rss_2.0Immunohematology FeedSciendo RSS Feed for Immunohematology Feed D. Issitt (1933–2023) Specialist in Transfusion Science program to be a medical laboratory scientist of a multiplex assay to identify weak D types in a mixed-race Brazilian population<abstract> <title style='display:none'>Abstract</title> <p><italic>RH</italic> allele variability is caused by several types of variants, resulting in altered RhD and RhCE phenotypes. Most of the weak D phenotypes in European-derived populations are weak D types 1, 2, or 3, which are not involved in alloimmunization episodes. However, the Brazilian population is racially diverse, and the accuracy of molecular and serologic tests developed in recent years has allowed for the identification of other <italic>RH</italic> variants, that are common in the Brazilian population, such as weak D type 38 or weak partial 11, the latter involved in alloimmunization cases. Furthermore, patients with these two weak D variants must be transfused with D– red blood cell units, as do patients with weak D type 4 or DAR, which are also common D variants in Brazil. Weak D type 38 and weak partial 11 can be serologically misclassified as weak D types 1, 2, or 3 in patients, based on European experience, or as D– in donors. Additionally, pregnant women may unnecessarily be identified as requiring Rh immune globulin. RhCE phenotypes are reliable indicators of RhD variants. For individuals with the Dce phenotype, the preferred approach is to specifically search for <italic>RHD*DAR</italic>. However, when encountering DCe or DcE phenotypes, we currently lack a developed method that assists us in rapidly identifying and determining the appropriate course of action for the patient or pregnant woman. Two multiplex assays were proposed: one for the identification of <italic>RHD*weak partial 11, RHD*weak D type 38</italic>, and <italic>RHD*weak D type 3</italic> and another for <italic>RHD*weak D type 2</italic> and <italic>RHD*weak D type 5</italic>. The multiplex assays were considered valid if the obtained results were equivalent to those obtained from sequencing. Expected results were obtained for all tested samples. The proposed multiplex allele-specific polymerase chain reaction assays can be used in the molecular investigation of women of childbearing age, patients, and blood donors presenting a weak D phenotype with DCe or DcE haplotypes in a mixed-race population, such as Brazil.</p> </abstract>ARTICLEtrue on programs for achieving Specialist in Blood Banking certification in the United States: 2023<abstract> <title style='display:none'>Abstract</title> <p>A person who has achieved the Specialist in Blood Banking (SBB) certification is a medical laboratory scientist who receives advanced training in blood banking and transfusion medicine and has passed an examination given by the American Society for Clinical Pathology. There are several pathways or “eligibility routes” to qualify for the examination to obtain SBB certification, with the most common route involving enrollment in a Commission on Accreditation of Allied Health Education Programs-accredited SBB program. The goal of this study was to compile information about the current accredited SBB programs in the United States and SBB exam statistics for purposes of assessing changes in the programs and detecting trends in SBB exam takers and pass rates. SBB program coordinators were surveyed about qualitative and quantitative aspects of their programs. Current data, changes over time, and nationally available data were tabulated for comparison. This information may be helpful for all medical laboratory scientists interested in considering further studies and certification in blood banking and transfusion medicine.</p> </abstract>ARTICLEtrue of incompatible blood to a patient with alloanti-Sc1<abstract> <title style='display:none'>Abstract</title> <p>Sc1 is a high-prevalence blood group antigen that is part of the Scianna blood group system. The clinical significance of Scianna antibodies is not well understood because of their rarity; there are only a handful of cases in the literature. This scarcity of information can make it difficult to decide on the best course of action when transfusing a patient with alloantibodies to Scianna blood group antigens. We describe a case of an 85-year-old woman presenting with melena and a hemoglobin of 66 g/L. Upon request for crossmatched blood, a panreactive antibody was found, later elucidated to be alloanti-Sc1. Because of the urgent nature of the transfusion, the patient was transfused with 2 incompatible, presumed Sc1+, red blood cell units with no evidence of an acute or delayed transfusion reaction. This case has been shared with the International Society of Blood Transfusion Rare Donor Working Party, via their Outcome of Incompatible Transfusion form, and adds to the body of evidence on clinical significance of antibodies to the antigens of the Scianna blood group system.