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BACKGROUND: Patients transfused at more than one health care facility face safety risks, because their transfusion record is fragmented. Blood group antibodies documented at one facility may be unknown to others. Because many antibodies are evanescent, access to prior antibody records is important for preventing incompatible transfusions and delayed hemolytic reactions. The study goal was to quantify multisite transfusion activity and its impact on antibody record accuracy. STUDY DESIGN AND METHODS: Patients (n = 100) undergoing hospital transfusion testing were surveyed to determine the locations and dates of any prior trans

BACKGROUND: Concurrent alloantibodies are defined as two or more blood group (BG) antibodies coexisting in a given patient. These antibodies are significant because they can present major problems in compatibility testing. The goals of this study were to determine the properties of concurrent BG antibodies. STUDY DESIGN AND METHODS: The transfusion records of 18,750 patients at a Veterans Affairs medical center were reviewed to identify alloimmunized individuals. The following data were collected on patients making concurrent antibodies: antibody specificities, time of first detection, whether the antibodies disappeared over time, and, if so, their time of disappearance. RESULTS: Multiple alloimmunization occurred in 21.7% (96/443) of alloimmunized patients, constituting 39.9% (230/577) of all antibodies. The rate at which an antibody was concurrent with another antibody varied by antigenic specificity (p

Current textbooks for transfusion medicine state that anti-A and/or anti-B (anti-A/B) agglutination titers--and thus the respective antibody concentrations--reach their maximum in individuals 5 to 10 years old and then gradually decline with the increasing age of the individual. This statement is largely based on a study by Thomsen and Kettel that dates to 1929. In the present article, ABO antibodies in sera of 175 healthy persons aged 61 to 97 years, as well as sera of 170 newborn infants and children aged 0 to 17 years, were analyzed. Microhemagglutination tests were performed with all sera and complemented by ABO enzyme-linked immunosorbent assays to measure the immunoglobulin class (IgM, IgG, and IgA) of the anti-A/B. As in a previous study using sera of persons aged 20 to 67 years, individual differences exceeded age-related changes for all variables. Median values of IgG and IgA anti-A/B were elevated in elderly persons of blood group O, whereas no significant changes were observed in other variables. In particular, the decrease in agglutination titers with the increasing age of the individuals was far less pronounced than previously described; even in sera of persons aged 90 to 97 years, median agglutination titers of 128 were found. Results in the sera of children confirm previously reported data that agglutination titers and IgM anti-A/B reached adult levels at the age of 5 to 10 years.

P blood group system antibodies are encountered frequently in clinical transfusion practice. The authors describe an improved method for removing P antibodies from patient specimens without dilution. Solid- phase synthetic P antigens were used to neutralize serums containing P blood group system antibodies; 26 alloantibodies with specificity other than P were not inhibited. The synthetic P antigens are also used to characterize the heterogeneous immunochemical fine specificity of antibodies to P1 and P + P1 + Pk.

A microcapillary method utilizing phthalate esters or an ultracentrifuge method are both capable of separating autologous from homologous erythrocytes in polytransfused patients. The microcapillary technique which is readily adaptable to blood bank laboratories provides a previously unavailable method for defining blood group antigen typings in transfused patients. Such typings are of vital importance in the laboratory evaluation of transfused patients with multiple or weak blood group antibodies.

Blood group antibodies tend to occur in a small group of sensitive people. Thus, in Rh-negatives, those who produce anti-Rh are more likely than others to form still other antibodies. In the sensitive group production of anti-Rh may be a forerunner of other antibody production. In a study of sera from 2,851 antenatal patients it was found that 13.9% of women who had formed anti-Rh also formed a non-Rh-system immune antibody. In women with no anti-Rh only 0.1% formed an immune antibody.

Three patients are described who produced a variety of blood group antibodies following exposure to foreign red cells. These findings are considered in relation to the theory that a small group of individuals possess an ability, possibly genetically determined, to readily form antibodies and the theory that the first antibody formed may augment the production of other antibodies.

A statistical study of the incidence and specificity of multiple irregular blood group antibodies shows predominance of those within the Rh-Hr, Kell, and Duffy systems. When multiple antibodies included those in the Lewis, Lutheran, MNS, P, or Kidd systems, the other antibodies were usually in the Rh-Hr, Kell, and Duffy systems. The following categories of donors: 1a Group O Rh-neg. (dce/dce) K-neg. Fya-neg. 1b Group O Rh-neg. (dce/dce) K-neg. Fyb-neg. 2a Group O Rh-pos. (R1R1-DCe) K-neg. Fya-neg. 2b Group O Rh-pos. (R1R1-DCe/DCe) K-neg. Fyb-neg. 3a Group O Rh-pos. (R2R2-DcE7DcE) K-neg. Fya-neg. 3b Group O Rh-pos. (R2R2-DcE/DcE) K-neg. Fyb-neg. are further subtyped for Lea, Leb, P, Jka, Jkb, M, N, S, s, and Lua. Erythrocytes from these donors, frozen in glycerol, with Anti-A, and Anti-B antibodies removed during deglycerolization simplifies the problem of finding compatible blood for patients with multiple antibodies.

Concentration of serum proteins, including blood group antibodies and complement components, is achieved rapidly and economically by dialysing the serum against dry Carbowax 20-M, a polyethylene glycol polymer with a molecular weight of 20,000. Such concentrates require no fluid or electrolyte readjustment for red cell testing and may be used for the identification of weak antibodies, the conversion of rare but unreliable antisera into useful laboratory reagents, and the preparation of serum specimens with high complement activity.

