As GC more often failed to detect clinically significant antibodies of low-titer, users should be especially mindful of possible post-transfusion hemolysis.

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