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A positive direct antiglobulin test is a criterion for the diagnosis of systemic lupus erythematosus (SLE). In general, severe hemolysis is absent in SLE. Sometimes, these patients may show hemolysis when presenting with antiphospholipid syndrome (APS). It is essential to exclude an underlying alloantibody along with autoantibody. We had reported a case of a 24-year-old female SLE along with an APS patient requiring transfusion support with underlying allo-anti-S antibody. We provided two units of S antigen-negative best-matched units to the patient who tolerated it well and showed improvement.

Background: Multiply transfused patients (MTPs) are often at risk of alloimmunization and other transfusion-associated complications. These complications could be ameliorated through extended blood typing prior to transfusion of blood and blood products. Objective: The aim of this study was to assess the knowledge and practice of safe blood transfusion in MTPs by physicians. Materials and Methods: This was a cross-sectional questionnaire-based study of physicians who attended a scientific conference of the West Africa College of Physicians in Asaba, Delta State. Result: Most of the respondents (68%) managed patients requiring multiple blood transfusions. Forty-seven respondents (68.1%) had a blood transfusion policy for MTPs in their respective centers, and 43 (68.1%) had no transfusion trigger hemoglobin level in their respective health facilities. Respondents who had a blood transfusion policy in their centers had a better knowledge of safe blood transfusion than those that did not, P = 0.008. None of the respondents reported carrying out antibody screening before and after multiply transfusing the patients. Although 100% performed initial screening for transfusion transmissible infections (TTIs), only 11.6% repeated screening for TTIs annually. Conclusion: Practice of safe blood transfusion in MTPs was found to be poor among physicians in Nigeria. Hospitals and training institutions should design ways to update knowledge of physicians on safe blood transfusion especially in MTPs and by so doing optimize safe blood transfusion practices, so as to improve the quality of life of patients.

In Palestine, antibody screening is done antenatally only for pregnant women who are Rh-D negative. However, we report the first hemolytic disease of the newborn (HDN) due to anti-e in Palestine, illustrating the importance of alloantibodies other than anti-D as a cause of HDN. A pregnant woman had e-antigen negative and her blood group was B positive developed alloantibody against her infant erythrocyte e-antigen that lead to severe jaundice due to fetal erythrocyte destruction by this maternal alloantibody. Postnatal workup for the severe hyperbilirubinemia indicated that the newborn' erythrocytes were sensitized by the maternal anti-e alloantibody. Furthermore, the positive direct Coombs test was reported. This case highlights the importance of antibody screening for all pregnant women irrespective of the D antigen status to detect and manage erythrocyte alloimmunization to any other clinically significant blood group antigens.

Background: Anti-Lewis antibodies, usually do not react at 37°C, hence are clinically insignificant. However, on rare occasions, these antibodies have been reported as the cause for hemolytic transfusion reaction (HTR). Aim: We report our experience on the 6 cases of anti-Lewis antibodies that reacted at room temperature (RT) and at 37°C. Materials and Methods: Standard serological methods were employed in detection and identification of antibodies. Demographic and clinical details were obtained from the records on the subjects under study. Results: These were found among the patients and the blood donors of varied age groups and gender (21 to 65 years). Also, they were found among the patients with varied clinical diagnosis. The 2 patients in second trimester had anti-Le a or anti-Le b and other 2 male patients had anti-Le ab or anti-Le b with wide thermal amplitude were found during the course of pre- transfusion compatibility tests including antibody screening and cross-matching. Two male donors typed Le (a−b−) had anti-Le ab with wide thermal amplitude. Lewis antigen negative RBC units were provided for transfusion in the situation. Conclusion: Although antibodies to Lewis blood group antigens often react at lower temperatures and therefore remain clinically insignificant, some of them, on rare circumstances, may react at higher temperature of 37°C and may produce hemolytic episode or at least yield reduce survival of incompatible red cells in transfusion recipients. On safer side, the antigen-negative unit may be used in transfusion. The donors' registry with detailed phenotype profile may go a long way to provide blood for transfusion in emergency situations.

