8 Antibody Identification (cont’d) ExclusionsExclude based on negative reactions to cells having presumed homozygous expressions of antigenExclude with one negative cellExceptions
9 Evaluation of Panel Tube Testing In what phase(s) and at what strength(s) did the positive reactions occur?Do all of the positive cells react at the same phase, or do any react at different or multiple phases?Does the serum reactivity match any of the remaining specificities?
10 Evaluation of Panel (cont’d) Tube, Gel, Solid PhaseAre all commonly encountered RBC antibodies ruled out?Is the autologous control positive or negative?Is there sufficient evidence to prove the suspected antibody?Is the patient lacking the antigen corresponding to the antibody?
11 Cost-effective Methods Use of outdated reagent red cellsUse of diluted antisera for screeningUse of unlicensed antisera for screeningUse of outdated antiseraUse of proper controls for outdated or unlicensed antisera
12 SummaryNo matter what test method you use in your Blood Bank, the approach to antibody identification should always be the same.No test method is perfect, so use the one that works best for your facility.
14 Case 1 70 year old Caucasian female Admitted with cellulitis of right legTransfused 3 months agoThree units of blood ordered STATBlood type: O PositiveDAT: NegativeRh Phenotype: C+E-c+e+Antibody screen 4+ positive (all three screening cells) using automated solid phase testing
15 Case 1 – Initial Panel Results DCcEeKFyaFybJkaJkbLeaLebP1MNSsRT37AHG1+1+2+21+w33+456w7891011A/C
16 Case 1 – Selected Cells D C c E e K Fya Fyb Jka Jkb Lea Leb P1 M N S s DCcEeKFyaFybJkaJkbLeaLebP1MNSsRT37AHG1+1+231+s45
17 Case 1 – Additional Selected Cells DCcEeKFyaFybJkaJkbLeaLebP1MNSsRT37AHG1+231+s42+
18 Case 2 34 year old Caucasian female Admitted with abdominal pain and bleedingHemoglobulin: 8.9 g/dLHistory of transfusion (> 3 months ago)History of pregnancyBlood type: AB PositiveRh Phenotype: C-E+c+e-Hospital reports 2+ using Gel (SC-I)
19 Case 2 – Initial Panel Results DCcEeKFyaFybJkaJkbLeaLebP1MNSsRT37AHGPEG1+1+1+s234mi+56w7891+w1011A/C
20 Case 2 – Selected Cells D C c E e K Fya Fyb Jka Jkb Lea Leb P1 M N S s DCcEeKFyaFybJkaJkbLeaLebP1MNSsPEG1+23w41+5mi+6PT NT
21 Case 2 – Ficin Treated Panel DCcEeKFyaFybJkaJkbLeaLebP1MNSsIS37AHG1+2+2+s1+234mi+51+s6w7891011A/C