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Introduction Lewis antibodies have been thought to play a small role in clinical transfusion practice, but recent reports suggest that they have gained more importance in the context of transfusion and transplantation. Data regarding the prevalence of Lewis antibodies and their clinical significance in the Indian context is very limited. Hence, this study was aimed at analyzing the serological characteristics and clinical significance of Lewis antibodies encountered in our patient and donor populations. Methods The retrospective data analyzed the records of red cell antibody screening results and the additional serological evaluation performed on the donor and patient samples included in the study. Results A total of 26 study subjects were noted to have Lewis antibodies (including 6 healthy donors and 20 patients). Of them, 13 individuals had anti-Leb, 10 had anti-Lea and the remaining three had an anti-Lea/Leb mixture. IgG Lewis antibodies were detected in 7 individuals. All cases of IgM Lewis antibodies detected were reacting at 37°C. Two patients were suspected of having hemolytic transfusion reactions due to Lewis antibodies. Antigen-negative cross-match compatible units were provided for transfusion in the recipients. Conclusion Lewis antibodies of the IgM class reacting at 37°C should be regarded as clinically important. The present study findings urge that the lab personnel look for the thermal amplitude of Lewis antibodies, irrespective of the fact that the antibody class and antigen-negative crossmatch compatible units should be provided to avoid hemolytic transfusion reactions.

Background:Children with exposure to coronavirus disease 2019 in recent times (asymptomatic or symptomatic infection) approaching congenital heart surgery programme are in increasing numbers. Understanding outcomes of such children will help risk-stratify and guide optimisation prior to congenital heart surgery.Objective:The objective of the present study was to determine whether convalescent coronavirus disease 2019 children undergoing congenital heart surgery have any worse mortality or post-operative outcomes.Design:Consecutive children undergoing congenital heart surgery from Oct 2020 to May 2021 were enrolled after testing for reverse transcription-polymerase chain reaction or rapid antigen test and immunoglobulin G antibody prior to surgery. Convalescent coronavirus disease 2019 was defined in any asymptomatic patient positive for immunoglobulin G antibodies and negative for reverse transcription-polymerase chain reaction or rapid antigen test anytime 6 weeks prior to surgery. Control patients were negative for any of the three tests. Mortality and post-operative outcomes were compared among the groups.Results:One thousand one hundred and twenty-nine consecutive congenital heart surgeries were stratified as convalescence and control. Coronavirus disease 2019 Convalescent (n = 349) and coronavirus disease 2019 control (n = 780) groups were comparable for all demographic and clinical factors except younger and smaller kids in control. Convalescent children had no higher mortality, ventilation duration, ICU and hospital stay, no higher support with extracorporeal membrane oxygenation, high flow nasal cannula, no higher need for re-intubations, re-admissions, and no higher infections as central line-associated bloodstream infection, sternal site infection, and ventilator-associated pneumonia on comparison with coronavirus disease 2019 control children.Conclusions:Convalescent coronavirus disease 2019 does not have any unfavourable outcomes as compared to coronavirus disease 2019 control children. Positive immunoglobulin G antibody screening prior to surgery is suggestive of convalescence and supports comparable outcomes on par with control peers.

The study aimed to determine the specificity and sensitivity of the Ortho BioVue two-column agglutination system for the detection of low concentrations of clinically significant antibodies in serum. The BioVue system was compared with the conventional tube technique [LISS-Coombs indirect antiglobulin test], and the two-stage Papenzyme test was used to resolve discrepancies between the two methods. We tested 3000 serum samples from randomly selected patients at King Hussein Medical Centre. Both the antibody screening and identification gave negative results in 2952 patients and positive results in 48 patients. We found the BioVue system to be the more sensitive technique. However, if papain enzyme-treated cells were included in the conventional tube technique when applied to antibody screening and identification, both methods would be of comparable sensitivity

Detection of clinically significant alloantibodies during pretransfusion testing is essential before any blood transfusion. Sometimes, clinically insignificant antibodies unrelated to blood group antigen may interfere with routine testing. Their interpretation is often made only after tedious immunohematology workup resulting in the exclusion of all possible clinically significant antibodies. We encountered such incidence which interfered with crossmatching. In our case, direct antiglobulin test was negative, indirect antiglobulin test and autocontrol were positive with pan-reactive antibody screening test, and group-specific units were incompatible. After meticulous workup, we could find that these antibodies were directed against the enhancement media, low-ionic strength solution in this case.

The landscape of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) diagnostic testing is rapidly evolving. While serology testing has limited diagnostic capacity for acute infection, its role in providing population-based information on positivity rates and informing evidence-based decision making for public health recommendations is increasing. With the global availability of vaccines, there is increasing pressure on clinical laboratories to provide antibody screening and result interpretation for vaccinated and non-vaccinated individuals. Here we present the most up-to-date data on SARS-CoV-2 antibody timelines, including the longevity of antibodies, and the production and detection of neutralizing antibodies. Additionally, we provide practical guidance for clinical microbiology laboratories to both verify commercial serology assays and choose appropriate testing algorithms for their local populations.

Background and objective Routine antenatal anti-D prophylaxis (RAADP) to RhD-negative women is most often administered in gestational age (GA) 28-30 weeks with the next anti-D dose administered postpartum. The aim of this study was to analyse the proportion of RhD-negative women where RAADP is not detectable at term and in a pilot study to investigate whether RAADP administered in GA 28 and 38 results in detectable levels at term, post-term and post-delivery. Materials and methods In a retrospective analysis, 4280 RhD-negative women carrying an RHD positive fetus were included and the proportion with a negative antibody screen at delivery was determined. In the second part, 39 pregnancies were included prospectively, a second dose of RAADP was administered in GA 38 weeks, and anti-D was quantified before the second dose and then weekly for 5 weeks. Results In the retrospective analysis, 20·5% (856/4280) with RAADP administered in GA 28 were negative in routine antibody screening at delivery. In the small prospective study, 18% (7/39) had a negative antibody screen and 26% (10/39) had levels below 0·005 IU/ml, in the quantification assay, in GA 38. Anti-D prophylaxis administered in GA 38 showed detectable levels of anti-D up to 30 days post-delivery, with concentration at delivery 0·060 ± 0·034 IU/ml (mean ± SD). Conclusion Approximately 20% of the RhD-negative women show non-detectable levels of anti-D at term. A second dose of RAADP at GA 38 results in stable concentrations of anti-D at term, post-term and post-delivery, but with large interindividual variation.

