Performance Evaluation of Unexpected Antibody Screening Test Including Di(a) Cell Using 3% Surgiscreen Sub-Code D in Korean Multi-Transfused Patients / 대한수혈학회지

BACKGROUND: The Dia antigen has been found to have a relatively higher incidence among Korean populations. However, the current popular antibody screening panels contain no Dia positive cells. To prevent hemolytic transfusion reaction, screening for unexpected antibody plus screening for Dia positive cells should be performed. In this study, we evaluate the performance of the 3% Surgiscreen Sub-code D (Ortho-Clinical Diagnostics, USA) manufactured as a 3-cell panel including Dia cell versus the ID-DiaCell I-II (DiaMed, Switzerland) as a 2-cell panel plus ID-DiaCell Dia+ (DiaMed, Switzerland) in screening for irregular red blood cell alloantibodies. METHODS: From December 13, 2013 to April 24, 2014, we tested the 3% Surgiscreen by the AutoVue Innova system and the ID-DiaCell in parallel to evaluate reagent sensitivity in detecting irregular antibodies in multi-transfused patients' plasma or serum. Identification of unexpected antibody tests was performed for positive screening results. RESULTS: Antibody-positive rates were 4.2% (79/1885) and 4.6% (87/1885) for antibody screening with the 3% Surgiscreen and the ID-DiaCell, respectively. Among the 1885 samples, 1875 (99.5%) showed concordant results between the 2 methods, while 10 results differed. From the 10 discrepancies, 1 result was positive only on the 3% Surgiscreen. The prevalence of anti-Dia antibody was 10.1% and 9.2% in the 3% Surgiscreen and the ID-DiaCell, respectively. CONCLUSION: The 3% Surgiscreen manufactured as 3-cell showed a high concordance rate ompared to standard methods. The prevalence of anti-Dia showed no difference between the 2 reagents.

Comparison of Effectiveness between Blood Bank Automation System and Manual Method for ABO-RhD Blood Typing and Antibody Screening Test in a Single Center / 대한수혈학회지

BACKGROUND: The automation system for blood typing and antibody screening has been developed and is now used widely. In this study, we evaluated the economic effectiveness between automation system QWALYS-3 (DIAGAST, Loos Cedex, France) and manual testing. METHODS: Clinical samples from March 2012 were used for comparison of the costs and TAT for ABO-RhD blood typing and antibody screening. The costs included those of materials (reagents and consumables), labor, and equipment depreciation. TAT was analyzed for either blood typing only for one, 16, and 32 samples or blood typing and antibody screening for the same number of samples. RESULTS: The blood typing TAT for one, 16, and 32 samples was 4.5, 35.1, and 70.1 minutes by manual and 24.0, 36.0, and 38.1 minutes by automated system. Both blood typing and antibody screening TAT for one, 16, and 32 samples was 27.5, 75.0, and 129.9 minutes by manual and 45.0, 52.0, and 54.0 minutes by automation. CONCLUSION: The blood automation system reduced TAT only for the batch test, therefore, when using the automation system, blood bank test size and emergency situation should be considered.

The First Case of Anti-f(ce) and Anti-Csa Antibodies in Korea / 대한수혈학회지

Anti-f(ce) has been associated with hemolytic transfusion reaction (HTR) and hemolytic disease of the fetus and newborn (HDFN), however, anti-Cs(a) has not been associated with red blood cell (RBC) destruction. Although anti-Cs(a) has clinical insignificance as a high-titer low-avidity (HTLA) antibody, this antibody can cause confusion in interpreting an antibody identification test, particularly coexistence of a clinically significant antibody. A 65-year-old woman with liver metastases of Klatskin tumors and cholangitis was admitted to the hospital for abdominal pain. She developed hematochezia on hospital day 10. She was at the status of active bleeding and required transfusion. The result of antibody identification test was warm-reactive autoantibody and unidentifiable alloantibody, therefore, the least incompatible packed RBCs had to be transfused to the patient. No hemolytic transfusion reaction occurred and hemoglobin level was normalized. Thereafter, anti-f(ce) and anti-Cs(a) antibodies were identified in the patient's serum. To the best of our knowledge, this is the first report of anti-f and anti-Cs(a) antibodies in Korea.

