Unit Immunohematologi

PDN

Antibody Identification
Determined the specificity & significance
of RBC antibodies.

Selecting blood for transfusion.

Monitoring potential cases of HDN


IgG Antibody


IgM Antibody


When we do antibody identification?
Antibody screening positive
Incompatible crossmatch
Discrepancy in serum grouping
Patients History
Age,Sex,Race.
Diagnosis.
H/O transfusion,pregnancies& medication.
Provides clue in antibody identification
especially in complex cases.
Transfusion History
DCT positive in recently transfused pt may
indicate DHTR ( within 3 months )

Antigens typing not conclusive.

Interpretation of results should be careful
Basic Rules for Antibody
Identification.
Always include the original reactive cells.
Always include the patients own cells.
Always use a variety of techniques.
Always record results quantitatively.
Include group A
1
,group A
2
and cord blood
where appropriate.
continues

Interpret results by considering negative
results first.

Confirmation of antibody identification.
Evaluation of Panel Results.
1. Is the auto control positive or negative ?

Negative : alloantibody present

Positive : Present of autoantibody or
both.

Phases and strength of
reactions
IgM antibodies react at saline RT after IS.

IgG Antibodies react at AHG phase .

Multiple antibodies react at various phases
and strength.

Exclusion of antibody
Antibody fail to react with cell known to
have the corresponding antigen.
Only cells that gave negative reactions
in all phases of testing should used for
ruling out antibodies.
Does the serum reactivity match
the remaining specificities ?

Pattern of single antibody usually match
the antigram.

Reactivity not matched a
specific pattern.
Multiple antibodies.
Cold reactive auto antibody.
Antibody showing dosage effect.
Antibody directed against high & low
frequency antigens.
Are all commonly encountered
RBC antibodies ruled out ?

Serum may contain more than one
antibody.

May masked the presence of another .

Patients Antigen

Should lack the antigen to the
alloantibody produced.
Antigens typing is useful in
resolution of complex cases.
Eliminates many possibilities.
Problems in Antibody
Identification.
A. Multiple Antibodies.

2 or more antibodies difficult to
interpret results.
Reactions of Multiple Antibodies

Does not fit pattern of single antibody.
Reactions of red cells panels at different
phase. Should be evaluate differently.
Unexpected results are obtained when
antibody specificity is confirmed.
Antibodies to high incidence
antigen

React with all red cells panel with equal
strength.
Auto control negative.
E.g. Anti Jk
3
k.

Antibodies to low incidence
antigens

Pts serum react with the particulars donor
unit only.
Screening & panel cells negative.
E.g Anti Mia ,
Cold Autoantibodies
React with all cells, including A/C .

Prewarmed technique.

Monospecific anti IgG.

Cold auto adsorption.

Selection of blood for
transfusion

Red cells chosen for transfusion to a
patient with an antibody should be
negative for the corresponding antigen.
Even if the antibody no longer detectable.
To prevent a secondary immune
response.
Continues

The blood bank must maintain records of
all patients whom antibody have been
detected.

An antiglobulin crossmatch procedure is
required if the serum contain or previously
contained a significant antibody.
Special Serologic Techniques
Enzim enhances the reactivity e.g ( Rh,
Kidd, Lewis) but eliminates others eg.(
Duffy, MNS
Elution- dissociate IgG antibody
Adsorption- process of removing antibody
from serum by combining a serum with
appropriate RBCs.
Neutralization