BACKGROUND AND OBJECTIVES: The aim of the blood transfusion service should be to provide effective blood and blood components, which are as safe as possible and adequate to meet patient's need. To achieve safe blood transfusion practice, many blood transfusion center in India follow routine type and screen protocol for all patient's and donor's blood samples to detect unexpected alloantibodies. The present study is aimed at assessing the frequency and type of unexpected red cell alloantibodies in general patient population and donors at a tertiary care teaching hospital in western India. MATERIALS AND METHODS: In this prospective study, samples of patients as well as blood donors were processed for ABO and Rh “D” grouping as well as antibody screening with three cell screening panel on fully automated immunohematology analyzer. Positive sample in three cell screening panel was further evaluated for identification of specific alloantibody with eleven cell identification panel by column agglutination technique. Results were recorded, and data were analyzed to calculate the frequency of unexpected alloantibody. RESULTS: A total of 74,214 patient samples and 80,173 donor samples were processed for type and screen. Out of which, 512 patients and 11 donors were identified with alloantibody. Most common alloantibody found in the present study is anti-D (0.075%), followed by anti-E (0.041%), anti-c (0.021%), anti-K (0.0205%) in Rh and Kell blood group system. CONCLUSION: Antibody screening and identification of specific alloantibody help in identifying most appropriate blood unit that lacks the corresponding antigen and prevent alloimmunization.

INTRODUCTION: With the increased utilization of immunohematology (IH) analyzers in the transfusion medicine, type, and screen policy is the method of choice. Still, the importance of routine crossmatching could not be overruled. Here, we tried to understand the clinical conditions and safety of red cell transfusion and their outcomes. MATERIALS AND METHODS: This prospective study was conducted by IH laboratory, Medical College Kolkata, Blood Bank from October 1, 2015 to March 31, 2016. A set of 3cc ethylenediaminetetraacetic acid and clotted blood samples of the patients were received according to sample acceptance criteria. Blood grouping by conventional tube technique followed by crossmatching was performed by column agglutination technology (CAT) in polyspecific (IgG + C3d) gel media. Any positive result was rechecked in duplicate with additional two group-specific donor units. The persistent incompatibility was further evaluated using direct anti-human globulin test, auto control, antibody screening, and antibody identification by CAT. RESULTS: On the evaluation of 14,387 sets of patients' sample, only 100 were found to be incompatible (0.69%). Incompatibility rate is higher in females (59%). Eighty-five of these patients were repeatedly transfused. Only 38% of incompatible crossmatch were positive on indirect anti-human globulin test/antibody screening. Antibody could be identified in 16 of them. Seventeen of 100 incompatible samples (17%) presented with panagglutination, were managed with Rh, Kell phenotype/best-matched red cell units. In these 16 patients, 23 alloantibodies were identified; allo anti-E was the most common. CONCLUSION: This study showed antibody against the Rh system as the most common cause of incompatibility.

Alloimmunization is a detrimental effect of transfusion therapy which makes availability of compatible blood difficult due to increased incidence of development of alloantibody and autoantibody, which can lead to mild-to- fatal adverse reactions. This case report illustrates the effective resolution of a case with multiple alloantibodies using advanced immuno-haematological workup with rare antisera. This report also re-emphasizes the need for universal antibody screening and identification for both donors and patients as part of pre-transfusion testing. The assessment of need for transfusion helped in deriving an effective plan of action for supportive care to the patient against the fear of hemolytic reaction. The provision of right and compatible (antigen negative) blood helped in management of patient during chemotherapy. This case emphasizes the indispensable need of devising and maintaining a Rare Blood Donor Register in developing nations. The Rare blood donor registry will help revolutionize the current transfusion practices, and will provide better means of managing critical care patients with single/ multiple antibodies.

