Increased alloimmunisation and transfusion reaction reporting in patients with solid-phase panreactivity

Olofson, Andrea M.; Chandler, Rachael M; Marx-Wood, Cynthia R.; Babcock, C. A.; Dunbar, Nancy M.

doi:10.1136/jclinpath-2017-204355

Cited by 3 publications

(3 citation statements)

References 7 publications

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“…Recently, solid-phase unidentified reactions have been associated with female sex or diagnoses like cancer, pregnancy, surgery, and trauma, and data gathered in our patients are in line with these observations [24]. Although it has been recently reported that a minority of patients with nonspecific reactivity at SPRCA might develop new auto- or alloantibodies, the majority of them tend to become definitely negative at following alloantibody screenings, thus confirming the elusive nature of these results [24,25]. In our scenario, however, consisting in patients at very low transfusion risk, the false-positive results could require additional investigations finally resulting in the delay of surgical procedures.…”

Section: Discussionsupporting

confidence: 86%

Red Cell Alloantibody Screening: Comparative Analysis of Three Different Technologies

Orlando¹,

Bianchi²,

Valentini³

et al. 2018

Transfus Med Hemother

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Background: The detection of irregular antibody is a critical issue in the management of red blood cell transfusion according to the Type & Screen (T&S) practice. In order to implement the T&S procedure at our blood bank, we compared three different automated analyzers based on column agglutination technique (CAT) or solid phase red cell adherence assay (SPACA) methods. Methods: Pre-transfusion antibody screening was performed in 986 patients candidate to elective surgery at low risk for red blood cell transfusion. We tested the following kits: the three-cell panel micro-CAT system ID-DiaCell I-II-III (DiaMed), the four-cell panel solid-phase system Capture-R Ready Screen-4 (Immucor), and the four-cell panel micro-CAT system Serascan Diana-4 (Grifols). Positive results were further investigated using corresponding identification panels, and discrepant results were investigated with all the antibody identification systems. Results: Among 986 samples, we observed 967 concordant negative results (98.1%), 8 concordant positive results (0.8% of cases), and 11 discrepant results (1.1%). Among discrepant samples, an alloantibody could been identified in two patents (anti-M, detected by Serascan Diana-4 and ID-DiaCell I, II, III; anti-Kp^a, detected by Capture-R Ready Screen-4 and Serascan Diana-4). Conclusion: Among the evaluated technologies, the four-cell panel micro-CAT system displayed the highest sensitivity and specificity with an optimal negative predictive value. These features might be relevant to the routine implementation of the T&S transfusion strategy.

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Section: Discussionsupporting

confidence: 86%

Red Cell Alloantibody Screening: Comparative Analysis of Three Different Technologies

Orlando¹,

Bianchi²,

Valentini³

et al. 2018

Transfus Med Hemother

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“…A similar phenomenon of panreactive SPRCA accompanied by a negative autocontrol and a lack of specificity but later acquired alloantibodies was described by Olofson et al, suggesting higher rates of both transfusion reactions and alloantibody development at 2% and 11%, respectively, compared to those without SPRCA panreactivity [17]. Liu et al reported approximately 18% of the gel‐based antibody screens as AUS.…”

Section: Discussionsupporting

confidence: 52%

The impact of an antibody investigation algorithm emphasizing specificity on reducing potential false‐positive warm autoantibody detection at a Canadian tertiary care centre

