J Korean Med Sci.  2009 Aug;24(4):632-635. 10.3346/jkms.2009.24.4.632.

Screening and Identification of Unexpected Red Cell Antibodies by Simultaneous LISS/Coombs and NaCl/Enzyme Gel Methods

• Shin JH
• Lee JY
• Kim JH
• Kim HR
• Lee JN

• KMID: 1779195
• DOI: http://doi.org/10.3346/jkms.2009.24.4.632

Abstract

We evaluated the clinical usefulness of simultaneous LISS/Coombs and NaCl/Enzyme testing using the gel method for screening and identification of unexpected antibodies in 15,014 samples. When unexpected antibodies were detected by either screening test, those antibodies were identified using both the LISS/Coombs and the NaCl/Enzyme gel test. The positive screening rates of the LISS/Coombs, NaCl/Enzyme, and combined tests (excluding 25 autoantibody cases) were 0.48%, 1.29%, and 1.39%, respectively. Among the 57 samples positive by both screening methods, the antibodies in 19.3% could be identified only by the NaCl/Enzyme method. Among the 137 samples positive only by NaCl/Enzyme screening, 74.5% showed positive results in antibody identification only by the NaCl/Enzyme test, although 7.3% were also positive in the LISS/Coombs test. The NaCl/Enzyme method thus showed about threefold higher detection rates than the LISS/Coombs method, especially in screening for Rh antibodies, and higher exact identification rates and discriminatory power for identifying mixed antibodies. Addition of the NaCl/Enzyme method to routine laboratory procedures may detect and identify considerable numbers of significant antibodies that might be missed if only the LISS/Coombs method is used.

Keyword

Erythrocyte Antigens; Unexpected Antibody; Gel Test; NaCl/Enzyme; Coombs' Test

MeSH Terms

Antibodies/*analysis/immunology
*Coombs' Test
Erythrocytes/*immunology
Hemagglutination Tests/*methods
Humans
Isoantibodies/analysis
Reagent Kits, Diagnostic

Reference

1. Chapman JF, Elliott C, Knowles SM, Milkins CE, Poole GD. Guidelines for compatibility procedures in blood transfusion laboratories. Transfus Med. 2004. 14:59–73.

2. Lapierre Y, Rigal D, Adam J, Josef D, Meyer F, Greber S, Drot C. The gel test: a new way to detect red cell antigen-antibody reactions. Transfusion. 1990. 30:109–113.

3. de Castilho LM, Pellegrino J Jr, Bechelli AP, Le Pennec PY, Mendes NF. Evaluation of recent techniques for detection of red blood cell antibodies in sera of reference samples, patients, pregnant women, and blood donors. J Clin Lab Anal. 1996. 10:250–256.

4. Lee WH, Kim SY, Kim HO. The incidence of unexpected antibodies in transfusion candidates. Korean J Blood Transfus. 2000. 11:99–103.

5. Cho YK, Kim DS, Lee HS, Choi SI. The frequency and distribution of unexpected antibodies in surgical patients at Chonbuk National University Hospital. Korean J Lab Med. 2004. 24:67–71.

6. Jung TK, Lee NY, Bae HG, Kwon EH, Park SH, Suh JS. Unexpected antibody positivity with the use of the LISS/Coombs gel test. Korean J Clin Pathol. 2001. 21:422–425.

7. Lee JS, Cho D, Shin MG, Ryang DW. Usefulness of NaCl/Enzyme gel test for the identification of unexpected antibodies. Korean J Lab Med. 2006. 26:204–209.

8. Bromilow IM, Adams KE, Hope J, Eggington JA, Duguid JK. Evaluation of the ID-gel test for antibody screening and identification. Transfus Med. 1991. 1:159–161.

9. Nathalang O, Chuansumrit A, Prayoonwiwat W, Siripoonya P, Sriphaisal T. Comparison between the conventional tube technique and the gel technique in direct antiglobulin tests. Vox Sang. 1997. 72:169–171.

10. Pereira A, Mazzara R. Enzyme techniques in pretransfusion testing. Transfusion. 1993. 33:884.

11. Issitt PD, Combs MR, Bredehoeft SJ, Campbell ML, Heimer M, Joyner L, Lorentsen L, Remley C, Bullock S, Bumgarner J, Zakeriniasar M, Kirkland A, Melroy H, Millikin D. Lack of clinical significance of "enzyme-only" red cell alloantibodies. Transfusion. 1993. 33:284–293.

12. Garner SF, Devenish A, Barber H, Contreras M. The importance of monitoring 'enzyme-only' red cell antibodies during pregnancy. Vox Sang. 1991. 61:219–220.

13. Judd WJ, Steiner EA, Nugent CE. Appropriate serological testing in pregnancy. Vox Sang. 1992. 63:293–296.

14. Michalewska B, Ejduk A, Pniewska K. Acute haemolytic transfusion reaction apparently caused by the 'enzyme-only' anti-E. Vox Sang. 2005. 89:61.

15. Reisner R, Butler G, Bundy K, Moore SB. Comparison of the polyethylene glycol antiglobulin test and the use of enzymes in antibody detection and identification. Transfusion. 1996. 36:487–489.