ABSTRACT
【Objective】 To discuss the case reports concerning anti-CD47 monoclonal antibody interfere in pre-transfusion testing, so as to find mitigation strategies for this drug interference. 【Methods】 Blood transfusion cases in clinical trials concerning CD47 mAb drugs at home and abroad were retrieved from PubMed, Medline, Web of Science, Wanfang data knowledge service platform and CNKI database. The characteristics and solutions of this drug interfering with pre-transfusion testing were analyzed. 【Results】 A total of 26 cases concerning anti-CD47 mAb interference in pretransfusion testing were retrieved, and 16 valid cases were included in this study (All received HU5F9-G4 as anti-CD47 mAb). After treatment with Hu5F9-G4, the discrepancy between forward and reverse blood typing reached 77% in pre-transfusion testing. Panagglutination was presented in antibody screenings, and all(100%) platelet antibody screenings was interfered. These results indicated that Hu5F9-G4 seriously affected the compatibility test of blood transfusion. Methods of eliminating anti-CD47 interference, as well as their advantages and disadvantages were further analyzed. 【Conclusion】 The advantages and disadvantages of eliminating anti-CD47 interference with pre-transfusion testing was analyzed according to its characteristics, which could provide reference for the laboratory testing.
ABSTRACT
We report a case of acute hemolytic transfusion reaction due to multiple alloantibodies. A 41-year-old male with multiple histories of transfusion was admitted for jaundice and oliguria after receiving two units of red blood cells in a local clinic. He showed acute renal failure and disseminated intravascular coagulation. Direct Coombs test was negative and antibody screening test showed strong positive results. Anti-E, anti-c, and anti-Jk(b) antibodies were identified in two panels of unexpected antibody assays. Acute hemolytic transfusion was diagnosed, and he was discharged after 1 month of supportive treatment. Unexpected antibody detection tests, including the antiglobulin phase, should be performed to prevent adverse transfusion reactions by unexpected antibodies. Better precision and quality control are necessary when performing pre-transfusion tests.
Subject(s)
Adult , Humans , Male , Acute Kidney Injury , Antibodies , Coombs Test , Disseminated Intravascular Coagulation , Erythrocytes , Isoantibodies , Jaundice , Mass Screening , Oliguria , Quality Control , Transfusion ReactionABSTRACT
BACKGROUND: Despite the advances in total laboratory automation, a considerable amount of work in blood banks is still done using outdated manual methods. Some automated pre-transfusion testing instruments have recently been developed. Of these, we evaluated and compared the AutoVue Innova (Ortho, USA) and the Techno TwinStation (DiaMed AG, Switzerland). METHODS: Forward and reverse ABO/Rh typing and unexpected antibody screening and identification tests were performed on 4,628 samples using the manual method and the two automated instruments. Two different anticoagulants (EDTA and citrate) were compared in ABO/Rh typing and unexpected antibody screening tests. Titrating studies were conducted on the following 7 dilutions using 5 samples of irregular antibodies with anti-E, anti-E & -c, anti-D, and anti-Le(a) with anti-Fy(a): 1:2, 1:4, 1:8, 1:16, 1:32, 1:64, and 1:128. The test throughput per hour, the time required to perform 1 and 100 tests, and a simulation test for total events occurring in 1 day were also measured. RESULTS: No erroneous results were reported between the two instruments and the manual method. Discrepancies observed in 10 cases (0.4%) of ABO/Rh typing were of higher intensity with AutoVue Innova than with the manual method. AutoVue Innova exhibited the highest sensitivity in the titrating study and throughput performance compared with the manual method and the Techno TwinStation. Especially in the throughput and time required to complete 100 antibody screening tests, AutoVue Innova had a 3.3- and 3.5-fold higher performance, respectively, than Techno TwinStation. CONCLUSIONS: Because both of the two fully automated instruments (AutoVue Innova and Techno TwinStation) had high levels of accuracy and performance, it is expected that use of fully automated instruments will reduce human labor, turnaround time, and operator error in the blood bank.