Hutspardol,

Boyd,

Zamar

et al. 2023

Vox Sanguinis

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Background and ObjectivesTo reduce potential false‐positive warm autoantibody (WAA) by solid‐phase red cell adherence assay (SPRCA), our centre implemented a new antibody investigation algorithm (AIA) by classifying cases with panreactive SPRCA but negative saline‐indirect antiglobulin test as ‘antibody of undetermined significance’ (AUS) after excluding clinically significant antibodies. We assessed the effects of the new AIA and subsequent alloantibody formation in patients with AUS.Materials and MethodsSamples from patients with positive SPRCA screens between 1 September 2017 and 31 August 2021 were selected for the study. Frequencies of antibodies classified by the old and new AIAs were compared using Fisher's exact test. Patient demographics, transfusion history and antibody formation in cases of AUS were collected.ResultsA significant reduction in potential WAA frequencies from 127/1167 (11%) to 53/854 (6%) was observed (p < 0.001) when compared between the old and new AIAs among 2021 positive SPRCA antibody screens. While no patients with AUS later transitioned to potential WAA using the new AIA, four patients developed alloantibodies, including anti‐E, anti‐C, both anti‐C and anti‐E, and anti‐Wra.ConclusionA significant reduction in the frequencies of potential false‐positive WAA detection at our centre was observed after implementing the new AIA, leading to less resource and phenotypically matched red blood cell (RBC) use. Some patients still developed subsequent RBC alloimmunization, so clinically relevant alloantibodies should be carefully excluded before determining AUS, taking forming or evanescent antibodies into consideration.

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“…[4][5][6] One pattern of such reactivity is panagglutination, although the exact mechanism for this phenomenon remains unclear. 3,7,8 In addition, SPRCA assays appear to be more sensitive for the detection of warmreactive autoantibodies than other primary antibody detection methods. 4,6 In a previous study of NSP antibodies, the authors identified an interesting pattern of reactivity: panreactive SPRCA plasma testing with a negative PEG-tube test and a negative DAT.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of solid-phase panreactivity with negative direct antiglobulin testing

Little,

Blackall

2023

Immunohematology

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Solid-phase red cell adherence (SPRCA) is a sensitive platform for antibody detection, but nonspecific reactions may occur. One pattern of apparent nonspecific reactivity is a panagglutinin with a negative direct antiglobulin test (DAT). The purpose of this study was to define the clinical characteristics of patients with these nonspecific reactions and their associated serologic findings. Twenty patients with panreactive SPRCA testing results were identified between November 2022 and May 2023. In addition to panagglutinins, these patients had (1) a negative polyethylene glycol (PEG) antibody detection test, (2) a negative PEG autocontrol, and (3) a negative DAT. The strength of SPRCA panreactivity and the results of eluate testing (by tube and SPRCA) were studied. Clinical characteristics of patients included age, sex, and primary diagnosis. Each patient was also assessed for evidence of hemolysis. Fourteen female and six male patients were evaluated (average age 44 years). Primary diagnoses included pregnancy (n = 10), acute bleeding (n = 4), orthopedic (n = 3), and other (n = 3). There was no clinical or laboratory evidence of hemolysis. The predominant strength of SPRCA panreactivity was evenly distributed across reaction grades (1+ to 3+). Fifty-five percent of the eluates tested in PEG showed panreactivity, consistent with warm-reactive autoantibodies, while 85 percent of eluates tested by SPRCA were panreactive. Six discrepant cases, in which PEG eluate testing was negative and solid-phase eluate testing showed panreactivity, were associated with weak solid-phase plasma panreactivity (1+). In addition, the reactivity strengths of the eluates tested by SPRCA were invariably more strongly reactive than those eluates tested in PEG. Panagglutination is a distinct SPRCA-only plasma reactivity pattern. Despite a negative PEG tube and DAT, most panagglutinins are warm-reactive autoantibodies. Fortunately, these “interfering” panagglutinins do not appear to be clinically significant and are easily managed by an alternative testing method such as PEG.

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Increased alloimmunisation and transfusion reaction reporting in patients with solid-phase panreactivity

Abstract: Our data suggest that patients with SPP have higher rates of reported transfusion reactions and alloantibody development compared with those without SPP.

Cited by 3 publications

References 7 publications

Red Cell Alloantibody Screening: Comparative Analysis of Three Different Technologies

Red Cell Alloantibody Screening: Comparative Analysis of Three Different Technologies

The impact of an antibody investigation algorithm emphasizing specificity on reducing potential false‐positive warm autoantibody detection at a Canadian tertiary care centre

Evaluation of solid-phase panreactivity with negative direct antiglobulin testing

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