Daratumumab (DARA), a monoclonal anti-CD38 antibody, belongs to the new generation of immunotherapy in refractory relapsed multiple myeloma. CD38 is weakly expressed on human erythrocytes. By its intrinsic anti-CD38 activity, DARA also interferes in routine pretransfusion compatibility testing such as antibody screening for red blood cells (RBCs) alloantibodies and compatibility testing. Treating RBCs with dithiothreitol eliminates the DARA interference. We report two cases of serological interference of DARA in pretransfusion testing and how timely information before starting the second patient on DARA prevented the delay in pretransfusion compatibility testing and blood availability.

Introduction: “Type and screen” policy involves the prior determination of patient blood group and antibody screening at the time of admission irrespective of the need of the blood transfusion to the patient. Materials and Methods: As a part of our retrospective analysis, we have evaluated our data from January 2014 to June 2016. Blood grouping was done by column agglutination technology (CAT) using DiaClon ABO/D+ Reverse Grouping cards (BIO-RAD, Switzerland). Antibody screening and identification were done using three cell panels (ID-DiaCell I-II-III Asia panel by BIO-RAD, Switzerland) and 11 cell panels (ID-DiaPanel-P by BIO-RAD, Switzerland) on CAT with LISS/Coombs cards. Results: A total of 17,896 patients requests for “type and screen” were received by the department during the study. Out of which 201 (1.12%; 1 in 89 patients) patients were found to have positive antibody screen. Out of 201 patients (132 females; 69 males); mean age group of 45.6 years (range: 1 day–85 years). Out of 201, 145 patients developed single antibody, 15 patients had double antibody, and in 41 positive antibody screens the specificity of alloantibodies were not identified either due to an interfering autoantibody (n = 10) or the specificity was not resolved on extended panels (n = 31) even with enzymes. Conclusion: “Type and screen” policy helps in timely blood group typing of the patients and providing enough time for the blood bank to arrange for blood. Our analysis shows the presence of an alloantibody in every 89 requests received for “type and screen.”

Background: All antibodies to red cell antigens, other than naturally occurring anti-A and anti-B are considered unexpected. They can be either alloantibodies or auto antibodies. In pregnant women, these antibodies may cross the placenta and cause haemolytic disease of the foetus and newborn (HDFN). Timely detection of such antibodies in antenatal women is essential for early management of HDFN. Methods: A prospective cross-sectional study was carried out on 2060 multiparous pregnant women attending the Government Maternity Hospital, Tirupati to detect prevalence of unexpected antibodies. The women were grouped and typed for ABO and rhesus (Rh) D antigens by tube method and screened for alloantibodies by column agglutination technology. The medical and detailed obstetric history of these women were reviewed. Results: The overall prevalence of alloantibodies was 1.1%. There was a statistically significant difference between alloimmunization rates in the Rh D-antigen negative and D-antigen positive women (12.8% versus 0.3%). The antibodies detected in this study were, anti-D (63.8%), anti-D+C (13.7%), anti-C, anti-E, anti-M, anti-Lea, and anti-Leb (4.5% each). Anti-D contributed to 77.3% of total alloimmunization in this study. Conclusions: In spite of the introduction of prophylactic Rh- immunoglobulin, anti-D (77.3%) is still a common antibody identified in the antenatal women of our region. In developing countries like India, universal antenatal antibody screening, though desirable may not be justified at present as the cost and infrastructure required would be immense. However, it is necessary to impose properly formulated protocols to screen at least the pregnant women with adverse obstetric history.