</p> </abstract>ARTICLEtrue of immunohematologic testing in mother and newborn ABO incompatibility<abstract> <title style='display:none'>Abstract</title> <p>The aim of this study was to define risk factors for jaundice and anemia in newborns with a positive direct antiglobulin test (DAT) and/or with an incompatible crossmatch due to ABO incompatibility between mother and newborn. ABO incompatibility has become a more significant cause of hemolytic disease of the fetus and newborn since the introduction of effective anti-D prophylaxis. The condition is common and, if clinically significant at all, causes only mild jaundice, which can be treated with phototherapy (PT). However, rare and serious presentations, requiring transfusion therapy, have been noted. Clinical, laboratory, and immunohematologic data were collected retrospectively from medical records of ABO-incompatible newborns and their mothers over a 5-year period (2016–2020) from University Hospital Centre Zagreb. Two groups of newborns were compared: those who needed medical intervention because of hyperbilirubinemia or anemia and those who did not. Within the group of newborns requiring intervention, we also compared those with A and B blood groups. Over the 5-year period, 72 of 184 (39%) newborns required treatment. The treatment was PT in 71 (38%) newborns and erythrocyte transfusion in 2 (1%). In 112 (61%) newborns, ABO incompatibility was an accidental finding while performing blood group typing; these newborns did not require any therapy. In conclusion, we found a statistical, but not clinically significant, difference between the groups of treated and untreated newborns, related to the mode of delivery and DAT positivity within hours of delivery. There were no statistically significant differences in characteristics between the groups of treated newborns, except for two newborns with blood group A who received erythrocyte transfusions.</p> </abstract>ARTICLEtrue LW blood group system: not just “tagging along” with D<abstract> <title style='display:none'>Abstract</title> <p>This update of the Landsteiner-Wiener (LW) blood group system (Grandstaff Moulds MK. The LW blood group system: a review. Immunohematology 2011;27:136-42. Storry JR. Review: the LW blood group system. Immunohematology 1992;8:87–93) reports new information on the distribution of genetic variants in ICAM4 and reviews the complex serologic identification of the high-prevalence LWEM antigen. The role of ICAM4 in sickle cell disease and malaria susceptibility is discussed.</p> </abstract>ARTICLEtrue monocyte monolayer assay, an method for prediction of survival of transfused incompatible red blood cells: a review<abstract> <title style='display:none'>Abstract</title> <p>It has long been a goal of transfusion medicine scientists to predict which patients will make clinically significant antibodies when transfused with donor red blood cells (RBCs). But this goal has yet to be achieved. Not all patients have an adverse response to an RBC transfusion by making an antibody to an RBC antigen, and for patients who do, in most cases, they form antibodies to common antigens for which provision of antigen-negative RBCs is not difficult. However, for patients who make antibodies to many antigens and for patients who make an antibody requiring rare blood that is negative for a high-prevalence antigen, knowing the clinical significance of that patient’s antibody is important for effective and timely transfusion. This review of the literature provides information on the monocyte monolayer assays (MMAs) developed to predict the outcome of incompatible RBC transfusion. One of these assays has been used for almost 40 years in the United States to predict the outcome of RBC transfusion in patients with alloantibodies for whom provision of rare RBCs is very difficult. Because all transfusion medicine facilities and blood centers will not likely implement the MMA, it is important that the selection of the referral laboratory be carefully made. The MMA is a proven test in the prediction of incompatible transfusion outcomes in patients with IgG-only antibodies. It has been helpful in decision-making when rare blood components are not available or not available quickly, although decisions on blood transfusion must be made by the physician attending the patient and blood should not be withheld waiting for the MMA result in an urgent situation.