This report documents a mild case of hemolytic disease of the newborn (HDN) associated with anti-Jk3. The Filipino mother had previously had six children none of whom had been affected by HDN. She had been transfused at the time of her second pregnancy. Anti-Jkb and anti-Jk3 were detected in the maternal serum at the time of her seventh delivery. No prenatal serologic tests for blood group antibodies had been performed. The cord blood was found to have a positive direct antiglobulin test and anti-Jkb plus anti-Jk3 were eluted. The infant was treated with phototherapy.

The investigation of a failure of proficiency showed that certain saline solutions are inappropriate for use in blood group serology tests. In particular, it was found that solutions of unexpectedly low pH and/or those autoclaved and stored in plastic containers could severely compromise the sensitivity of the antiglobulin test when used as wash solutions. The observed loss of sensitivity ranged from a reduction in titration score to a complete failure in the detection of clinically significant blood group antibodies. It is suggested that careful consideration should be given to the source, pH, and storage container of saline solutions intended for use in serological tests and that improved standardization and sensitivity could be achieved by using phosphate-buffered saline pH 7.0 to 7.2 for all such purposes. It is recommended that unbuffered saline solutions of pH less than 6.0 should not be used for serological testing.

Two hundred four examples of blood group antibodies, reactive only by the indirect antiglobulin test, were examined by the two-layer albumin capillary (TLAC) technique. Fifty-nine per cent of the examples tested were reactive by this technique. TLAC reactivity appeared to be related to antibody specificity, but a positive association between TLAC reactivity and IgG subclass composition was not confirmed.

In November 1984, the Standards Committee of the American Association of Blood Banks changed the requirements for pretransfusion testing by making the performance of an antiglobulin crossmatch optional when the antibody screening test is negative. The crossmatch would be necessary only to confirm ABO compatibility. Many will welcome this change; others will persist in their current methods. This article presents data supporting the use of the manual hexadimethrine bromide (Polybrene) test, a 1-minute room temperature procedure, as a crossmatch technique when the antibody screening test is negative. The manual Polybrene test (MPT) is an effective method for detecting ABO incompatibility. Forty-seven randomly selected serums gave expected results with A1, A2, and B red cells. Only 66 percent of 84 group B sera were serologically incompatible with A2B red cells by MPT, but the same results (69% positive) were observed using a 5-minute low-ionic- strength solution (LISS) room temperature technique. As only 37 percent of these crossmatches were incompatible using a LISS immediate spin (IS) method, the reliability of an IS method is questioned. An MPT crossmatch provides added security in that most unexpected blood group antibodies are demonstrable by this method. Of 106 serums tested which contained antibodies, 83 reacted. We believe that the MPT provides a rapid and sensitive test that, accompanied by a carefully performed antibody screening test, meets the requirements of Standards and will provide for safe red cell transfusion without the need for an antiglobulin crossmatch.

Antiglobulin sera, from nine different manufacturers, have been tested over a two-year period for their ability to detect different nonagglutinating, IgG and IgM blood group antibodies and for the presence of undesirable antibodies that cause the agglutination of nonglobulin coated red blood cells. There are not so many differences in anti-IgG levels among the sera as there are differences in anticomplement levels. Over the two-year period, there have been, in general, increases in the amounts of anti-IgM antibodies in the sera tested. Several of the sera, apparently prepared by dilution of raw rabbit serum and not by adsorption, contain antibodies that cause the agglutination of red blood cells not coated with IgG, IgM, or any of the components of complement.

Experiments were conducted using the technique of quantitative hemagglutination with an electronic particle counter to study the specific and nonspecific uptake of blood group antibodies by previously sensitized erythrocytes. Specific attachment of a second antibody was impaired by prior RBC sensitization. It was found possible to quantitate simultaneously the amount of both specific and nonspecific second antibody uptake.

Some factors affecting the sensitivity of the automated methods for blood group antibody detection have been evaluated. The experiments revealed influencing differences between various albumin preparations. In the BMC method, one lot of albumin permitted no significant antibody detection. In the LISP technique, a plateau of maximum Polybrene activity was found. The beginning of this plateau depended on both the albumin preparation and the Polybrene lot. In the BMC method, methyl cellulose gave optimal sensitivity within a concentration range of 0.3 to 0.5 per cent. The stability of test cells stored in ACD at 4 C was studied. All test cells could be used safely up to two weeks. Cells from different donors showed variable reactivity after three weeks.

The properties of four albumin-agglutinating sera demonstrating a spectrum of reactivities are reported. All cause pan- and auto-agglutination in albumin. Direct and indirect reacting caprylate-dependent agglutinins are described, as are two sera with undefined specificity not related to the presence of caprylate stabilizer in the albumin. Immunoelectrophoretic evidence was obtained to support the concept of albumin-immunoglobulin complex formation in the genesis of albumin agglutination. Most albumin agglutinins react only with albumin stabilized by short-chain fatty acids; however, other specificities may be represented. Albumin agglutinins should be clearly identified in the blood bank to prevent confusion with blood group antibodies.

Ten commercial “broad-spectrum” antiglobulin sera, which had satisfied NIH standards, were evaluated and compared with six antiglobulin sera of varying specificities prepared in the authors' laboratories. The majority of the commercial antisera had adequate anti-IgG, although four were definitely weaker and failed to detect weak IgG antibodies. Most of the commercial antiglobulin sera had inadequate anticomplement, eight failing to react with cells strongly sensitized with complement, from patients with hemolytic anemia. Most of the commercial antiglobulin sera reacted poorly with cells weakly or moderately sensitized with complement-binding blood group antibodies, such as anti-Lewis. Evidence that adequate anticomplement activity should be present in routinely employed antiglobulin sera is discussed.