Daratumumab, a monoclonal antibody targeting CD38, is approved to treat multiple myeloma. Red blood cells express low levels of CD38, which can result in a false-positive antibody screen in daratumumab-treated patients. Educational materials were developed to inform healthcare professionals (HCPs) and blood transfusion management department personnel (BTMDP) about this risk and recommended measures to mitigate that risk. Materials were distributed in European countries where daratumumab was commercially available. This post-authorization safety study was designed to evaluate whether HCPs and BTMDP understood the materials. An anonymous, cross-sectional, non-interventional, web-based survey was distributed in 12 European countries. Four key questions were identified, for which a correct answer from at least 80% of respondents was considered indicative of satisfactory effectiveness. A total of 408 participants completed the questionnaires (62.3% (n = 254) HCPs and 37.7% (n = 154) BTMDP). Responses were consistent between groups. All respondents were aware of the educational materials (the first key question) and at least 80% correctly answered three of the four key questions. A key question regarding which blood typing test(s) daratumumab interferes with did not achieve satisfactory effectiveness (60% correct responses). In a weighted analysis, 79% of respondents correctly identified the recommended measures for daratumumab-treated patients requiring transfusion. This was attributed to an error in the survey’s German translation; in a sensitivity analysis, 90% of participants correctly responded to this question. Results suggest that participants were aware of the educational materials, the risk of daratumumab interference with blood testing, and recommended measures to mitigate that risk.

Objective The aim: To investigate the utility of testing for chlamydial heat shock protein 60 (CHSP60) antibodies in the diagnosis of tubal infertility. Patients and methods Materials and methods: All the collected samples were assayed for IgM and IgG antibodies to chlamydia trachomatis and chlamydial heat shock protein 60 (CHSP60) by using immunofluorescence and enzyme-linked immunosorbent assay (ELISA) techniques, respectively. Results Results: There were no substantial differences between antibodies to C. trachomatis in females with tubal infertility (67%) and non-tubal infertility (48%). However, women with tubal infertility (45%) have more anti-CHSP60 antibodies than non-tubal infertility (9%). Antibody screening for C. trachomatis has only (63%) sensitivity and (54%) specificity for detecting tubal infertility. On the other hand, the CHSP60 antibody testing has (44%) sensitivity and 92% specificity for diagnosing tubal infertility. A positive microimmunofluorescence (MIF) titer was observed in 12 of 18 (67%) females with the tubal problem, 31 of 64 (48%) with non-tubal infertility (P=0.3, OR=2.2, 95% CI=0.71 to 8.01). The CHSP60 antibodies were found in 8 of 18 (45%) females with tubal problem & 6 of 64 (9%) women with non-tubal infertility, power factor alpha α P=0.004, OR=9.3, 95% CI=2.1 to 43.2, power= 1.002 for n= 0.05). Incorporating CHSP60 and C. trachomatis antibodies testing gives an excellent positive probability proportion of 10 to diagnose C. trachomatis associated tubal infertility. Conclusion Conclusions: CHSP60 antibody testing is a more specific evaluation than antibody testing for C. trachomatis for predicting chlamydia-associated tubal infertility. Using these tests at the first infertility examination may help the immediate diagnosis for non-interceptive tubal infertility.

Background: Malaria is a mosquito-borne infectious disease caused by protozoan parasites of the genus Plasmodium. As migration of populations from endemic areas to Europe and overseas recreational travel to endemic regions increase, there is also a growing risk of transfusion-transmitted tropical diseases by blood components. Material and Methods: In the present study two routine Plasmodium spp. ELISA (CAPTIA™ Malaria EIA, Trinity Biotech, and Malaria EIA, BioRad) were compared with a new commercial ELISA (ELISA IgG, EUROIMMUN). From December 1, 2015 until November 30, 2016, 1,096 plasma samples from blood donors with a potential risk of malaria infection were collected at two blood transfusion centres in Germany and Switzerland. Results: The samples were tested comparatively with the ELISA from EUROIMMUN and the routine test used at the respective centre. Thirty-four of 595 (5.7%) tested blood samples from centre 1 and 49 of 501 (9.8%) tested blood samples from centre 2 showed reactivity on either or both ELISAs. All 83 reactive samples were sent for confirmation to the Diagnostic Centre of the Swiss Tropical and Public Health Institute (Swiss TPH) in Basel, Switzerland. Sixteen samples, which previously were reactive in the routine Plasmodium spp. EIA assays, were proven positive after confirmation testing (i.e., 4 positive and 12 inconclusive results), indicating an anti-Plasmodium antibody prevalence in blood donations of 1.5%. From these 16 reactive samples, 13 were also detected by the index test, resulting in an assay sensitivity of 81.2%. A specificity of 98.6% was calculated (1,065/1,080 confirmed negative samples). The overall agreement with the reference centre was 95.8% in centre 1 and 94% in centre 2. Conclusion: The comparison of the new EUROIMMUN ELISA and the established CAPTIA™ Malaria EIA (Trinity Biotech) and Malaria EIA (BioRad) used for routine blood donor screening in two laboratory blood donation centres revealed that all tested ELISAs show comparable sensitivities and are equally suitable for anti-Plasmodium antibody screening in blood banks.

Background: The WHO recommends that pre-transfusion testing should include ABO/RhD grouping followed by screen- ing for red blood cell (RBC) alloantibodies using the indirect antiglobulin test (IAT). However, in Uganda, current practice does not include RBC alloantibody screening. Objective: To assess the utility of ‘home-made’ reagent RBCs in alloantibody screening. Materials and methods: In a laboratory-based study, group O RhD positive volunteer donors were recruited and their extended phenotype performed for C, c, E, e, K, Fya, Fyb Jkb, S and s antigens. These ‘home-made’ reagent RBCs were preserved using Alsever’s solution and alloantibody detection tests performed. For quality assurance, repeat alloantibody screening of patients’ samples was done at Bloodworks Northwest Laboratory in Seattle, United States. Results: A total of 36 group O RhD positive individuals were recruited as reagent RBC donors (median age, 25 years; range, 21 – 58 years; male-to-female ratio, 1.6:1). Out of the 311 IATs performed, 32 (10.3%) were positive. Confirmatory IAT testing in the United States was in agreement with the findings in Uganda. Conclusion: Use of ‘home-made’ reagent RBCs during pre-transfusion testing in Uganda is feasible. We recommend the introduction of pre-transfusion IAT alloantibody screening in Uganda using ‘home-made’ reagent RBCs to improve trans- fusion safety. Keywords: Blood transfusion; ‘Home-made’ reagent RBCs; Pre-transfusion testing; RBC alloantibody screening; Uganda.

