An unusual case of reagent interference in transfusion medicine workup: Pan reactive indirect antiglobulin test caused by commercial saline solution
At the regional transfusion service in the Region of Southern Denmark, serological investigations are primarily carried out using column agglutination techniques. This case study examines an unusual instance of reagent interference in pretransfusion testing using column agglutination at the Hospital...
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| Vydáno v: | Transfusion medicine (Oxford, England) Ročník 35; číslo 2; s. 192 - 196 |
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| Hlavní autoři: | , , , , |
| Médium: | Journal Article |
| Jazyk: | angličtina |
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England
Blackwell Publishing Ltd
01.04.2025
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| ISSN: | 0958-7578, 1365-3148, 1365-3148 |
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| Abstract | At the regional transfusion service in the Region of Southern Denmark, serological investigations are primarily carried out using column agglutination techniques. This case study examines an unusual instance of reagent interference in pretransfusion testing using column agglutination at the Hospital of Southern Denmark, Aabenraa.
A 72-year-old male patient presented for pretransfusion testing prior to hernia surgery. He typed as O RhD negative without discrepancies, but the antibody screen showed weakly positive reactions. Routine investigations showed discrepancies, leading to further investigations.
Various serological tests were performed using in-house and commercial red test cells suspended in different suspension media and with different column agglutination cards and cassettes. Further investigations included washing of test cells, testing alternative saline solutions, varying incubation temperatures, testing without antihuman-globulin, and applying proteolytic enzymes.
Reactivity was present with red cells suspended in ID-CellStab (BioRad) but not in Red Cell Diluent (Quidel-Ortho). Reactivity was abolished by using trypsin-treated cells, indicating either the presence of an antibody reacting with-or unspecific agglutination depending on-a trypsin-sensitive protein, in both cases enhanced by ID-CellStab.
This case highlights the importance of recognising reagent-dependent reactivity in serological testing. Adjustments to the suspension media resolved the incompatibility. Immunohematology laboratories should consider potential reagent interference when unexpected agglutination occurs. |
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| AbstractList | At the regional transfusion service in the Region of Southern Denmark, serological investigations are primarily carried out using column agglutination techniques. This case study examines an unusual instance of reagent interference in pretransfusion testing using column agglutination at the Hospital of Southern Denmark, Aabenraa.
A 72-year-old male patient presented for pretransfusion testing prior to hernia surgery. He typed as O RhD negative without discrepancies, but the antibody screen showed weakly positive reactions. Routine investigations showed discrepancies, leading to further investigations.
Various serological tests were performed using in-house and commercial red test cells suspended in different suspension media and with different column agglutination cards and cassettes. Further investigations included washing of test cells, testing alternative saline solutions, varying incubation temperatures, testing without antihuman-globulin, and applying proteolytic enzymes.
Reactivity was present with red cells suspended in ID-CellStab (BioRad) but not in Red Cell Diluent (Quidel-Ortho). Reactivity was abolished by using trypsin-treated cells, indicating either the presence of an antibody reacting with-or unspecific agglutination depending on-a trypsin-sensitive protein, in both cases enhanced by ID-CellStab.
