Red Cell Alloantibody Screening: Comparative Analysis of Three Different Technologies

Abstract

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.

Comparison of two column agglutination tests for red blood cell antibody testing

“…Inconsistent results were also found by Quillen et al, who reported for automated solid-phase systems non-repeatability for the detection of antibodies to E, Jk a , and Fy a [29]. A recent comparison found unspecified reactions in 7 cases for the solid phase assay compared to 2 for gel card agglutination [12].…”

“…Therefore, decreased sensitivity with differentiation panels that contain only one instead of two antigen-positive cells is plausible. One group recently published similar findings for Kp a , which increases the sensitivity of the test system if included in screening at the cost of having four instead of three cells per sample in the screening [12].…”

“…This includes testing for prenatal anti-D, which could be detected up to the fifth dilution step in solid-phase testing, while card testing was generally only positive up to the fourth dilution step [28]. The solid-phase system’s superior sensitivity contrasts with its low specificity [12]. Weisbach et al found inconclusive reactivities, possibly mostly false positive reactions, in 1.38% and 0.13% of samples tested with a solid-phase and gel card system, respectively [11].…”

“…Among these, antihuman globulin non-tube tests have been found to be superior to the others [9]. Solid-phase reactions on microtiter plates [10] are known to be sensitive but lack sufficient specificity: They produce inconclusive results 2.5 to 10 times more frequently than column systems [11, 12]. Column agglutination may be performed using cards that either trap agglutinates in a dextran-acrylamide matrix, or in a matrix consisting of glass beads [13–15].…”

A comparison of three column agglutination tests for red blood cell alloantibody identification

“…According to several international guidelines (such as BSH (British Society for Haematology) and CBO ('Centraal Begeleidingsorgaan') [3], the screening cell set must answer to certain requirements such as the inclusion of at least one cell with homozygous expression of the Fy a , Fy b (Duffy antigens), Jk a , Jk b (Kidd antigens), S and s antigens (MNSs antigens) and heterozygous expression for the K (Kell) antigen [4,5]. If the antibody screen is negative, it can be predicted that more than 99% [2,6] of the RBC units electronically matched for ABO groups will be compatible in the crossmatch (XM) test [7]. A positive antibody detection test is followed by the determination of the antibody specificity and the assessment of its clinical significance.…”