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Abstract
Background
The microcolumn assay technique offers significant advances in identification of unexpected antibodies; however, some erythrocyte antibodies still remain unidentified. To see if NaCl/Enzyme test is useful for the identification of antibodies, we compared the LISS/Coombs and NaCl/Enzyme tests for identification rates, and investigated an association between the frequency of each antibody and a history of transfusion or gestation.
Methods
From June 2004 to June 2005, antibody screening tests were carried out on 5,517 patients using the LISS/Coombs gel test (DiaMed AG, Switzerland). When antibodies were detected, antibody identification tests were carried out with the LISS/Coombs and NaCl/Enzyme gel tests (DiaMed AG) simultaneously.
Results
Unexpected antibodies were detected in 79 patients (1.43%). These antibodies were identified in 39 (49.4%), 59 (74.7%), and 68 patients (86.1%) by the LISS/Coombs test, the NaCl/Enzyme test, and the two tests combined, respectively. With the addition of the NaCl/ Enzyme test, unexpected antibodies were further identified in 29 cases (anti-Lewis, 14; anti-Rhesus, 13; and anti-P1, 2). On the other hand, 9 cases (anti-M, 5; anti-Fyb, 3; and anti-N, 1) were identified by the LISS/Coombs test only. Of the unexpected antibodies found in patients without a previous history of transfusion or gestation, anti-Lewis (50.0%, 10/20) was the most common, while in patients with the history anti-Rhesus (48.1%, 26/54) was the most frequent.
References
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Table 1.
The frequency of unexpected antibodies in patients grouped by gender, age and diagnosis
| Characteristics | N (%) of patients tested | N (%) of antibodies detected | Frequency of antibody*, (%) |
|---|---|---|---|
| Gender | |||
| Male | 2,588 (46.9) | 32 (1.24) | 0.58 |
| Female | 2,929 (53.1) | 47 (1.60) | 0.85 |
| Age | |||
| <19 | 267 (4.8) | 4 (1.50) | 0.07 |
| 20–39 | 930 (16.9) | 16 (1.72) | 0.29 |
| 40–59 | 2,067 (37.5) | 26 (1.26) | 0.47 |
| >60 | 2,253 (40.8) | 33 (1.46) | 0.60 |
| Diagnosis | |||
| Non-hematologic malignancy | 2,437 (44.2) | 39 (1.60) | 0.71 |
| Hematologic malignancy | 343 (6.2) | 11 (3.21) | 0.20 |
| Liver diseases | 81 (1.5) | 2 (2.47) | 0.04 |
| Aplastic anemia | 59 (1.1) | 3 (5.08) | 0.05 |
| Renal diseases | 39 (0.7) | 1 (2.56) | 0.02 |
| Idiopathic thrombocytopenic purpura | 32 (0.6) | 5 (15.63) | 0.09 |
| Autoimmune disease | 13 (0.2) | 3 (23.08) | 0.05 |
| Others | 1,929 (35.0) | 15 (0.78) | 0.27 |
| Not defined | 584 (10.6) | 0 (0.00) | 0.00 |
| Total (%) | 5,517 (100.0) | 79 (100.0) | 1.43 |
Table 2.
The results of antibody identification by the LISS/Coombs and NaCl/Enzyme gel test
| Antibody specificity* | N |
LISS/Coombs |
NaCl/Enzyme |
||||
|---|---|---|---|---|---|---|---|
| Negative | Identified | Unidentified | Negative | Identified | Unidentified | ||
| Rh system | |||||||
| Anti-C | 2 | 1 | − | 1 | − | 2 | − |
| Anti-c | 4 | − | 4 | − | − | 4 | − |
| Anti-D | 1 | − | 1 | − | − | 1 | − |
| Anti-E | 16 | 2 | 11 | 3 | − | 16 | − |
| Anti-E+c | 4 | − | − | 4 | − | 4 | − |
| Anti-e | 5 | − | 3 | 2 | − | 5 | − |
| Lewis system | − | ||||||
| Anti-Lea | 18 | 1 | 9 | 8 | − | 18 | − |
| Anti-Leb | 4 | − | 1 | 3 | − | 4 | − |
| Anti-Lea+b | 3 | − | 1 | 2 | − | 3 | − |
| Others | |||||||
| Anti-Fyb | 3 | − | 3 | − | 2 | − | 1 |
| Anti-M | 5 | − | 5 | − | 5 | − | − |
| Anti-N | 1 | − | 1 | − | − | − | 1 |
| Anti-P1 | 2 | − | − | 2 | − | 2 | − |
| Unidentified | 11 | − | − | 11 | 1 | − | 10 |
| Total (%) | 79 (100) | 4 (5.1) | 39 (49.4) | 36 (45.6) | 8 (10.1) | 59 (74.7) | 12 (15.2) |
Table 3.
The frequency of unexpected antibodies in patients with or without a history of transfusion or gestation
| Antibody specificity |
History of transfusion or gestation |
Total (%) | ||
|---|---|---|---|---|
| Present (%) | Absent (%) | Not defined (%) | ||
| Rh system | 26 (48.1*) | 5 (25.0*) | 1 (20.0) | 32 (40.5) |
| Anti-C | 2 (3.7) | − | − | 2 (2.5) |
| Anti-c | 4 (7.4) | − | − | 4 (5.1) |
| Anti-D | − | 1 (5.0) | − | 1 (1.3) |
| Anti-E | 12 (22.2) | 3 (15.0) | 1 (20.0) | 16 (20.3) |
| Anti-E+c | 4 (7.4) | − | − | 4 (5.1) |
| Anti-e | 4 (7.4) | 1 (5.0) | − | 5 (6.3) |
| Lewis system | 12 (22.2†) | 10 (50.0†) | 3 (60.0) | 25 (31.6) |
| Anti-Lea | 10 (18.5) | 7 (35.0) | 1 (20.0) | 18 (22.8) |
| Anti-Leb | − | 3 (15.0) | 1 (20.0) | 4 (5.1) |
| Anti-Lea+b | 2 (3.7) | − | 1 (20.0) | 3 (3.8) |
| Others | 8 (14.8) | 3 (15.0) | − | 11 (13.9) |
| Anti-Fyb | 2 (3.7) | 1 (5.0) | − | 3 (3.8) |
| Anti-M | 3 (5.6) | 2 (10.0) | − | 5 (6.3) |
| Anti-N | 1 (1.9) | − | − | 1 (1.3) |
| Anti-P1 | 2 (3.7) | − | − | 2 (2.5) |
| Unidentified | 8 (14.8) | 2 (10.0) | 1 (20.0) | 11 (13.9) |
| Total | 54 (100.0) | 20 (100.0) | 5 (100.0) | 79 (100.0) |
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