This case highlights the importance of recognising reagent-dependent reactivity in serological testing. Adjustments to the suspension media resolved the incompatibility. Immunohematology laboratories should consider potential reagent interference when unexpected agglutination occurs. At the regional transfusion service in the Region of Southern Denmark, serological investigations are primarily carried out using column agglutination techniques. This case study examines an unusual instance of reagent interference in pretransfusion testing using column agglutination at the Hospital of Southern Denmark, Aabenraa.BACKGROUNDAt the regional transfusion service in the Region of Southern Denmark, serological investigations are primarily carried out using column agglutination techniques. This case study examines an unusual instance of reagent interference in pretransfusion testing using column agglutination at the Hospital of Southern Denmark, Aabenraa.A 72-year-old male patient presented for pretransfusion testing prior to hernia surgery. He typed as O RhD negative without discrepancies, but the antibody screen showed weakly positive reactions. Routine investigations showed discrepancies, leading to further investigations.CASE PRESENTATIONA 72-year-old male patient presented for pretransfusion testing prior to hernia surgery. He typed as O RhD negative without discrepancies, but the antibody screen showed weakly positive reactions. Routine investigations showed discrepancies, leading to further investigations.Various serological tests were performed using in-house and commercial red test cells suspended in different suspension media and with different column agglutination cards and cassettes. Further investigations included washing of test cells, testing alternative saline solutions, varying incubation temperatures, testing without antihuman-globulin, and applying proteolytic enzymes.METHODSVarious serological tests were performed using in-house and commercial red test cells suspended in different suspension media and with different column agglutination cards and cassettes. Further investigations included washing of test cells, testing alternative saline solutions, varying incubation temperatures, testing without antihuman-globulin, and applying proteolytic enzymes.Reactivity was present with red cells suspended in ID-CellStab (BioRad) but not in Red Cell Diluent (Quidel-Ortho). Reactivity was abolished by using trypsin-treated cells, indicating either the presence of an antibody reacting with-or unspecific agglutination depending on-a trypsin-sensitive protein, in both cases enhanced by ID-CellStab.RESULTSReactivity was present with red cells suspended in ID-CellStab (BioRad) but not in Red Cell Diluent (Quidel-Ortho). Reactivity was abolished by using trypsin-treated cells, indicating either the presence of an antibody reacting with-or unspecific agglutination depending on-a trypsin-sensitive protein, in both cases enhanced by ID-CellStab.This case highlights the importance of recognising reagent-dependent reactivity in serological testing. Adjustments to the suspension media resolved the incompatibility. Immunohematology laboratories should consider potential reagent interference when unexpected agglutination occurs.CONCLUSIONThis case highlights the importance of recognising reagent-dependent reactivity in serological testing. Adjustments to the suspension media resolved the incompatibility. Immunohematology laboratories should consider potential reagent interference when unexpected agglutination occurs. |
| Author | Yazer, Mark H. Sprogøe, Ulrik Rasmussen, Kristina Fruerlund Bach‐Hansen, Helle Pedersen, Martin Tøffner |
| AuthorAffiliation | 2 Department of Clinical Immunology Odense University Hospital Odense Denmark 1 Department of Blood tests, Biochemistry and Immunology University Hospital of Southern Denmark Aabenraa Denmark 3 Department of Pathology University of Pittsburgh Pittsburgh Pennsylvania USA |
| AuthorAffiliation_xml | – name: 3 Department of Pathology University of Pittsburgh Pittsburgh Pennsylvania USA – name: 2 Department of Clinical Immunology Odense University Hospital Odense Denmark – name: 1 Department of Blood tests, Biochemistry and Immunology University Hospital of Southern Denmark Aabenraa Denmark |
| Author_xml | – sequence: 1 givenname: Martin Tøffner orcidid: 0009-0003-9087-5977 surname: Pedersen fullname: Pedersen, Martin Tøffner organization: Department of Blood tests, Biochemistry and Immunology University Hospital of Southern Denmark Aabenraa Denmark – sequence: 2 givenname: Helle surname: Bach‐Hansen fullname: Bach‐Hansen, Helle organization: Department of Blood tests, Biochemistry and Immunology University Hospital of Southern Denmark Aabenraa Denmark – sequence: 3 givenname: Kristina Fruerlund surname: Rasmussen fullname: Rasmussen, Kristina Fruerlund organization: Department of Clinical Immunology Odense University Hospital Odense Denmark – sequence: 4 givenname: Mark H. surname: Yazer fullname: Yazer, Mark H. organization: Department of Clinical Immunology Odense University Hospital Odense Denmark, Department of Pathology University of Pittsburgh Pittsburgh Pennsylvania USA – sequence: 5 givenname: Ulrik orcidid: 0000-0003-4426-5054 surname: Sprogøe fullname: Sprogøe, Ulrik organization: Department of Clinical Immunology Odense University Hospital Odense Denmark |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/39548858$$D View this record in MEDLINE/PubMed |
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| Cites_doi | 10.21307/immunohematology-2019-052 10.1111/j.1537-2995.2011.03327.x 10.4103/ajts.AJTS_99_20 10.4103/ajts.AJTS_100_17 |
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| Title | An unusual case of reagent interference in transfusion medicine workup: Pan reactive indirect antiglobulin test caused by commercial saline solution |
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