Antibody IdentiÞcation Part 1 - Blood Bank Guy
Antibody Identification
Part 1: The Basics A Blood Bank Guy Video Podcast
D. Joe Chaffin, MD March 2012
Part 1
? Prerequisites ? Geography of a panel ? Antibody ID method ? Case examples
Tuesday, March 6, 12
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Tuesday, March 6, 12
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Prerequisites
? Blood Group Overview ? General facts ? Podcast from December 2011 ? Pretransfusion Testing ? Testing methodologies ? Antibody screen ? Podcast from February 2012
Tuesday, March 6, 12
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When Do We I.D.?
? Following a positive antibody screen ? Patients, prenatals, donors ? When testing suggests a new antibody ? To confirm a previously identified
antibody (per facility SOP)
Tuesday, March 6, 12
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Definitions
? Alloantibody ? Antibody against RBC antigens
not present on patient's own RBCs
? Autoantibody ? Antibody against RBC antigens
present on patient's own RBCs
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What's a Panel?
? Just an expanded antibody screen ? Uses group O reagent RBCs ? RBCs from 8-20 donors ? Patient serum or plasma ? IS / 37 C / AHG if tubes ? AHG only if gel or solid phase ? Reactions documented on a sheet
that outlines every RBC's phenotype
Tuesday, March 6, 12
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Geography
? Let's take a close look at a panel ? Important to know your way around ? There are variations, but this is a
general guide
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A series of 8-20 group O donor reagent red cells, each tested for all main antigens ("phenotyped")
Rh-hr (or "Hr") = Modified Wiener Rh genotype for donor
R1: DCe R2: DcE R0: Dce RZ: DCE
r': dCE r": dcE r: dce ry: dCE
Other stuff: -Donor ID -Special Antigen Type
Co(b+)
Tuesday, March 6, 12
D, C, c, E, e, Fya, Fyb, Jka, Jkb, K, k, Lea, Leb, M, N, P1, S, s
Full donor phenotype D phenotype for each donor, C phenotype for each donor,etc...
* * * * * * * *
Tuesday, March 6, 12
A series of 8-20 group O donor reagent red cells, each tested for all main antigens ("phenotyped")
Rh-hr (or "Hr") = Modified Wiener Rh genotype for donor
R1: DCe R2: DcE R0: Dce RZ: DCE
r': dCE r": dcE r: dce ry: dCE
Other stuff: -Donor ID -Special Antigen Type
Pt. phenotype results
+
9
Tuesday, March 6, 12
0
+
10
Jk(a+b?): Assume "double dose" Jka Jk(a+b+): "Single dose" Jka and Jkb Jk(a?b+): Assume "double dose" Jkb
11
Tuesday, March 6, 12
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Jka
Jka
Jkb
Jka
Jkb
Jkb
Cell 1
FyaCell 2 Fya
FyCa ell 5 Fy
Tuesday, March 6, 12 Tuesday, March 6, 12
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Tuesday, March 6, 12
IS AHG
0 3+ 0 3+ 0 3+ 0 3+ 00 00 00 00 00 00 0 3+
IS = Immediate spin 37 = 37 C Incubation AHG = Anti-human globulin IAT = Indirect antiglobulin test
(=AHG)
This is also tube testing! (often with PEG)
15
Tuesday, March 6, 12
IS 37 AHG
0 1+ 3+ 0 1+ 3+ 0 1+ 3+ 0 1+ 3+ 000 000 000 000 000 000 0 1+ 3+
IS = Immediate spin 37 = 37 C Incubation AHG = Anti-human globulin IAT = Indirect antiglobulin test
(=AHG)
This is tube testing!
LISS Albumin Saline PEG
14
AHG
IS = Immediate spin
37 = 37 C Incubation
3+
AHG = Anti-human globulin
IAT = Indirect antiglobulin test
3+
(=AHG)
3+
3+
This could be:
0
-Tube testing
0
OR -Gel testing
0
OR
0
-Solid-phase testing
0
0
3+
16
Tuesday, March 6, 12
3+ 0 0 0 0 0 0 3+ 4+ Pos Control 0 Neg Control
3+ 3+ 0 0 0 0 0 0 3+ 0
IS = Immediate spin 37 = 37 C Incubation AHG = Anti-human globulin IAT = Indirect antiglobulin test
(=AHG)
This could be: -Tube testing OR -Gel testing OR -Solid-phase testing
17
Tuesday, March 6, 12
IS = Immediate spin
37 = 37 C Incubation
3+
AHG = Anti-human globulin
IAT = Indirect antiglobulin test
3+
(=AHG)
3+
3+
This is almost always:
0
-Gel testing
0
OR
0
-Solid-phase
0
0
0
3+
18
All other results are suspect
If the AC is positive:
Ya Gotta Have a Plan...
? Consistent approach minimizes error ? Most are simple, but cutting corners
increases risk for dumb mistakes
? Use this or your own system, but use the same approach every time!
Tuesday, March 6, 12
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Tuesday, March 6, 12
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