Eleven Years' Experience with Unexpected Antibody Screening Tests Including a Di(a) Cell in Transfusion Candidates / 대한수혈학회지

BACKGROUND: The Di(a) antigen has been detected with a relatively higher incidence among the Korean and Southeast Asian population. A 'Type and Screen' procedure is recommended for efficient transfusion, therefore, we perform antibody screening tests using antibody screening panels containing a Di(a) cell. The purpose of this study was to report on the experience of unexpected antibody screening test including a Di(a) cell in the Korean population. METHODS: We analyzed the results of antibody screening testing and identification performed during the recent 11-year period from January 2002 to December 2012. A commercially available three-cell antigen panel (Diacell I, II, Di(a); DiaMed, Murten, Switzerland) was used for antibody screening. Antibodies were identified using a LISS/Coombs gel card and NaCl/Enzyme card, using the DiaMed-ID system (DiaMed, Murten, Switzerland). RESULTS: The frequency of unexpected antibodies was 1.23% (1,918/156,161); the most frequently detected antibodies were anti-E (292 samples), followed by anti-E,c (127 samples), anti-Le(a) (103 samples), and anti-Di(a) (91 samples). CONCLUSION: Results of this study showed that the most identified unexpected antibodies were clinically significant, and, in particular, anti-Di(a) antibodies are detected frequently in the Korean population. Thus, unexpected antibody screening test including a Di(a) cell is thought to be helpful in Korea for safe transfusion.

Change of the Disposal and the Cancellation Ratio after Enforcement of a Precedent Antibody Screening Test / 대한수혈학회지

BACKGROUND: In the clinical setting, for convenience of transfusion, blood is requested in advance, even though 'the type and screen' method has been used for the efficient supply of blood. We employed the precedent antibody screening test method for all patients who were scheduled for surgery, and compared the disposal rate and the clear rate pre and post-activity. METHODS: We evaluated the disposal rate and the cancellation ratio before and after employment of the precedent antibody screening test method for all patients expected to undergo surgery. A comparison of the frequency and type of side effects of transfusion was also performed. RESULTS: The disposal rate and the cancellation ratio showed a decrease, from 1.48% to 1.29%, and from 17.0% to 11.0%. No significant change was observed in the cause of disposal and the side effects of transfusion. CONCLUSION: Enforcement of a precedent antibody screening test resulted in a decrease in the disposal and clear rates. In addition, it aided in reduction of the amount of work performed at the blood bank by establishing the proper utilization of blood and reducing unnecessary cross match testing. There appears to be no problem regarding the stability of transfusion. However, for the sample showing a positive result on the antibody screening test, an effort to decrease the side effects of transfusion, such as exhaustive cross-matching and increasing the rate of identification, would be needed.

Change of the Disposal and the Cancellation Ratio after Enforcement of a Precedent Antibody Screening Test / 대한수혈학회지

BACKGROUND: In the clinical setting, for convenience of transfusion, blood is requested in advance, even though 'the type and screen' method has been used for the efficient supply of blood. We employed the precedent antibody screening test method for all patients who were scheduled for surgery, and compared the disposal rate and the clear rate pre and post-activity. METHODS: We evaluated the disposal rate and the cancellation ratio before and after employment of the precedent antibody screening test method for all patients expected to undergo surgery. A comparison of the frequency and type of side effects of transfusion was also performed. RESULTS: The disposal rate and the cancellation ratio showed a decrease, from 1.48% to 1.29%, and from 17.0% to 11.0%. No significant change was observed in the cause of disposal and the side effects of transfusion. CONCLUSION: Enforcement of a precedent antibody screening test resulted in a decrease in the disposal and clear rates. In addition, it aided in reduction of the amount of work performed at the blood bank by establishing the proper utilization of blood and reducing unnecessary cross match testing. There appears to be no problem regarding the stability of transfusion. However, for the sample showing a positive result on the antibody screening test, an effort to decrease the side effects of transfusion, such as exhaustive cross-matching and increasing the rate of identification, would be needed.

A case of acute hemolytic transfusion reaction due to anti-Di(a) antibody: A case report / 대한마취과학회지

Many medical institutions in Korea have recently been performing an antibody screening test as one of the essential elements of a pre-transfusion test. The Dia antigen is well known as one of the antigens with low incidence among Caucasians; however, it has been discovered with a relatively higher incidence among Mongoloid populations. The frequency of the Dia antigen among the Korean population is estimated to be 6.4-14.5%. But in Korea, a screening panel of cells from abroad without Dia positive cells has been commonly used when a patient has an unexpected antibody screening test. Here we report a case of acute hemolytic transfusion reaction due to Anti-Dia antibody. To prevent other transfusion reaction by anti-Dia antibody, addition of Dia positive cells as unexpected antibody screening test is recommended.

