Blood compatibility testing: Difference between revisions

When multiple antibodies are present, or when an antibody is directed against a high-frequency antigen, the normal antibody panel procedure may not provide a conclusive identification. In these cases, ''hemagglutination inhibition'' can be used, wherein a ''neutralizing substance'' cancels out a specific antigen.<ref name="Mais 2014"/> Alternatively, the plasma may be incubated with cells of known antigen profiles in order to remove a specific antibody (a process termed ''adsorption''); or the cells can be treated with enzymes such as ficain or papain which inhibit the reactivity of some blood group antibodies and enhance others.{{r|McPherson2017|pp=723–9}} The effect of ficain and papain on major blood group systems is as follows:<ref name="HillHanna2017">{{cite journal|last1=Hill|first1=Ben C.|last2=Hanna|first2=Courtney A.|last3=Adamski|first3=Jill|last4=Pham|first4=Huy P.|last5=Marques|first5=Marisa B.|last6=Williams|first6=Lance A.|title=Ficin-Treated Red Cells Help Identify Clinically Significant Alloantibodies Masked as Reactions of Undetermined Specificity in Gel Microtubes|journal=Laboratory Medicine|volume=48|issue=1|year=2017|pages=24–28|issn=0007-5027|doi=10.1093/labmed/lmw062|pmid=28007780|doi-access=free}}</ref><ref name=CSTM>{{cite web|title=Questions and Answers on Proteolytic Enzymes Used in Blood Group Serology|url=https://www.transfusion.ca/Resources/CSTM-Blog/January-2018/Questions-and-Answers-on-Proteolytic-Enzymes-Used|website=Canadian Society for Transfusion Medicine|author=Eric Ching|access-date=2021-01-28}}</ref>

* Destroyed: Duffy (Fy^a and Fy^b), Lutheran, MNS

People who have tested positive for an unexpected blood group antibody in the past may not exhibit a positive reaction on subsequent testing; however, if the antibody is clinically significant, they must be transfused with antigen-negative blood regardless.<ref name="uptodate">{{cite web|title=Pretransfusion testing for red blood cell transfusion|last=Uhl|first=L|date=11 Jan 2021|work=[[UpToDate]]|url=https://www.uptodate.com/contents/pretransfusion-testing-for-red-blood-cell-transfusion|access-date=27 Jan 2021}}</ref>

!  !! [[ABO blood group system|ABO]] !! [[Rh blood group system|Rh]] !! [[Kell antigen system|Kell]] !! [[Duffy antigen system|Duffy]] !! [[Kidd antigen system|Kidd]] !! [[Lutheran antigen system|Lutheran]] !! [[MNS antigen system|MNS]] !! [[Lewis antigen system|Lewis]] !! [[P antigen system|P]] !! [[Ii antigen system|Ii]]

! Most common in [[hemolytic disease of the newborn]]

! Enhanced by [[ficain]]<ref name="HillHanna2017">{{cite journal|last1=Hill|first1=Ben C.|last2=Hanna|first2=Courtney A.|last3=Adamski|first3=Jill|last4=Pham|first4=Huy P.|last5=Marques|first5=Marisa B.|last6=Williams|first6=Lance A.|title=Ficin-Treated Red Cells Help Identify Clinically Significant Alloantibodies Masked as Reactions of Undetermined Specificity in Gel Microtubes|journal=Laboratory Medicine|volume=48|issue=1|year=2017|pages=24–28|issn=0007-5027|doi=10.1093/labmed/lmw062|pmid=28007780|doi-access=free}}</ref> and [[papain]]<ref name=CSTM>{{cite web|title=Questions and Answers on Proteolytic Enzymes Used in Blood Group Serology|url=https://www.transfusion.ca/Resources/CSTM-Blog/January-2018/Questions-and-Answers-on-Proteolytic-Enzymes-Used|website=Canadian Society for Transfusion Medicine|author=Eric Ching|access-date=2021-01-28}}</ref>

! Destroyed by [[ficain]]<ref name="HillHanna2017" /> and [[papain]]<ref name=CSTM/>