Red blood cell (RBC) transfusion to neonates is thought to rarely provoke an immune response. Neonatal testing guidelines suggest that antibody screening is not necessary when the mother has no antibodies. Alternatively, maternal blood samples can be used for antibody screening and cross-matching. However, the guidelines are based on small-scale studies of white-dominant populations. Furthermore, transfusion-related alloimmunization is less well established among children and adolescents as a whole among Japanese and East Asians. To elucidate the incidence of transfusion-related alloimmunization among neonates, children, and adolescents, and whether current guidelines are applicable to Japanese populations, a nationwide retrospective multicenter cohort survey was conducted in 50 tertiary-care hospitals in Japan. Between 2001 and 2015 inclusive, recipients of at least 1 allogeneic RBC transfusion were categorized into groups A-F according to their age at the time of transfusion: (A) neonates1 month; (B) infants 1 to12 months; (C) children 1 to5 years; (D) prepubescents 5 to10 years; (E) young pubescents 10 to15 years; and (F) adolescents/young adults 15 to20 years. Excluding maternally derived antibodies and naturally occurring, cold-reactive, and/or nonspecific antibodies, 69 (0.61%) of 11350 RBC recipients20 years old formed at least 1 clinically significant alloantibody. The alloimmunization rate differed significantly (P .0001) by age: none (0%) of 3407 in group A; 11 (0.46%) of 2410 in group B; 18 (0.76%) of 2361 in group C; 9 (0.80%) of 1119 in group D; 12 (1.15%) of 1043 in group E; and 19 (1.88%) of 1010 in group F. Clearly different incidences of alloimmunization emerged in group A compared to B, C, D, E, or F, as confirmed by logistic regression analysis adjusted by numbers of donor exposure. Alloimmunization did not occur from RBC transfusions within the first month of life and rarely occurred (0.46%-0.80%) after transfusion within the first decade of life. Alloimmunization occurred in 1.15%-1.88% of young pubescents and adolescents/young adults. These findings support the use of guidelines developed in Europe and the United States for East Asian pediatric recipients.

Objectives: Detection of maternal irregular antibodies against red blood cell antigen is vital in the management of hemolytic disease of fetus and newborn. There are no uniform guidelines related to antenatal antibody screening and identification in the developing Country like India. This study was aimed to identify such alloimmunization and its associations. Materials and Methods: This prospective study was conducted on antenatal mothers at a tertiary care center. The mothers having a history of anti-D administration, blood transfusion, and autoimmune disorders were excluded from the study. Initial indirect antiglobulin test (IAT) was performed in all blood samples by conventional tube technique (CTT) to identify alloimmunization. IAT-positive samples were screened for irregular antibody by column agglutination technology (CAT). Antibody screen-positive samples were further analyzed in 11-cell panel by CAT. Antibody strength was measured by serial double dilution by CTT. The source of isoimmunization was identified by extended Rh phenotype of women, husband, and newborn. Results: A total of 12 (2.3%) women out of 530 were positive for IAT and antibody screen. Antibody could be identified in 11 women, of which anti-D (5) was the most common, followed by anti-C + anti-D (4), anti-C + anti-E (1), and anti-C (1). All four cases of anti-D + anti-C were distinguished from anti-G by differential adsorption and elution. There was a significant association with alloimmunization versus increased gravid status, antepartum hemorrhage, and past history of newborns with neonatal jaundice. Conclusion: All pregnant women with history of antepartum haemorrhage, newborn with neonatal jundice should be screened for alloantibody for early detection and better management of HDFN.

Naturally occurring anti-Kpa antibody is extremely rare and was first reported in 1957, named after the first producer 'Penney'. However, the subsequent anti-Kpa reports presented were all anti-Kpa due to isoimmunization. Individuals with severe bacterial infections particularly Gram-negative bacteria are known to be capable of producing cross-reactive antibodies against Kell blood group system. However, such uncommon antibodies like anti-Kpa can be easily missed in routine pre-transfusion testing unless the panel cells containing low incidence antigen are used for antibody screening. Here, we report a case of naturally occurring anti-Kpa antibody, identified incidentally during pre-transfusion testing of a 12-month-old female infant with the diagnosis of Niemann-Pick disease and recurrent bacterial (Escherichia coli) infection.

Thalassemias are considered important health issues throughout Iraq, involving its Kurdistan region. This disorder, particularly its major form, needs lifelong regular transfusions. But this form of medical care is associated with various complications including red cell alloimmunization and autoimmunization. This study determined the frequency and associations of alloimmunization among multi-transfused patients with β-thalassemia major. The subjects were 204 patients who were registered at a thalassemia care center in Sulaymaniyah-Iraqi Kurdistan. The patients’ records were analyzed, their red cells were phenotyped for ABO/RhD antigens using the gel card method, and irregular antibody screening/identification was performed using the standard tube method. Alloantibodies were detected in 5.8% of the patients, while DAT was positive in 4% of the patients, which indicated autoantibodies. The identified alloantibodies were anti-E (2.4%), anti-C (1.4%), anti-e (1%), and anti-K (1%). A patient’s age at the start of transfusion (＞2 years) (P=0.042) and a positive history of transfusion reactions (P=0.003) were correlated with a significantly higher rate of alloantibody formation. From the results of our study, we conclude that measures to decrease the development of alloantibodies may incorporate matching for Rhesus and Kell systems and early induction of blood transfusions. Copyright Ⓒ 2020 The Korean Society for Clinical Laboratory Science. All rights reserved.

