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CONTENTS
Immunohematology
Volume 11, Number 3, 1995

ABSTRACT

ABO discrepancy with monoclonal ABO reagents caused by a pH-dependent autoantibody
M.S. Kennedy, A.Waheed, and J. Moore

The r' gene is overrepresented in hrB-negative individuals
C.L. Beal, C.K. Oliver, D.M. Mallory, and P.D. Issitt

Detection of Lewis, P1, and some MNS blood group system antibodies by a solid phase assay
S. Rolih, R. Thomas, and L. Sinor

Correlation of monocyte monolayer assays and posttransfusion survival of Yt(a+) red cells in patients with anti-Yta
R.J. Eckrich, D.M. Mallory, and S.G. Sandler

A simple screening method to evaluate the presence of alloantibodies with concomitant warm autoantibodies
R. yen and M.L. Angeles

A practice guideline and decision aid for blood transfusion
B. Littenberg, H. Corwin, A. Gettinger, J. Leichter, and J. AuBuchon


ABO discrepancy with monoclonal ABO reagents caused by a pH-dependent autoantibody

M.S. Kennedy, A.Waheed, and J. Moore

ABO discrepancy was noted when a patients unwashed saline red cell suspension was tested with monoclonal ABO reagents. The discrepancy was resolved when a washed ( 3) saline red cell suspension was used in repeat testing. The patients serum contained an autoagglutinin that reacted optimally below pH 7.0. The discrepancy occurred when monoclonal ABO reagents, formulated at a low pH, lowered the pH of the reaction mixture, and autoagglutination was observed. Immunohematology1995;11:7173.

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The r' gene is overrepresented in hrB-negative individuals
C.L. Beal, C.K. Oliver, D.M. Mallory, and P.D. Issitt

G.M. Haslam, J. Sajur, Y. Fournier, J. Aulph, M. Persaud, and N. Heddle

A screening program was implemented to identify hrB donors. D C+, DC, and D+C samples from African-American donors were typed with multiple examples of anti-hrB and anti-hrB-like, and one example each of anti-V and anti-VS. Of 75 DC+ donors, 4 (5%) typed as hrB, and 14 others had weak or variable expression of hrB. Of these 18 individuals, 15 were VVS+, and 3 were V+VS+. No hrB sample was found in 90 C donors, 26 of whom were V+VS+, and 1 was VVS+. A review of our records of 44 hrB patients and donors studied earlier revealed that at least 12, and possibly as many as 30, carried r or rs. All hrB donors found in our screening program had DC+VS+ RBCs, indicating an overrepresentation of r. Our record review also showed that the presence of r and rs more often results in hrB RBCs, and that the most effective way to screen for hrB donors is to type African Americans who have DC+ RBCs. Immunohematology 1995;11:7477.

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Detection of Lewis, P1, and some MNS blood group system antibodies by a solid phase assay


S. Rolih, R. Thomas, and L. Sinor

Some solid phase red cell adherence (SPRCA) assays are designed to detect IgG antibodies to red blood cell (RBC) antigens. These assays use anti-IgG-coated red cells as the indicator. It is reported that most antibodies to Lea, Leb, P1, M, and N fail to react by solid phase (SP), presumably because they are IgM antibodies. Those detected are assumed to be IgG. In one year, during routine testing using SPRCA to screen patients for intended RBC transfusion, 28 of 59 such examples were found to react: anti-Lea(9), -Leb(1), -M(14), -N(1), and -P1(3). A study was undertaken to determine if reactivity was due to crosslinking by IgM antibodies of antigen-positive indicator RBCs to antigen-positive reagent RBC monolayers, or due to detection of IgG antibodies. Antibodies were tested according to standard SP protocols, except where IgG-neutralized indicator RBCs were substituted for anti-IgG-active indicator cells. The 59 samples were retested with antigen-positive and antigen-negative indicator RBCs. Only 5 of 59 reacted optimally when antigen-positive indicator cells were used: anti-Lea(2), -Leb(1), -M(1), and -N(1). The reactions of all antibodies were abolished when the anti-IgG component of the indicator was neutralized by soluble IgG. These findings show that detection of most Lewis, P1, M, and N antibodies by SPRCA is dependent on the presence of an IgG antibody in the serum. Immunohematology1995;11:7880.

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Correlation of monocyte monolayer assays and posttransfusion survival of Yt(a+) red cells in patients with anti-Yta


R.J. Eckrich, D.M. Mallory, and S.G. Sandler

Anti-Yta is an antibody to a high-frequency (99.8%) antigen and has been reported to have variable clinical significance. A retrospective review of monocyte monolayer assay (MMA) results on sera from 79 patients with anti-Yta was conducted to determine the reliability of this assay to predict the clinical significance of anti-Yta. Results of the MMA, other serological tests, and patient transfusion histories were analyzed. The MMA was found to be a reliable predictor of the clinical significance of anti-Yta when samples for analysis were collected at least six weeks after initial detection of the antibody. Only 18.2 percent of those examples of anti-Yta tested appeared to be clinically significant. Immunohematology1995;11:8184.

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A simple screening method to evaluate the presence of alloantibodies with concomitant warm autoantibodies

R. yen and M.L. Angeles

Autoantibodies are present in the serum of patients with autoimmune hemolytic anemia. Extensive serologic investigation is often needed to determine if alloantibodies are also present. To aid in the investigation, a simple method of serum dilution is described. The serum dilution method was compared to allogeneic red blood cell adsorptions in 119 cases tested over a two-year period. In 20 percent of the cases, the same underlying alloantibodies were detected by both the serum dilution method and allogeneic adsorption. In 42 percent of the cases, all autoantibody reactivity was removed by both methods. No clinically significant alloantibodies were missed using serum dilution as compared to allogeneic adsorptions. We conclude that serum dilution is a simple, rapid way to initially assess for the presence of alloantibodies that co-exist with autoantibodies. Immunohematology 1995;11:8587.

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A practice guideline and decision aid for blood transfusion

B. Littenberg, H. Corwin, A. Gettinger, J. Leichter, and J. AuBuchon

An attempt was made to reduce exposure of patients to blood products by using a point-of-ordering decision support system and strict adherence to a practice guideline, by observing physician behavior in the multidisciplinary intensive-care unit (ICU) of a tertiary-care medical center. Hemoglobin (Hg) level at the time of transfusion, total units of red blood cells (RBCs) per admission, units per patient per ICU day, fraction of patients receiving no transfusions, and incidence of single-unit transfusions covering 628 patients were measured. In Phase 1, RBC transfusion behavior was observed without intervention. In Phase 2, a special order form for RBCs that suggested a transfusion threshold of 8.6 g/dL of Hg was introduced. In Phase 3, the suggested threshold was lowered to 7.0 g/dL and required all transfusions that did not meet the new guideline to be prospectively reviewed by a transfusion medicine physician. The Hg level at transfusion fell from 8.5 g/dL to 8.2 g/dL (p = 0.008). The use of single-unit transfusions fell from 32 percent to 17 percent (p = 0.001), but there was no change in the number of patients receiving any blood, the total units per admission, or units per patient per day. In this setting, a practice guideline with a point-of-decision support system did not influence blood usage. Intermediate outcomes (such as the level of anemia at transfusion or compliance to a guideline) should not substitute for more substantial outcomes (reduction in blood use or virus exposure) in assessing medical practices. Immunohematology 1995;11:8894.

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George Garratty, PhD, FRCPath, Scientific Director, American Red Cross Blood Services, Southern California Region, 1130 S. Vermont Avenue, Los Angeles, CA 90006.

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