Haematology Watch


ANTIBODY IDENTIFICATION

Mehmood

PRINCIPAL:

REQUIREMENTS:

A panel of cells should be selected according to the reactions observed in screening phase. Extended panel is used.

PROCEDURE:

RESULT:

INTERPRETATION: All positive with autocontrol +: autoantibody. One/Few positive: alloantibody.

Figure Antibody Identification.doc Figure Antibody Identification.doc
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Type : doc
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HTML Tables

 
 
 
 
 

1. Look at any positive agglutination in the row of Autocontrol cells:

          - if positive at IS, patient has cold autoantibody; if positive at 37C, warm autoantibody exists. Proceed to adsorption testing to remove autoantibody from the patient’s serum, and then test again.

          - if negative, proceed to step 2.

 

 2. Look at the zero reactions in the Agglutination columns:

           - if no zero reaction seen, there are multiple antibodies. Send the sample to a reference lab for further workup.

           - if zero reaction is seen, cross those antigen columns that are positive in the row of zero reaction. Do it for all the rows of cell panels having zero reaction.

                                      NOTE: Do not cross those panels which have heterozygous expression of antigens i.e. Fya+, Fyb+; antibody to either of them will not react strongly.

 

3. Look at any antigen negative column:

           - if an antigen is missing in all cell panels, mark it ? to remember that its exclusion is deferred if no antibody is found. If it happens like this, make a panel cell having that antigen and repeat testing at IS, RT, 37C, AHG, & Enzyme-treatment phases.         

 

4. For the remaining antigen columns, look at the effect of temperature on reaction strength:

           - if positive at IS but negative at 37, cross all antigens that react at 37C.

           - Do it vice versa.

           - if there are still > 1 antigen columns to be crossed, proceed to step 4.

 

5. For the remaining antigen columns, look at the effect of enzyme treatment:

           - if reaction was weaker at IS or 37C but  is enhanced in Enzyme column, look at the presence of two cell panels showing any antigen from Rh, Kidd, Lewis, and I systems. Justify your conclusion by finding absence of that antigen in two rows showing no enhancement.

           - if reaction was stronger at IS or 37C but is weakened in Enzyme column, look at the presence of two cell panels showing any antigen from  Duffy and MNSs systems. Justify your conclusion by finding absence of that antigen in two rows showing no enhancement.     

 

6. Probe the history and/or diagnosis of the patient:

            - If the antibody is a cold reacting antibody, this antibody is just a nuisance antibody, and is insignificant i.e. harmless to the allogeneic RBCs having antigen specific for it.

            - If the antibody is a warm reacting, this antibody is significant. Arrange a donor who lacks antigen for that antibody.

                             NOTE: Antibodies having wide thermal range can give reaction both at IS and 37C.

 

7. Confirmation of antibody identity:

           To counter-check the result, perform phenotyping of patient’s RBCs; a person having anti-C will be lacking C antigen on the RBCs, and so on.