Background and Objectives: Crossmatching is one of the bases of pretransfusion testing. Resolving problems in crossmatching should be carried out after proper planning and following departmental guidelines, and hence that time is not wasted, or blood withheld from patient unnecessarily. The aim of this study was to find the prevalence and cause of incompatible crossmatch and to formulate root cause analysis to help ensure safe transfusion. Materials and Methods: This was a prospective study conducted at a tertiary care hospital in North India, from December 2018 to November 2019. Request for blood components was received along with 2 ml labeled sample in ethylenediaminetetraacetic acid and plain tube. Crossmatching was done by column agglutination method in polyspecific (IgG + C3d) bead cards by ortho clinical diagnostic using semi-automated biovue. In case of any incompatible result, it was resolved using appropriate steps. Results: During the study period from December 2018 to November 2019, only 67 (0.65%) of the 10,320 samples received were found to be crossmatch incompatible and evaluated and appropriate donor units issued. The crossmatch incompatibility was much higher in the females (46, 68.7%) than the males (21, 31.3%). The direct antiglobulin test (DAT) was positive in nine patient samples, and the indirect antiglobulin test was found positive in 37 incompatible crossmatch units. Eleven cases of incompatible crossmatch were due to wrong blood in tube, seven due to contamination of reagents, and three due to DAT-positive donor units. Conclusion: In this study, alloimmunization (55.2%) was the most prevalent cause of incompatible crossmatch, and the most common alloantibody identified was anti-E. Incompatible crossmatch poses a challenge in the field of transfusion medicine. Root cause analysis is a systemic method for identifying all the contributing factors to a problem, so that the corrective action can be taken. A logical stepwise approach will enable the provision of safe transfusion.

Background and Objectives: The frequencies of clinically significant blood groups antigens (Rh, Duffy, Kell, Kidd, MNS, P and Lewis) should be known to BTS to manage patients with clinically significant antibodies. This study was conducted to help develop in-house cell panels to manage such patients. Methods and Materials: A total of 331 donors with O blood group with age group of 18 to 45 years, repeatedly donating blood were included in the study. They were screened for antigens of Rh, Kell, Kidd, Duffy, MNS, P and Lewis blood group system. Results: Among 331 donors, 299 (90.3%) donors were RhD Positive. e antigen was prevalent in 328 (99.1%) donors. Only 2 (3.5%) donors with E antigen were lacking D antigen also. All D negative donors (9.7% of total donors) were having strong expression of c and e antigen on their red cells. In Kell system, 100% donors were k antigen positive. All K positive donors are also positive for D antigen. In Kidd and Duffy system, Jka and Fya are more prevalent. In Lewis system, Lea-Leb+ (66.5%) is the commonest phenotype. In MNS system, M antigen was present in 87.61% of donors and s antigen in 83.38% of donors. Conclusions: Knowledge of red cell antigen phenotype frequencies in a population is helpful in terms of their ethnic distribution, in creating a donor data bank for preparation of indigenous cell panels, and providing antigen negative compatible blood to patients with multiple alloantibodies.

Background & objectives: Blood transfusion therapy involves multiple steps to ensure selection of safe blood component for transfusion. This includes testing for infectious markers, full ABO compatibility, free from any clinically significant red cell antibodies and acceptable donor's red cell survival rates without destruction of recipient's red cells. The red cell antibodies present in healthy blood donors can cause severe haemolytic transfusion reaction, especially in massive blood transfusion recipients and paediatric patients. Hence, screening of red cell antibodies in donor blood is important to provide compatible blood products and to avoid haemolytic transfusion reactions in susceptible patient population. This study was planned to assess prevalence, aetiology and type of unexpected red cell antibodies in a large number of whole blood donor population in north India. Methods: This three-year prospective observational study included blood donor samples for antibody screening from January 2015 to December 2017. A total of 166,803 healthy blood donors including 156,128 (93.6%) males and 10,675 (6.4%) females were screened. Results: The prevalence of red cell antibodies was 0.17 per cent in our donor population. Of the total 286 donors with red cell antibodies, 248 (86.7%) had alloantibodies, 30 (10.5%) had autoantibodies and eight donors (2.8%) showed positive antibody screening with inconclusive results. Interpretation & conclusions: Alloimmunization to red cell antigens is a challenging task for current transfusion practices. The antibody screening in blood donors may improve the quality and safety of blood transfusion in the recipients. It also reduces the risk of complications from incompatible blood transfusions.

Red blood cell alloimmunization to antigens other than D, such as C, c, E, e, and antigens in the Kell, MNS, and Duffy blood group systems, has emerged as an important cause of hemolytic disease of the fetus and newborn (HDFN). Antibody screening for these antibodies is not routinely practiced for all antenatal patients in developing countries, mainly because of financial constraints. Here we report a rare case of HDFN due to dual antibodies to Rh and Kidd blood group system antigens: anti-E and anti-Jka. This case report highlights the importance of routine and regular antenatal screening of all pregnant women for proper monitoring and follow-up.

Objective: To understand the status and characteristics of hepatitis B, hepatitis C, syphilis and HIV antibody screening in one dental hospital, and to provide scientific basis for the prevention and treatment of common infectious diseases in dental medical institutions. Methods: Collect all samples of patients screened for hepatitis B, hepatitis C, syphilis and HIV from one stomatological hospital in 2018-2019, and make statistics on the distribution of common infectious diseases among patients in stomatology, such as age, gender, type of treatment, department of treatment, etc. Results: The positive rate of hepatitis B was 2.27%, 39.42% in males and 60.58% in females. It was mainly detected by outpatient department, accounting for 87.5%. The age was concentrated in 30 - 60 years old, accounting for 77.88%. It was mainly distributed in oral and maxillofacial surgery, orthodontics and implant, accounting for 82.69%. The positive rate of hepatitis C was 0.1%, 33.33% in men and 66.67% in women. It was mainly detected by outpatient department, accounting for 83.33%. The age is concentrated in 20 - 50 years old, accounting for 100%. It is mainly distributed in oral and maxillofacial surgery, orthodontics and implant, accounting for 100%. The positive rate of syphilis was 0.18%, 33.33% for men and 66.67% for women. It was mainly detected by outpatient department, accounting for 83.33%. The age is concentrated in 30 - 50 years old, accounting for 100%. It was mainly distributed in oral and maxillofacial surgery, orthodontics and implant, accounting for 83.33%. HIV was not detected. Conclusion: The positive detection rate of common infectious diseases in the stomatological hospitals is generally lower than the average level. It is mainly distributed in the department of implant, oral and maxillofacial surgery and orthodontics. The highest positive detection rate of common infectious diseases is hepatitis B which is 2.27%, and the lowest is HIV which is 0.