The Frequency of Unexpected Antibodies and Clinical Characteristics of Transfusion Candidates in a General Hospital During the Past 12 Years / 임상검사와정도관리

BACKGROUND: Unexpected antibodies are an important cause of hemolytic transfusion reaction. Thus, unexpected antibody screening and identification tests should be performed before every transfusion. We evaluated the frequency and distribution of unexpected antibodies and the clinical characteristics of patients in a Korean secondary general hospital with 745 beds in the past 12 years. METHODS: Between March 2000 and October 2011, unexpected antibody screening and an identification test using the Bio-Rad ID-System (Bio-Rad, USA) were performed in 72,600 patients. RESULTS: Of the 72,600 patients, 467 (0.64%) showed positive results for antibody screening tests. Among them, alloantibodies were identified in 324 (69.4%) patients and the types of alloantibodies were not identified in 64 (13.7%) patients. Autoantibodies were detected in 71 (15.2%) patients and panagglutination reactions were detected in 8 (1.7%). Of the 467 cases, 164 (35.1%) had a history of transfusion in our hospital. Among the 324 patients in whom alloantibodies were identified, anti-E (37.3%), anti-Lea (16.7%), anti-E and anti-c (14.8%), anti-C and anti-e (5.6%), anti-Leb (4.9%), anti-D (4.6%), anti-Jka (3.1%), anti-S (2.5%), and anti-M (1.9%) were detected. In 41 of the 324 (12.7%) of these patients, the types of antibodies were identified with the NaCl/Enzyme gel test but not with the LISS/Coombs gel test. CONCLUSIONS: Among the 467 patients, 130 (27.8%) in whom unexpected antibodies were detected, were scheduled for surgery. Because 101 of these 130 patients (77.7%) were unimmunized, unexpected antibody screening may be important in secondary hospitals with patients who do not have a detailed transfusion history. We identified Rh, P, and Lewis group antibodies more efficiently with a combination of the LISS/Coombs gel test and the NaCl/Enzyme gel test.

Detection of Anti-Lua in an Unexpected Antibody Screening Test: A Case Report and Literature Review / 대한수혈학회지

Lutheran a antigen (Lua) is detected in 6 to 8% of Caucasians and Africans. In Korean and other Asian populations, it is very rare or nearly absent. Therefore, although Lua has a considerable immunizing capacity, sensitization to Lua is a rare event. Here we report on a rare case of anti-Lua in a 70 year-old female patient with Lu (a-/b+) phenotype and review the relevant literature. Due to the paucity of Lua positive panel cells in antibody screening and identification tests, detection of this rare antibody to Lua antigen is not feasible. Therefore, we should keep in mind the possibility of the misleading false negative result in detection of antibody to this low incidence antigen.

Frequency of Detection of Unexpected Antibodies in Transfusion Candidates at a Secondary Hospital in Gyeongbuk Province / 대한수혈학회지

BACKGROUND: Antibody screening and identification tests are indispensable tools for protecting patients from acute hemolytic transfusion reaction. The column agglutination method has been widely used because of its simplicity and superiority to other methods for detecting warm antibodies. The purpose of this study was to analyze the frequency, distribution and clinical characteristics of unexpected antibodies found in transfusion candidates at a secondary hospital in Gyeongbuk Province, Korea. METHODS: The antibody screening tests were carried out with 9,275 sera samples using the column agglutination method from July 2009 to September 2011. The antibodies were screened and identified using the DiaMed-ID system (DiaMed, Murten, Switzerland). RESULTS: The positive rate for antibody screening tests was 0.5% (50/9,275). Unexpected antibodies were identified in 36 cases (0.4%). The most frequently detected antibody was anti-Lea in 15 cases (30%), followed by anti-Leb in 10 cases (20%) and anti-E in 8 cases (16%). Antibodies that remain unidentified were detected in 11 cases (22%). CONCLUSION: Compared with previous reports, this study demonstrated that the frequency and distribution of unexpected antibodies were no different than those found in general hospitals. This study may provide data for the frequency and characteristics of unexpected antibodies in a secondary hospital.

