The role of the elution in antibody investigations

Yazer, Mark H.; Triulzi, Darrell J.

doi:10.1111/j.1537-2995.2009.02304.x

Cited by 11 publications

(8 citation statements)

References 8 publications

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“…Only 0.6% of the 160 total elution studies performed at the adult hospital yielded new serologic information not available through the IAT. This finding is consistent with results reported previously, [1][2][3][4][5] although it is important to note that these studies used more stringent criteria, similar to those used at the pediatric hospital. However, by using the strict criteria presented in this study, we found that only 2.3% of the eluates yielded new serologic information (pediatric hospital).…”

Section: Discussionsupporting

confidence: 92%

“…1,7,8 A nonreactive eluate can be associated with medications, underlying disease states, and elevated globulin levels, all of which are unrelated to alloantibody formation. Eluates of this kind in no way affect transfusion practice.…”

Section: Discussionmentioning

confidence: 99%

“…Unfortunately, the yield of elution tests contributing novel serologic information is thought to be low. [1][2][3][4][5] The criteria for performing elution testing vary across institutions and could affect the yield of the test to some extent. The primary indication for elution testing is a newly reactive DAT in the context of recent RBC transfusion (eg, 1 month).…”

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confidence: 99%

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Strict vs Lenient Criteria for Elution Testing

Veeraputhiran

Pesek

Blackall

2011

American Journal of Clinical Pathology

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In this study, 2 patient populations, using different elution strategies, were compared to evaluate eluate yields under more and less restrictive conditions. An informative eluate was defined as one in which an antibody that could be clinically significant was detected in the eluate but was not detectable in the plasma at the time of elution testing. The results for 160 direct antiglobulin tests (DATs) and 160 elution studies were evaluated in 71 patients at the adult hospital (lenient criteria). The results for 372 DATs and 43 elution studies were evaluated in 123 patients at the pediatric hospital (strict criteria). The yields from these eluates were 0.6% at the adult hospital (C antibody) vs 2.3% at the pediatric hospital (Jk(a) antibody). Thus, the yield of information from eluate testing is low regardless of the stringency applied to testing. However, considering the cost and time required for testing, more stringent criteria are advised.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Strict vs Lenient Criteria for Elution Testing

Veeraputhiran

Pesek

Blackall

2011

American Journal of Clinical Pathology

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“…The red cells can be coated with IgG or complement alone or with a combination. [1] These coated red cells are difficult to accurately phenotype, which may be required for selection of appropriate unit of blood for transfusion in these patients. [2]…”

Section: Introductionmentioning

confidence: 99%

Removal of antibodies from red cells: Comparison of three elution methods

Katharia

Chaudhary

2013

Asian J Transfus Sci

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Background:Direct antiglobulin test (DAT) is the most common test done in immunohematology lab, which detects immunoglobulin and fragments of complement attached to the red blood cells. These coated red blood cells are difficult to accurately phenotype, which may be required for selection of appropriate unit of red blood cells for transfusion.Aims:We have studied the efficacy of various elution methods in removing the antibodies coating the red cells and their impact on different blood group antigen activity.Materials and Methods:Patient samples sent for serological evaluation of autoimmune hemolysis were included in the study. DAT and Indirect antiglobulin test (IAT) were performed using gel cards (ID system, DiaMed Switzerland). Antibody coated red cells, either by in-vivo or in-vitro sensitization, were used to assess the outcome of three elution methods.Results:Out of 93 DAT positive samples already sensitized in vivo, 28 (30 %) samples became DAT negative post elution using either of three methods, while 36 (38.8%) showed reduction in strength of reaction, whereas in 29 (31.2%) there was no change in strength of reaction. Similarly, out of the 17 samples prepared by in vitro sensitization, 12 samples became completely negative after glycine-HCl/EDTA elution, 9 and 5 samples became negative after heat elution and chloroquine diphosphate elution methods, respectively.Conclusion:On comparative analysis glycine-HCl/EDTA elution method was better than the other two methods and can be used for eluting immunoglobulins from intact red cells.

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“…Finally, while we and others have instituted similar guidelines on TR ST, we recognize that other hospitals may already have relaxed their policies (with scepticism on the informativeness of eluate testing as well) . Continuing with the cost of comprehensive serologic testing might only be justified in environments with low caseloads or resistance to nuanced algorithms.…”

Section: Discussionmentioning

confidence: 93%

Serologic assessments in acute transfusion reactions: practices and yields

et al. 2019

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Background & Objectives Serologic testing after transfusion reactions (TRs) aims to find accountable immune haemolytic incompatibility. Our hospital policies recommend serologic testing in all TR, except for low‐risk fevers (subclinical temperature <39°C) or uncomplicated allergic reactions. Assessing compliance with these guidelines and serologic testing yields may provide insights on quality of practice and value. Materials & Methods Interrogation of two haemovigilance databases identified all possible‐to‐definite TR over a 4‐year period (2013–2016) at four academic hospitals. We reviewed the performance and outcome of serologic testing by site, year, reaction type, implicated product and service. Results Serologic testing occurred in 769 (55%) of 1408 referrals, with 1153 (82%) compliant with guidelines. Similar proportions deviated to overtesting (85/550 [15%]) and undertesting (174/858 [20%]), with undertesting seen most often in atypical TR. Overall, 30 (4.4%) of 769 cases had a new finding, but only 2 (0.3%) reflected host‐derived antibodies. Overall, the number needed to test to discover an unexpected allospecificity was 385, or 253 if limited to high‐risk fevers. Reaction‐ and product‐specific yields ranged from 0% to 48%. The yield in complicated allergic reactions was low at 2%, constituting only predictable passive isohaemagglutinin(s) in retrospect. Investigated IVIG TR accounted for most of this cohort’s signal by passive isohaemagglutinins in 48%. Conclusion The performance of post‐TR serologic testing revealed practice gaps and expected context‐specific yields. Tailored serologic testing (i.e. indirect antiglobulin tests for alloantibodies in post‐RBC/high‐risk febrile reactions, ± isoagglutinin‐focused tests after IVIG or ABO‐minor‐mismatched platelets) may improve value and liberate resources for other unmet needs in TR investigation.

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The role of the elution in antibody investigations

Abstract: The strength of the DAT does not indicate the likelihood of an informative eluate. Performing an eluate when the antibody detection test is positive has limited value.

Cited by 11 publications

References 8 publications

Strict vs Lenient Criteria for Elution Testing

Strict vs Lenient Criteria for Elution Testing

Removal of antibodies from red cells: Comparison of three elution methods

Serologic assessments in acute transfusion reactions: practices and yields

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