Background Studies presenting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection fatality rate (IFR) for healthy individuals are warranted. We estimate IFR by age and comorbidity status using data from a large serosurvey among Danish blood donors and nationwide data on coronavirus disease 2019 (COVID-19) mortality. Methods Danish blood donors aged 17–69 years donating blood October 2020–February 2021 were tested with a commercial SARS-CoV-2 total antibody assay. IFR was estimated for weeks 11 to 42, 2020 and week 43, 2020 to week 6, 2021, representing the first 2 waves of COVID-19 epidemic in Denmark. Results In total, 84944 blood donors were tested for antibodies. The seroprevalence was 2% in October 2020 and 7% in February 2021. Among 3898039 Danish residents aged 17–69 years, 249 deaths were recorded. The IFR was low for people, The COVID-19 infection fatality rate was low for citizens younger than 51 years without comorbidity (3.36 per 100000 infections). The infection fatality rate increased with age and comorbidity but declined from the first to second wave of the epidemic.

Anti-HIV antibody screening and confirmatory tests include rapid diagnostics tests (RDT), which have limited sensitivity, and high-sensitivity ELISA and western blot tests, which are laborious and require technical proficiency. Thus, there is an unmet need for novel rapid, simple, and highly sensitive tests. A pilot study was conducted to assess the performance of a recently developed ultrasound particle agglutination (UPA) method for high-sensitivity HIV antibody detection using 51 confirmed positive and 310 presumably negative plasma samples, and 6 commercially available anti-HIV-1 seroconversion panels (total 56 members). Optimal cutoff value of the UPA method was determined by receiver operating characteristics (ROC) analysis, providing clinical sensitivity and specificity of 100% and 98.1%, respectively. The performance characteristics of UPA, compared with those of some established RDT's and ELISA tests using HIV seroconversion panels, showed 2 days earlier HIV antibody detection than other RDT's and 2nd-generation ELISA, and at approximately the same time as 3rd-generation ELISA. The preliminary analysis of the UPA method performance characteristics showed that it meets the minimum requirements of the WHO guidelines for RDTs as first-line assays. This pilot study paves the way for more detailed validation studies of the UPA method for HIV antibody detection in clinical practice.

BACKGROUND The periodic transfusion of red blood cells (RBCs) is an essential supportive therapy for beta-thalassemia and sickle cell anemia (SCA) patients. Nevertheless, this therapy can cause some adverse effects, such as RBC alloimmunization. This study aimed to determine the prevalence of RBC's alloimmunization and frequency of Rhesus (Rh) and Kell (K) antigens among SCA and beta-thalassemia patients in Al-Madinah region of Saudi Arabia. METHODS A cross-sectional study was conducted on 137 multiple transfusion patients with SCA and beta-thalassemia, who attended two of the largest hospitals located in Al-Madinah, Saudi Arabia. Demographic and medical data were collected from medical files of patients. Blood samples were collected from patients and Rh and Kell typing were done. Also, antibody screening and identification tests were performed. RESULTS There were 66 (48.18%) pediatric patients with mean age of 7.8 years, while adult patients were 71 (51.82%) with mean age of 24.5 years. RBC alloantibodies were found in 9 patients (6.57%), and the most frequent alloantibody was anti-K. Antigen e (99.05%) was the most common antigen, while the least common was the antigen K (3.81%). The association between age (pediatric and adult) and alloimmunization rates was insignificant. CONCLUSIONS Although the RBC alloimmunization rate among SCD and beta-thalassemia patients in this study is low compared to other studies in Saudi Arabia and countries all over the world, it still warrants more attention. Phenotyping of donors/recipients' RBCs for K and Rh subgroups may reduce the risk of alloimmunization and increase the efficiency of blood transfusion.

Antiviral monoclonal antibody (mAb) discovery enables the development of antibody-based antiviral therapeutics. Traditional antiviral mAb discovery relies on affinity between antibody and a viral antigen to discover potent neutralizing antibodies, but these approaches are inefficient because many high affinity mAbs have no neutralizing activity. We sought to determine whether screening for anti-SARS-CoV-2 mAbs at reduced pH could provide more efficient neutralizing antibody discovery. We mined the antibody response of a convalescent COVID-19 patient at both physiological pH (7.4) and reduced pH (4.5), revealing that SARS-CoV-2 neutralizing antibodies were preferentially enriched in pH 4.5 yeast display sorts. Structural analysis revealed that a potent new antibody called LP5 targets the SARS-CoV-2 N-terminal domain supersite via a unique binding recognition mode. Our data combine with evidence from prior studies to support antibody screening at pH 4.5 to accelerate antiviral neutralizing antibody discovery. This article is protected by copyright. All rights reserved.

Evaluation of susceptibility to emerging SARS-CoV-2 variants of concern (VOC) requires rapid screening tests for neutralising antibodies which provide protection. We developed a receptor-binding domain specific hemagglutination test (HAT) which correlated with neutralising antibodies (R=0.74-0.82) in two independent cohorts from 798 convalescents. Home-dwelling older individuals (80-99 years, n=89) had significantly lower antibodies after one dose of BNT162b2 vaccine than younger adult vaccinees (n=310) and naturally infected individuals (n=307). The second vaccine dose boosted and broadened the antibody repertoire to VOC in naïve but not previously infected, older and younger adults. >75% of older adults responded after two vaccinations to alpha and delta, but only 59-62% to beta and gamma, compared to 96-97% of younger vaccinees and 68-76% of infected individuals. Overall, the HAT provides a surrogate marker for neutralising antibodies, could be used as a simple inexpensive, rapid test, rapidly adaptable to emerging VOC for large-scale evaluation of potentially diminishing vaccine effectiveness.