</p> </abstract>ARTICLEtrue comparison of results from antihuman globulin-graded reactions with the monocyte monolayer assay<abstract> <title style='display:none'>Abstract</title> <p>Blood transfusions are a common medical treatment. Risks arise when compatible blood is not available. This study assesses the correlation between antibody reaction strength at the antihuman globulin (AHG) phase of testing and the antibody clinical significance as predicted using the monocyte monolayer assay (MMA). Multiple examples of anti-K donor plasma samples were selected to sensitize K+k+ red blood cells (RBCs). Reactivity was confirmed by testing the sensitized K+k+ RBCs at saline-AHG. Antibody titers were determined by serial dilution using neat plasma. Sixteen samples were selected for the study based on comparable graded reactions with neat plasma (1+, 2+, 3+, and 4+) and similar titration endpoints. Each sample was used to sensitize the same Kk donor and then tested by monocytes to evaluate the clinical significance using the MMA, an <italic>in vitro</italic> procedure that mimics <italic>in vivo</italic> extravascular hemolysis to predict the survivability of incompatible transfused RBCs. The monocyte index (MI), i.e., the percentage of RBCs adhered, ingested, or both versus free monocytes, was calculated for each sample. Regardless of the reaction strength, all examples of anti-K were predicted to be clinically significant. While anti-K is known to be clinically significant, the immunogenicity rate of K ensures ample supply of antibody samples for inclusion in this project. This study demonstrates that <italic>in vitro</italic> antibody strength is highly subjective and variable. These results show no correlation between graded reaction strength at AHG and the predicted clinical significance of an antibody as assessed using the MMA.</p> </abstract>ARTICLEtrue hemolytic disease of the newborn of a terminology proposed to supersede Miltenberger–) phenotype in a Japanese blood donor<abstract><title style='display:none'>Abstract</title><p>The first Japanese En(a–) individual (T.N.) was found by screening red cells from 250,000 Japanese blood donors with monoclonal anti-En<sup>a</sup>. His serum contained no atypical antibodies and his partial red cell phenotype was M–N–S+s–, although a trypsinresistant N antigen was detected. His red cells were En(a–) and Wr(b–), as determined by various human and mouse monoclonal antibodies. The absence of glycophorin A (GPA) and the presence of apparently normal glycophorin B (GPB) were demonstrated by immunoblotting with antibodies to the extracellular and cytoplasmic domain of GPA and to epitopes common to GPA and GPB. Sialic acid levels of T.N.’s intact red cells were substantially lower than those of control MN cells. Serologic tests suggested that both of T.N.’s parents were heterozygous for a recessive GPA deficiency gene. <bold><italic>Immunohematology</italic></bold> 1993;9:105.</p></abstract>ARTICLEtrue possible relationship between colorectal carcinoma and ABO/Lewis blood groups<abstract><title style='display:none'>Abstract</title><p>The incidence of colorectal carcinoma was compared with the incidence of ABO and Lewis blood groups. The raw data showed the known overrepresentation of the Le(a–b–) phenotype, but also suggested an association of colorectal carcinoma with the Le(a–b+) phenotype in group O individuals. When the data were adjusted by taking into account the known loss of Lewis antigens by Lewis-positive patients, this association could be shown to be statistically significant. These results may indicate involvement of the secretory H antigen in colorectal carcinoma. <bold><italic>Immunohematology</italic></bold> 1993;9:101.</p></abstract>ARTICLEtrue cell antigen stability in K3EDTA<abstract><title style='display:none'>Abstract</title><p>Commercial blood grouping reagents are not approved for testing EDTA anticoagulated blood specimens that are more than 48 hours old. Many studies on the stability of blood group antigens in other anticoagulants have been reported, but none are available for EDTA. This study was undertaken to assess whether current commercially available blood grouping reagents give acceptable reactions with red cell antigens when the cells are stored for extended periods in EDTA We defined acceptable reaction strength to be 2 + (score 8). As expected, the A, B, and D reactions were very stable with red cells stored for 60 days. All antigens except Le<sup>a</sup> exhibited 2+ (score 8) or greater reactions at day 14, and at day 21 only the Le<sup>a</sup>, Fy<sup>b</sup>, and e antigens were less than 2+. On day 60, twelve of twenty-one antigens tested still exhibited 2+ or greater reactions. This study shows that antigen reactivity for red cells collected and stored in EDTA is at least equal to that for clotted specimens. These red cells can be used for reliable antigen typing for at least 14 days, and even longer for most antigens. <bold><italic>Immunohematology</italic></bold> 1993;9:109.</p></abstract>ARTICLEtrue