Background Red blood cell (RBC) alloimmunization is a major challenge to repeated transfusions in β-thalassemia-major patients. The aim of this study was to evaluate the magnitude of RBC alloimmunization and autoimmunization in regularly transfused Egyptian patients with β-thalassemia major and analyze factors that may be responsible for the development of antibodies. Patients and methods This study was conducted on 200 Egyptian β-thalassemia-major patients with age less than 16 years, who routinely visited the Pediatric Hematology Clinic of Ain Shams University Hospital for regular transfusions. All the patients underwent antibody screening. Patients with a positive antibody screen were further tested for antibody identification. The data were analyzed to find out the frequency of alloimmunization, and the patients' records were revised to analyze the factors influencing it. In case of pan-positivity of the antibody-screening cells and the autocontrol, adsorption by autogenic RBCs was performed to uncover the presence of alloantibodies. Results RBC alloantibodies were found in 21 (10.5%) patients. The most frequent alloantibodies encountered were anti-Kell (52.4%) and anti-E (19%). Autoantibodies were encountered in only one patient. They were the warm autoantibody type, and adsorbtion using autogenic RBCs was succesful in eliminating them. The frequency of blood transfusion, the transfusion index, serum ferritin, and the age at first transfusion showed a statistically significant correlation with alloimmunization ( P 0.05). Conclusion We conclude that alloimmunization to RBC antigens is a relatively frequent finding among Egyptian transfusion-dependent thalassemic patients. The most frequent antibodies detected were against the Kell and Rh blood groups, mainly anti-Kell and anti-E. The majority of alloantibodies detected in this study were clinically significant.

Mixed field agglutination in serology usually describes the presence of two populations of red cells. Here we present images with two uncommon reasons for mixed field reaction. In both the cases, we observed mixed field reaction during pretransfusion testing using column agglutination technology [Figure 1]. Relevant patient's history was obtained and further immunohematological work-up was carried out in both the cases to look for the possible cause. In the first case, there was no history of blood transfusion, direct antiglobulin test was negative. Antibody screening cells showed pattern and the antibody identified was anti-M. However, all the panel cells with heterozygous expression of M antigen showed mixed field agglutination. Presence of anti-M antibody was confirmed by enzyme treatment and phenotyping the patient for M antigen. In second case, uniform mixed field agglutination was observed with the antibody screening cells including the autocontrol. Direct antiglobulin test was negative. However, we suspected the interference of test results by fibrin residues. To confirm and to resolve the problem, we incubated patient's clotted sample at 37°C for 30 min and used well-separated serum sample for repeat antibody screening. As shown in the image of the second case, mixed field reaction resolved completely and on cross-matching the problem did not recur. Figure 1 Mixed field agglutination: Unusual causes and serological approach Knowing all the possible causes of mixed field reaction would help to resolve and interpret the results accordingly. Anti-M is generally a cold reacting antibody and its reaction strength may vary because of dosage. Antibodies to Lutheran and Sda antigens may show mixed field appearance but it is unusual for anti M antibodies.[1] However in the present case, mixed field reaction was noticed only with the panel cells having heterozygous expression of M antigen. Serum separation though a very simple technique has a great importance on the outcome of the immunohematological results. As illustrated in this case, failure to adhere to proper serum separation technique would unnecessarily create confusion and delay the transfusion support to the patient.

Context: Detailed reports of red cell alloantibody frequencies and specificities in the Thai population are limited. The aims of this study were to determine the specificity and compare the frequency of alloantibodies detected using column agglutination technology (CAT) and conventional tube techniques in blood donors and previously transfused patients. Settings and Design: We retrospectively reviewed antibody screening and identification records for two time periods: January-December 2006 during which conventional tube techniques were used and January 2008-December 2009 when CAT was used. Results: The overall prevalence of alloantibodies in both patients and donors when using conventional tube techniques was 0.7%, for patients only was 0.9% and donors 0.6%. The most frequent antibodies detected in both groups were anti-Lea, anti-Mia, anti-Leb, anti-P1 and anti-E. When using CAT, alloantibodies were found in 0.8% of patients and 0.13% of donors with the five most common alloantibodies found in patients were anti-Mia, anti-E, anti-Lea, anti-c and anti-Leb respectively. Similarly the common alloantibody specificities in donors were anti-Lea, anti-Mia, anti-Leb, anti-M and anti-D. Conclusions: One of the most commonly identified alloantibodies in the Thai population studied was anti-Mia suggesting that Mia positive red cells should routinely be included in antibody screening and identification in this population. For antibody screening and identification, CAT method detected immune and warm alloantibody (ies) more frequently than that associated with conventional tube techniques.