Background The detection of clinically significant antibodies to red blood cell antigens is important for the selection of compatible blood for patients. The conventional test tube technique (CTT) is commonly used as the gold standard test, but manual testing and visual detection of hemagglutination may produce errors. A more recently developed method, the column agglutination technique (CAT), facilitates ease of testing. Objectives To investigate the specificity and sensitivity of the CAT compared to the CTT for the screening of clinically significant antibodies from the Rh blood group. Material and methods Standard antibodies to the Rh blood group, anti-D, -C and -E, were used as examples of clinically significant antibodies in transfusion science. The antibodies were serially diluted by two-fold, then reacted with screening cells with different antigen expression. The hemagglutination reaction was investigated using both techniques, and the grades and scores of the reactions were used to analyze the sensitivity and specificity of the CTT and CAT. Results The CAT had a better sensitivity than the CTT. The lowest antibody dilution of 1:8192 could be detected using CAT, while a dilution of only 1:2048 could be detected with CTT. However, the CTT and CAT were equal in specificity. The 2 techniques specifically detected all antibodies to the screening cells. Conclusions Both the CAT and CTT showed 100% specificity. However, the CAT exhibited more sensitivity than the CTT, and can be used in substitution of, or in parallel with, the CTT technique for red blood cell phenotyping, antibody screening, identification, and crossmatching.

Aim The incidence of bleeding complications in laparoscopic surgery are low. At present, there are no national guidelines on pre-operative blood group and antibody screening (G&S) in patients undergoing emergency laparoscopic surgery. The aim of this study is to establish the incidence of intraoperative bleeding requiring transfusion during emergency laparoscopic appendicectomy. In turn, this will indicate the necessity of routine preoperative G&S. Method Retrospective data collection of all emergency laparoscopic appendicectomy procedures at a large tertiary hospital from January 2015 to January 2020 (5 years). Patients having routine or open procedures were excluded. The transfusion department records were used to identify any patients receiving a transfusion intraoperatively. Results 1362 emergency laparoscopic appendicectomy procedures were performed during the 5-year period. 4/1362 (0.29%) patients received intraoperative transfusion of blood products. Of these, 3 patients had known haematological disorders. One patient was transfused for bleeding associated with intraoperative miscarriage. Conclusions No patients required transfusion for surgical haemorrhage. The small number of patients requiring transfusion were predictable because of pre-existing haematological disorders and clinical status. Our data is one of the largest series available and the results demonstrate that routine preoperative G&S is not justified. Instead, a selective approach would ensure high risk patients are appropriately screened. In event of vessel injury and major haemorrhage, O negative blood can be used. Furthermore, we estimate that elimination of a routine second G&S sample could have saved our institution approximately £2500 per year.

Aim Laparoscopic cholecystectomy is generally safe with low rates of intraoperative bleeding. At present, there are no national guidelines on pre-operative blood group and antibody screening (G&S) for this procedure. The aim of this study is to establish the incidence of intraoperative haemorrhage requiring transfusion during laparoscopic cholecystectomy. This will indicate the necessity of routine preoperative G&S. Method Retrospective data collection of all patients having laparoscopic cholecystectomy at a large tertiary hospital from January 2015 to January 2020 (5 years). Patients having emergency procedures were excluded. The transfusion department records were used to identify any patients receiving a transfusion intraoperatively. Results 2894 laparoscopic cholecystectomy procedures were performed over the 5-year period. 150 patients having emergency surgery were excluded. The final group consisted of 2744 patients. 1392/2744 (50.7%) patients were managed as a day case. 1352/2744 (49.3%) patients underwent elective surgery. 5/2744 (0.002%) patients received an intraoperative transfusion of blood products for the management of pre-existing haematological disorders. Conclusions No patients required transfusion for surgical haemorrhage. The small number of patients requiring transfusion were predictable because of clinical status. Our data is one of the largest series available. The results demonstrate that routine preoperative G&S is not justified. Instead, a selective approach would ensure high risk patients are appropriately screened. In event of vessel injury and major haemorrhage, O negative blood can be used. Furthermore, we estimate that elimination of a routine second G&S sample could have saved our institution approximately £5200 per year.

Background Since no single test is always accurate and sensitive, two or more tests are used to increase the precision of evaluation. Different algorithms have been proposed by centers in Leiden, Basel, Vienna and Minnesota, etc. With an intention to develop an optimal algorithm for India, we evaluated pre-transplant compatibility tests for live-donor kidney transplants. Three tests complement dependent cyto-toxicity cross-match (CDCXM), flow-cytometry cross-match (FCXM) and anti-HLA antibody screening (HAS) were performed and confirmed by the anti-HLA antibody identification (HAI) assay in a multi-centric trial (three transplant centers) in India. Materials and methods All prospective recipients (and their potential donors) underwent low-resolution HLA typing as well as CDCXM, FCXM and HAS assays. In addition, HAI {single antigen bead assay; (SAB)} was done for all recipients to identify possible anti-HLA antibodies. In a virtual cross-match (VXM), antibody specificity was mapped to donor HLA type to determine donor-specific antibodies (DSA). Only patients without DSA were cleared for the transplant. Alternatively, patients with DSA were offered an exchange in the kidney paired donation (KPD) program. The screening results (CDCXM, FCXM, and HAS) were analyzed, individually as well as in combination of screening assays (CDCXM+HAS, CDCXM+FCXM, and FCXM+HAS) and the results were compared with those from the HAI test. Results Out of 100 patients, 69 were males and 31 were females; 85 recipients (85%) underwent a kidney transplant. The sensitivity of CDCXM was only 12.1% and the specificity of CDCXM was 100%; whereas the sensitivity of FCXM was 84.8% and the specificity of FCXM was 89.6%. The sensitivity and specificity of class I HAS was 88.2% and 84.3%, respectively. The sensitivity and specificity class II HAS was 88.0% and 80.0%, respectively. However, when both class I/II HAS were tested together the sensitivity increased to 97.0% and the specificity to 82.1%. Similarly, the sensitivity of combined FCXM+HAS had the sensitivity of 100% and the specificity of 76.1%; CDCXM+FCXM had the sensitivity of 84.8% and the specificity of 89.6% and CDCXM+HAS assays reached 97% with the specificity of 82.1%. Conclusions Our results showed that the algorithm of FCXM with HAS produced the best sensitivity of 100%. The specificity of 76.1% indicate that the combined FCXM+HAS assays may detect up to 24.9% false positive results. We suggest that these false-positives may be easily resolved by performing the virtual crossmatch based on HAI (SAB) results. In our reflex testing algorithmic approach only 49% patients needed HAI (SAB). Finally, our results suggested that the CDCXM assay may be discontinued in pre-transplant workup owing to its very low sensitivity (12.1%).

