Download PDF
Transfusionsmedizin 2021; 11(02): 100-107
DOI: 10.1055/a-1258-1227
Praxistipp

Antikörper-Adsorptionsmethoden für die Diagnostik von erythrozytären Alloantikörpern bei Patienten mit panreaktiven Autoantikörpern

Antibody Adsorption Methods for Pretransfusion Diagnostics of Red Cell Alloantibodies in Patients with Pan-Reactive Autoantibodies
Jan Greinacher
Institut für Immunologie und Transfusionsmedizin, Universitätsmedizin Greifswald
,
Kathleen Selleng
Institut für Immunologie und Transfusionsmedizin, Universitätsmedizin Greifswald
› Author Affiliations
› Further Information
Also available at
    Permissions and Reprints

Zusammenfassung

Der Nachweis und die Differenzierung von erythrozytären Alloantikörpern bei Patienten mit freien wärmereaktiven Autoantikörpern (WAK) im Plasma stellt das immunhämatologische Labor vor eine Herausforderung. Eine Allo- und/oder Autoadsorption kann die Autoantikörperreaktivität des Patientenplasmas reduzieren oder vollständig entfernen und vorhandene Alloantikörper demaskieren. Wir schlagen einen diagnostischen Stufenplan vor, der diese Methoden besonders berücksichtigt, und eine Transfusionsstrategie, die sich an der Dringlichkeit der Transfusion orientiert. Eine indizierte Transfusion darf durch die Diagnostik nicht verzögert werden.

Abstract

Diagnosis and differentiation of alloantibodies against red blood cells in patients with free red cell autoantibodies in plasma is challenging. Methods like allo- and auto-adsorption can reduce or eliminate autoantibody reactivity from the patient plasma. Thus, alloantibodies can be unmasked and detected. We suggest a diagnostic step-by-step procedure especially using these methods and have developed a transfusion strategy dependent on the urgency of transfusion. An indicated transfusion may not be delayed by laboratory diagnostics.

Schlüsselwörter

Panreaktivität - erythrozytäre Autoantikörper - erythrozytäre Alloantikörper - Alloadsorption - Autoadsorption

Key words

panreactivity - RBC autoantibodies - RBC alloantibodies - alloadsorption - autoadsorption


Publication History

Article published online:
01 June 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • Literatur

  • 1 Weiland T. Panagglutination in der prätransfusionellen Diagnostik: Ursachen und Abklärung. Transfusionsmedizin 2019; 9: 113-125
    Article in Thieme ConnectPubMedGoogle Scholar
  • 2 Schonewille H, van de Watering LM, Loomans DS. et al. Red blood cell alloantibodies after transfusion: factors influencing incidence and specificity. Transfusion 2006; 46: 250-256
    CrossrefPubMedGoogle Scholar
  • 3 Alves VM, Martins PR, Soares S. et al. Alloimmunization screening after transfusion of red blood cells in a prospective study. Rev Bras Hematol Hemoter 2012; 34: 206-211
    CrossrefPubMedGoogle Scholar
  • 4 Ahrens N, Pruss A, Kahne A. et al. Coexistence of autoantibodies and alloantibodies to red blood cells due to blood transfusion. Transfusion 2007; 47: 813-816
    CrossrefPubMedGoogle Scholar
  • 5 Delaney M, Apelseth TO, Bonet Bub C. et al. Red-blood-cell alloimmunization and prophylactic antigen matching for transfusion in patients with warm autoantibodies. Vox Sang 2020; 115: 515-524
    CrossrefPubMedGoogle Scholar
  • 6 Walker PS, Hamilton JR. Identification of Antibodies to Red Cell Antigens. Method 4-8: Adsorbing warm-reactive autoantibodies using autologous red cells. In: Fung MK, Grossman BJ, Hillyer CD, Westhoff CM. eds. Technical Manual. 18th ed. Bethesda ML, USA: Amer Assn of Blood Banks (AABB); 2014: 331-424
    Google Scholar
  • 7 Heddle NM, OʼHoski P, Singer J. et al. A prospective study to determine the safety of omitting the antiglobulin crossmatch from pretransfusion testing. Br J Haematol 1992; 81: 579-584
    CrossrefPubMedGoogle Scholar
  • 8 Lange J, Selleng K, Heddle NM. et al. Coombsʼ crossmatch after negative antibody screening – a retrospective observational study comparing the tube test and the microcolumn technology. Vox Sang 2010; 98: e269-e275
    CrossrefPubMedGoogle Scholar
  • 9 Ahrens N, Pruss A, Mayer B. Association between alloantibody specificity and autoantibodies to red blood cells. Transfusion 2008; 48: 20-24
    CrossrefPubMedGoogle Scholar
  • 10 Selleng K, Jenichen G, Denker K. et al. Emergency transfusion of patients with unknown blood type with blood group O Rhesus D positive red blood cell concentrates: a prospective, single-centre, observational study. Lancet Haematol 2017; 4: e218-e224
    CrossrefPubMedGoogle Scholar
  • 11 Leger RM. The Positive Direct Antiglobulin Test and Immune Mediated Hemolysis. Method 4-10 Polyethylene glycol adsorbtion procedure. In: Fung MK, Grossman BJ, Hillyer CD, Westhoff CM. eds. Technical Manual. 18th ed: Bethesda ML, USA: Amer Assn of Blood Banks (AABB); 2014: 425-448
    Google Scholar
  • 12 Leger RM. The Positive Direct Antiglobulin Test and Immune Mediated Hemolysis. Method 4-9 Adsorbing warm-reactive autoantibodies using allogeneic red cells. In: Fung MK, Grossman BJ, Hillyer CD, Westhoff CM. eds. Technical Manual. 18th ed: Bethesda ML, USA: Amer Assn of Blood Banks (AABB); 2014: 425-448
    Google Scholar
  • 13 Denomme GA, Westhoff CM. The Rh-System. Method 2-20: Dissociating IgG by chloroquine for antigen testing of red cells with positive DAT. In: Fung MK, Grossman BJ, Hillyer CD, Westhoff CM. eds. Technical Manual. 18th ed: Bethesda ML, USA: Amer Assn of Blood Banks (AABB); 2014: 317-336
    Google Scholar
  • 14 Ziman A, Cohn C, Carey PM. et al. Warm-reactive (immunoglobulin G) autoantibodies and laboratory testing best practices: review of the literature and survey of current practice. Transfusion 2017; 57: 463-477
    CrossrefPubMedGoogle Scholar
  • 15 Bundesärztekammer, Paul-Ehrlich-Institut. Hrsg. Richtlinie zur Gewinnung von Blut und Blutbestandteilen und zur Anwendung von Blutprodukten (Richtlinie Hämotherapie). Köln: Deutscher Ärzteverlag GmbH; 2017
    Google Scholar