Frequencies and Specificities of “Enzyme-Only” Detected Erythrocyte Alloantibodies in Patients Hospitalized in Austria: Is an Enzyme Test Required for Routine Red Blood Cell Antibody Screening?

Abstract

The aim of this study was to determine the frequencies and specificities of “enzyme-only” detected red blood cell (RBC) alloantibodies in the routine antibody screening and antibody identification in patients hospitalized in Austria. Routine blood samples of 2420 patients were investigated. The antibody screening was performed with a 3-cell panel in the low-ionic strength saline- (LISS-) indirect antiglobulin test (IAT) and with an enzyme-pretreated (papain) 3-cell panel fully automated on the ORTHO AutoVue Innova System. The antibody identification was carried out manually with an 11-cell panel in the LISS-IAT and with an enzyme-pretreated (papain) 11-cell panel. In total 4.05% (n = 98) of all patients (n = 2420) had a positive RBC antibody screening result. Of them 25.51% (25/98) showed “enzyme-only” detected specific or nonspecific RBC alloantibodies. Rhesus and Lewis system antibodies were found the only specificities of “enzyme-only” RBC alloantibodies: all in all 4.8% (4/98) were detected with anti-E, 3.06% (3/98) with anti-Lea, 3.06% (3/98) with anti-D after anti-D prophylaxis and 1.02% (1/98) with anti-e. In total, 14.29% (14/98) showed a nonspecific RBC alloantibody result with the enzyme test. The results of the present study demonstrate that a high number of unwanted positive reactions with the enzyme technique overshadows the detection of “enzyme-only” RBC alloantibodies. (Trial Registration: K-37-13).

Anti‐Jka that are detected by solid‐phase red blood cell adherence but missed by gel testing can cause hemolytic transfusion reactions

“…However, an increase has also been seen in the rate of SPRCA screens without clear antibody specificity . Such an increase in unwanted nonspecific reactions leads to increased labor and personnel costs …”

Red blood cell alloimmunization among hospitalized patients: transfusion reactions and low alloantibody identification rate

“…The methods used to identify alloantibodies, the characteristics of the alloantibody and very low titers are some factors associated with this. 14 , 15 Some alloantibodies are detected only with the use of special techniques, such as prolonged incubation, the use of enzyme-treated RBCs using ficin for example and low ionic concentration medium. 37 No special technique was used by the service to detect and identify alloantibodies in inconclusive cases using the gel hemagglutination technique.…”

“…13 Furthermore, many alloantibodies are not detected because of a low titer of antibodies, the absence of the antigen in the testing panel, or multiple antibodies. 14 , 15 This often results in a higher risk of delayed hemolytic transfusion reactions because of the selection of inappropriate RBC units for transfusion. 16…”

Red cell incompatibility due to antibody against ingredient in column matrix: A rare entity

“…7 The introduction Pretransfusion blood grouping, red blood cell antibody screening, and compatibility testing are essential to prevent incompatible blood transfusion and alloimmunization. 9 Sensitive cross-matching protocols were developed to further increase transfusion safety, including minor crossmatches, DCTs and ACs. However, minor crossmatching was given up since the introduction of antibody screening for donors.…”