Background Transfusion is a lifesaving treatment for lots of patients. However, in chronic blood recipients such as thalassemia patients, there are high concerns about alloantibody production that affects the quality of their life. Therefore, research on risk factors of alloimmunization has been started and followed. This study aimed at the determination of correlation probability between some HLADRB1 alleles and alloimmunization in Iranian thalassemia patients. Materials and methods The present study was conducted on 60 alloimmunized and 60 non-alloimmunized transfusion-dependent thalassemia patients. Antibody screening and identification tests were carried out using the tube method, and HLA-DRB1 genotyping was done using a single specific primer-polymerase chain reaction (PCRSSP). Results The results of antibody screening showed that the most prevalent alloantibodies were Anti-K (46.7 %), and followed by Anti-E (32.5 %), Anti-C (15.8 %), Anti-D (13.3 %), Anti-e (8 %), and Anti-c (5.8 %), respectively. DRB1*07:01 was detected more in non-responder patients (28.3 %). However, data analysis showed that there is no significant relationship between DRB1*07:01, *10, *13:01 frequency among responder and non-responder groups (p = 0·195, 0.648, 0.402, respectively). There was not any significant correlation between HLA-DRB1*10 and *13:01 allele and alloimmunization. There was a significant association between HLA-DRB1*12 and alloimmunization (p Conclusion The findings of this study represented that there is a significant relationship between HLADRB1*12 and Kell and E alloantibodies. Although more developed studies on other HLA alleles are demanded, these findings can be valuable in determining important alloimmunization risk factors to better management of transfusion complications.

BackgroundAntibody titration and the life span of the antibody against SARS-CoV-2 have been found to be determined by the clinical presentation as well. The extent of exposure of health care workers and the general public to SARS-CoV-2 needs to be assessed to monitor the COVID-19 pandemic. Thus, this study is an attempt in assessing the anti-SARs-COV-2 antibody in health care workers.MethodsThis laboratory-based cross-sectional study was performed in Manmohan Memorial Medical College and Teaching Hospital, Kathmandu from November 2020 to January 2021. A total of 185 HCWs were screened for anti-SARS-CoV-2 antibody in the blood serum specimens. A structured questionnaire was administered to collect information from HCWs. Anti-SARS- CoV-2 antibody screening was performed using a lateral flow immunoassay. Data were analyzed according to standard statistical methods using SPSS version 20.ResultsA total of 185 HCWs were participated in the study, among which 41 (22.2%) of them tested positive for anti-SARS-CoV-2 antibody. Among the 41 individuals who tested positive, 37 of them tested positive for IgG only and 4 of them tested positive for both IgM and IgG antibodies. Presence of history of SARS-CoV-2 infection (pConclusionThe burden of SARS-CoV-2 infection among healthcare workers seems to be high and HCWs are at risk of acquiring infection in the workplace. Anti-SARS-CoV-2 antibody screening among health care workers is highly recommended in multiple healthcare settings that can help in monitoring transmission dynamics and evaluation of infection control policies.

Mingchun Lin,1,2 Meixiu Liu,3 Shulian Zhang,1 Chao Chen,1 Jin Wang1 1Neonatal Department, Children’s Hospital of Fudan University, Shanghai, 201102, People’s Republic of China; 2Neonatal Fellowship Training at Children’s Hospital of Fudan University, Yueqing Maternal and Child Health Hospital, Wenzhou, Zhejiang Province, People’s Republic of China; 3Blood Bank, Children’s Hospital of Fudan University, Shanghai, 201102, People’s Republic of ChinaCorrespondence: Jin WangNeonatal Department, Children’s Hospital of Fudan University, No. 399, Wanyuan Road, Shanghai, 201102, People’s Republic of ChinaTel +86-21-64932960Email drwangjin@fudan.edu.cnPurpose: To review the neonatal cases with different types of minor blood group incompatible haemolytic diseases in China, and to improve the clinical understanding and management.Materials and Methods: Seven cases from January, 1st, 2013 to December 31st, 2019 were searched out and reviewed retrospectively. All clinical data and laboratory findings were collected.Results: There were totally seven cases enrolled including three cases of MNS, three of Diego, and one of Kidd combined with Rh, anti-RhE incompatibility. Among the seven cases, two had intrauterine transfusion, two underwent exchange transfusion, five received intravenous immune globulin, five cases developed anaemia, and three of them had transfusion. But among them, only four were found to have positive antibody screening and three were confirmed HDN with antibody types antenatally.Conclusion: The clinical presentation is diverse. Antibody screening followed by the technique of peak systolic velocity in the fetal middle cerebral artery (MCA-PSV) helps to filter out the severe cases.Keywords: neonatal haemolytic disease, HDN, alloimmunization, MNS blood group, Diego blood group, Kidd blood group

Introdução: A Organização Pan-Americana da Saúde estima que 2,0% da população deveria doar sangue regularmente. Os países da América Latina e Caribe coletam sangue equivalente a 1,5% de sua população, abaixo do preconizado, deixando a oferta para viabilidade transfusional indisponível. Objetivo: Realizar a identificação de anticorpos irregulares (IAI) no plasma de doadores de sangue com relevância clínico-transfusional dos sistemas Rh, KELL, DUFFY, KIDD e MN oriundos dos hemocomponentes descartados de doadores com pesquisa de anticorpos irregulares (PAI) positiva com idade entre 18 e 69 anos, independente de sexo, no Hemocentro do Estado do Amapá. Método: Foi utilizado para a realização dos testes para PAI e IAI o Gel Teste®. A análise estatística realizada foi o teste Qui-quadrado. Resultados: Durante os períodos entre junho de 2009 a janeiro de 2013 (Período I) e setembro de 2016 e março de 2017 (Período II), foram encontradas 144 amostras PAI positivas (0,28%) em 51.985 doações de sangue, porém foi realizado o IAI em apenas 111 amostras (0,21%), tendo como anticorpo mais frequente o anti-D em 26 amostras (22,8%), anti-Kpa em 19 amostras (19,3%), anti-Dia em 18 amostras (15,8%), e outros com menor frequência. Os sistemas Rh e KELL foram os mais frequentes e de grande relevância transfusional, o que corrobora a literatura científica sobre o assunto. Conclusões: Observou-se que bolsas positivas para os testes de PAI são desprezadas, gerando um custo em torno de R$ 163.772,64, visto que os hemocomponentes poderiam ser, em alguns casos, utilizados, o que aumentaria o número de bolsas no estado do Amapá e auxiliaria o serviço de hemoterapia.

