Frequencies and Specificities of “Enzyme-Only” Detected Erythrocyte Alloantibodies in Patients Hospitalized in Austria: Is an Enzyme Test Required for Routine Red Blood Cell Antibody Screening?
The aim of this study was to determine the frequencies and specificities of “enzyme-only” detected red blood cell (RBC) alloantibodies in the routine antibody screening and antibody identification in patients hospitalized in Austria. Routine blood samples of 2420 patients were investigated. The antibody screening was performed with a 3-cell panel in the low-ionic strength saline- (LISS-) indirect antiglobulin test (IAT) and with an enzyme-pretreated (papain) 3-cell panel fully automated on the ORTHO AutoVue Innova System. The antibody identification was carried out manually with an 11-cell panel in the LISS-IAT and with an enzyme-pretreated (papain) 11-cell panel. In total 4.05% ( ) of all patients ( ) had a positive RBC antibody screening result. Of them 25.51% (25/98) showed “enzyme-only” detected specific or nonspecific RBC alloantibodies. Rhesus and Lewis system antibodies were found the only specificities of “enzyme-only” RBC alloantibodies: all in all 4.8% (4/98) were detected with anti-E, 3.06% (3/98) with anti- , 3.06% (3/98) with anti-D after anti-D prophylaxis and 1.02% (1/98) with anti-e. In total, 14.29% (14/98) showed a nonspecific RBC alloantibody result with the enzyme test. The results of the present study demonstrate that a high number of unwanted positive reactions with the enzyme technique overshadows the detection of “enzyme-only” RBC alloantibodies. (Trial Registration: K-37-13). 1. Introduction Pretransfusion blood grouping, red blood cell (RBC) antibody screening, and compatibility testing are essential to prevent incompatible blood transfusion and alloimmunization. The Nobelist Karl Landsteiner, discoverer of the first human marker locus, published the results of a complete cross testing of the RBCs and sera of six people (including himself) in his 1901 paper [1–3]. Since then numerous other human blood group antigens have been described and categorized. Alloimmunization can cause a hemolytic transfusion reaction in individuals lacking the corresponding blood group antigen on their erythrocytes [4, 5]. RBC alloimmunization correlates with the number of transfusions [6–8], and the immunogenicity of the blood group antigens is crucial [5, 9]. About 25–28 antigens are known to cause hemolytic transfusion reactions and should be detected with the pretransfusion RBC antibody screening test [10]. The Rhesus (Rh), Kell (K), Duffy (Fy), and Kidd (Jk) antigens are some of these clinically significant blood group antigens [11]. Pretransfusion compatibility testing involves ABO grouping, Rh typing, RBC antibody screening, RBC antibody
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