Anti-Ok(a) Antibody: The First Case Report in Korea / 대한수혈학회지

Anti-Ok(a) was detected in a 56-year-old female patient who was admitted for surgical treatment of degenerative scoliosis. Because Oka is a high-incidence antigen, anti-Ok(a) antibody is extremely rare. No case of hemolytic transfusion reaction or hemolytic disease of the fetus and newborn caused by anti-Ok(a) antibody has been reported so far, however, it is likely that anti-Ok(a) is clinically significant based on several in vivo and in vitro studies. When a patient who is bearing anti-Ok(a) needs transfusion of RBCs, transfusion of autologous blood or Ok(a-) RBCs from family members is recommended.

Characteristics of RBC Alloimmunization Detected by Unexpected Antibody Screening Tests / 대한수혈학회지

BACKGROUND: Alloimmunization to RBC antigens may cause delayed hemolytic transfusion reactions and delayed serological transfusion reactions. In the present study, the frequency of alloimmunization and its clinical significance were evaluated. METHODS: Antibody screening tests for 17,365 samples from 11,372 patients were retrospectively analyzed during a 25-month period from February 2003 to March 2005. The records of transfusions and the clinical characteristics of the patients who had initially negative screening tests that converted to positive tests were evaluated. The unexpected antibody screening and identification tests were performed using the LISS/Coombs gel test with the DiaMed-ID system. RESULTS: The positive rate of the antibody screening tests was 1.36% (155/11,372). Thirty-eight patients (0.63%, 38/5,993) showed positive antibody screening tests from an initially negative screening. The most common clinically significant alloantibodies were Rh group antibodies (52.6%). The mean transfused RBC units, mean interval and mean transfusion frequencies for patients with initially negative antibody screening tests that converted to positive findings were 3.7 units, 56 days and 1.7 times, respectively. Antibodies from nine patients became undetectable following the first detection assay. CONCLUSION: RBC alloimmunization detected by unexpected antibody screening tests did not correlate with the quantity of transfusion and frequency of transfusion. One should be careful to recognize antibodies that are positive in an initial antibody screening test that subsequently become undetectable.

A Case of Severe Hemolytic Disease of the Newborn Due to Anti-Di(a) Antibody / 대한진단검사의학회지

Here we report a severe case of hemolytic anemia of the newborn with kernicterus caused by anti-Di(a) antibody. A full term male infant was transferred due to hyperbilirubinemia on the third day of life. Despite single phototherapy, the baby's total bilirubin had elevated to 30.1 mg/dL. After exchange transfusion, total bilirubin decreased to 11.45 mg/dL. The direct antiglobulin test on the infant's red cells was positive. The maternal and infant's sera showed a negative reaction in routine antibody detection tests, but were positive in Di(a) panel cells. The frequency of the Di(a) antigen among the Korean population is estimated to be 6.4-14.5%. Anti-Di(a) antibody could cause a hemolytic reaction against transfusion or hemolytic disease of the newborn. We suggest the need for reagent red blood cell panels to include Di(a) antigen positive cells in antibody identification test for Korean.

A Case of Anti-Wr(a) with Anti-E / 대한수혈학회지

Authors found a case of anti-Wr(a) with anti-E antibody in 67 years old female patient. Anti-Wr(a) in Korea was reported for the first time in 2005. Anti-Wr(a) has been associated with hemolytic transfusion reaction (HTR) and hemolytic disease of the newborn (HDN). It is necessary to study the incidence of Wr(a) antigen and anti-Wr(a) in Korea.

First case of Anti-Wra antibody in Korea / 대한수혈학회지

Authors found anti-Wra antibody in a 44-year-old female patient with uterine myoma for the first time in Korea. Since anti-Wright antibodies have been implicated in hemolytic transfusion reactions and hemolytic disease of the newborn, Wra positive cells should be included in the antibody screening panel in Korea.