The Bombay Blood Group (Oh) is characterized by absence of normal ABH antigens and presence of corresponding antibodies in serum. This blood group is suspected when a sample doesn’t show any reaction to anti-A and anti-B antibodies just like a normal O group would do but shows agglutination in reverse grouping or during antibody screening. Present case report highlights a case of 25 year old female who was incidentally detected having Bombay blood group and on further evaluation, one sibling and two first degree cousins were also detected having Bombay blood group. Such a clustering of Bombay blood group cases in a single-family is very rare and has never been reported in Punjab as per literature.

Background Hepatitis E virus (HEV) infection is hyper-endemic in China, it is characterized with a high morbidity of fulminant hepatitis and mortality in pregnant women. The first hepatitis E vaccine, HEV 239, was licensed in China in 2011 which provides an effective preventive measure. Objective To evaluate the cost-effectiveness of vaccination with HEV 239 in women of childbearing age in China and whether HEV antibody screening should be considered before vaccination. Methods A decision tree-Markov model was constructed to simulate HEV infection in a closed female cohort with an average first-marriage age of 25 years and evaluate health and economic outcomes of two potential vaccination strategies, direct vaccination and combined screening and vaccination, from a societal perspective. An incremental cost-effectiveness ratio (ICER, additional costs per disability-adjusted life-year (DALY) averted) was calculated for each vaccination strategy versus no vaccination and between two vaccination strategies. Univariate and probabilistic sensitivity analyses were conducted to assess the robustness of the model findings. Results ICERs of direct vaccination and combined screening and vaccination versus no vaccination were $4040 and $3114 per DALY averted, respectively, much lower than 1-time Chinese per-capita GDP ($8127). Direct vaccination would need additional $45,455 for each DALY averted compared with combined screening and vaccination, far more than the 3-time per-capita GDP. Probabilistic sensitivity analyses confirmed our findings that two vaccination strategies would be cost-effective if the willingness-to-pay reached the 1-time per-capita GDP, and that combined screening and vaccination would be more cost-effective than direct vaccination strategy. Conclusion Vaccinating women of childbearing age with HEV 239 would cost less than the 1-time per-capita GDP for each DALY averted in China, and the vaccination with a prior screening would be the optimal option.

BACKGROUND Parvovirus B19 (B19V) can cause severe anemia, hydrops foetalis, and even death in vulnerable patients. To prevent transfusion-transmitted B19V infection of at-risk patients, B19V antibody screening of blood donors was implemented. The cost-effectiveness of this intervention is unclear, as the likelihood of transmission through blood and subsequent complications for recipients are unknown. This study estimates the cost-effectiveness of anti-B19V donor screening in the Netherlands. STUDY DESIGN AND METHODS The estimates needed for the cost-effectiveness model were: the occurrence of B19V in Dutch blood donors, the number of anti-B19V tested products required by hospitals, the likelihood of morbidity and mortality given B19V infection, treatment costs, and screening costs. These estimates were obtained from literature and observational data. When data were unavailable, structured expert judgment elicitation and statistical modeling were applied. RESULTS The costs of preventing one transfusion transmitted B19V infection are estimated at €68,942 (€42,045 - €102,080). On average, 1.25 cases of morbidity and 0.12 cases of mortality are prevented annually. Although the perceived risk of transfusion transmitted B19V infection was low, half of the treating physicians favored anti-B19V screening. CONCLUSION The estimated mortality and morbidity caused by B19V infection was low in the risk groups. The cost-effectiveness ratio is similar to other blood safety screening measures. No guidance exists to evaluate the acceptability of this ratio. The explicit overview of costs and effects may further guide the discussion of the desirability of B19V safe blood products.

Blood type phenotype incompatibility including Rhesus between donors and patients may result in cross-matching problems, triggering alloimmunization, and caused Hemolytic Transfusion Reaction (HTR). Rhesus blood type incompatibility between mother and fetus may cause Hemolytic Disease of Fetus and Newborn (HDFN). Pretransfusion phenotypic blood groups matching also reduce cost efficiently which means antibody screening is no longer needed. The purpose of the study is to find the proportion Rhesus blood type phenotypes in routine blood donors at Blood Donor Unit, Indonesian Red Cross in Bandung city, Indonesia.The study is a descriptive and observational with cross sectional design. The study was done at Blood Donor Unit, Indonesian Red Cross in Bandung city from April 2016 to September 2017. The subjects were 142 routine blood donors, blood sampling was done simultaneously with blood donation. Rhesus antigen examination of ethylenediaminetetraacetic acid (EDTA) blood was done by gel method. Subjects characteristics were male (68%) and female (32%), with the mean age was 39 years. Examination of Rhesus antigen were found antigen D(100%), antigen e(98,6%), antigen C(97,9%), antigen c(38,7%) and antigen E(31,7%). Results of Rhesus phenotypes were DCe/DCe(61,3%), DCe/DcE(29,6%), DCe/dce(7%), DcE/DcE(1,4%) and DcE/dce(0.7%). The distribution of Rhesus blood type were affected by factors such as genetics, race, ethnicity, marriage, demography, and migration. Rhesus blood phenotypes proportion in routine blood donors at Blood Donor Unit, Indonesian Red Cross in Bandung city sorted from the most are DCe/DCe, DCe/DcE, DCe/dce, DcE/DcE and DcE/dce.Keywords: blood donor, phenotype, Rhesus