Detection of cell‐drug (hapten)‐antibody complexes by the gel test

Abstract

Most drugs causing immunocytopenias do not bind firmly to the affected cells. Consequently, the drug-dependent antibodies in such cases are completely removed from their binding sites by conventional cell washing. It has recently been shown that such cell-drug-antibody complexes do survive the washing procedure, if the drug (metabolite) was included in the wash medium. The study reported here used the microtube gel test to reexamine the reactivity of different drug-dependent red cell antibodies: cefotaxime (n = 1), carbimazole (n = 1), cianidanol (n = 1), diclofenac (n = 3), penicillin (n = 3), and nomifensine (n = 10). Whether the drug tested binds (penicillin, cianidanol, carbimazole, and diclofenac) or does not bind (cefotaxime and nomifensine) firmly to the cells, the resultant cell-drug-antibody complex could be recognized on and/or in the gel after it was separated from the mixture containing the drug by means of centrifugation alone and without washing. It is concluded that the gel test might be of value not only for the detection of drug-dependent antibodies, but also for the analysis of subtle drug--cell interactions.

Fatal acute diclofenac-induced immune hemolytic anemia

“…Standardized serological procedures, including the indirect antiglobulin test (IAT), direct antiglobulin test (DAT), eluate testing, and drug-dependent antibody (ddab) determinations, were performed by using the Micro-Typing system (DiaMed, Cressier sur Morat, Switzerland), as was previously described [8]. All antiglobulin reagents used were from commercial sources: anti-C3d (Dako, Hamburg, Germany), anti-IgG, anti-IgM, anti-IgA (Biotest, Dreireich, Germany), and acid elution reagents (Immucor, Rödermark, Germany).…”

Ceftriaxone-induced immune haemolysis: two case reports and a concise review of the literature

“…Standardized serological procedures, including the indirect antiglobulin test (IAT), DAT, eluate testing, and ddab determinations, were performed using the Micro-Typing System (DiaMed, Cressier sur Morat, Switzerland), as was previously described [16]. The following commercial reagents were used: anti-C3d (Dako, Hamburg, Germany), anti-IgG, anti-IgM, anti-IgA (Biotest, Dreieich, Germany), and acid elution reagents (Immucor, Rödermark, Germany).…”

Immune-Mediated Severe Hemolytic Crisis with a Hemoglobin Level of 1.6 g/dl Caused by Anti-Piperacillin Antibodies in a Patient with Cystic Fibrosis

“…Antibody screening test and eluate were negative. Drugdependent antibodies were investigated in the presence and absence of meropenem and of piperacillin and its metabolites (drug immune complex method), as described previously [11]. Antibodies to piperacillin of the IgM-and IgG-type were detected in the serum of the patient, the latter reacting up to a titre of 1:256.…”