Naturally-occurring Anti-Mia(a) in a 16-year-old Korean Man: A Case Study and a Review of the Literature / 대한진단검사의학회지

We report a case of naturally-occurring anti-Miltenberger (anti-Mia(a)) antibody in a 16-year-old man who had never been transfused before. During an operation for a trauma he received 2 units of packed red blood cells. He was negative on an antibody screening test, but positive a week after the surgery when an extended screening test was conducted using blood cells positive for Miltenberger III (Mi.III) phenotype. The Mi.III phenotype is a low incidence antigen among Caucasians, however, it is reported to be relatively high in incidence among people in South-East Asia. Anti-Mia(a) antibodies are clinically significant antibodies that cause hemolytic transfusion reactions (HTRs) and hemolytic disease of the newborns (HDNs). In addition, anti-Mia(a) has a high rate of incidence among Thais, Taiwanese, and Hong Kong Chinese. There has been no particular report on Koreans regarding the incidence of this antibody, it would therefore require further research on the Mi.III phenotype and anti-Mia(a).

Transfusion Therapy in a Patient with Hemolytic Transfusion Reaction due to Anti-Jka / 대한수혈학회지

No abstract available.

The Clinical Significance of Antibody Screening Test Including Di(a+) Panel Cell in Asian-Mongoloid Populations

The Di(a) antigen is well known as one of the antigens with low incidence among Caucasians; however, it has been discovered with a relatively higher incidence among Mongoloid populations. Thus, it has been speculated that the incidence of unexpected antibody against the Di(a) antigen might be relatively higher among these populations. Hemolytic transfusion reactions (HTRs) and hemolytic disease of the newborns (HDNs) caused by anti-Di(a) have been reported sporadically. However, there has been no prospective study on the incidence of anti-Di(a) in Mongoloid populations particularly. The authors conducted a series of antibody screening tests on 11,219 Korean individuals for 25 months, by using three kinds of screening cells including Di(a) cell. Anti-Di(a) was detected in 8 patients, seven of whom had a history of transfusions or were multigravida. The incidence of anti-Di(a) measured in this study was higher than expected, ranked third among unexpected antibodies identified during the period of the study, so it is strongly recommended that the Di(a+) panel cell must be incorporated into antibody screening test for safer transfusion in Asian-Mongoloid populations.

The Frequency of Unexpected Antibodies in Blood Donors and Transfusion Candidates in Korea / 대한수혈학회지

BACKGROUND: A retrospective study was performed to estimate the frequency of red cell antibodies in blood donors (n=1,620,023) and transfusion candidates (SNUH n=12,111, YUMH n=26,665) for last 2 years (2000~2001). The results of the antibody screening and identification tests, the frequency and specificities of antibodies identified compared with blood centers and two hospitals had been used the different test methods each others. METHOD: Blood centers had been used tube and micro-plate method simultaneously with an in house and commercial panels. SNUH had been used micro-plate method using V plate with an in house and commercial panels. YUMH had been used gel agglutination technique (DiaMed ID System : DiaMed, Murten; Switzerland) since 1998. RESULTS: The frequencies of red blood cell antibodies were 0.26% (4,204 / 1,620,023 donor sera ), 0.11% (135 / 12,111 patient sera in SNUH) and 0.48% (128 / 26,665 patient sera in YUMH). Female donors and old ages showed higher frequency of red cell antibodies than male and young ages. Most of antibodies detected in donors were clinically less relevant antibodies such as Anti-Lea and Leb (38.9%), anti-P1 (18.1%), anti-H(IH) (8.4%), anti-M (6.2%) and so on. Clinically significant antibodies including Rh system antibodies (2.0%) were few, and composed only 12% of all the antibodies detected. In patients, clinically relevant antibodies including Rh antibodies (40.4% in SNUH, 71.9% in YUMH) were more frequently observed comparing with in donors. CONCLUSION: Antibodies found in donors were mostly clinically less relevant. Antibody screening method used in blood centers would be standardized. Blood banks using gel technique showed high detection rate of clinically significant antibodies comparing with facilities using other methods.

A Case of Anti-Xga in a Young Man without Previous Transfusion / 대한진단검사의학회지

We report a case of naturally occuring anti-Xga in a 22-year-old man suffering from multiple traumas, who had no past history of transfusion or transplantation. The positive reaction was detected at 37 degrees Cin the antibody screening test with LISS/Coombs card (DiaMed AG, Cressier, Morat, Switzerland), which disappeared at the enzyme phase with the NaCl/Enzyme card (DiaMed AG). The Xga antigen was negative on his red cell surfaces. The unexpected antibody was finally identified as anti-Xga. We found four of twelve units of packed red blood cells that were compatible with the patient's serum. Anti-Xga is a very rare unexpected antibody in Korea, so we need more study in order to determine incidence and the significance of this antibody.