Asian Journal of Transfusion Science

ILLUSTRATION
Year
: 2015  |  Volume : 9  |  Issue : 2  |  Page : 115--116

Hemolysis: A positive agglutination reaction while studying titration of anti A/B antibody for ABO-incompatible solid organ transplants


Satyam Arora, Veena Doda, Mitu Dogra, Urvershi Kotwal 
 Department of Transfusion Medicine, Post Graduate Institute of Medical Education and Research, Dr. Ram Manohar Lohia Hospital, New Delhi, India

Correspondence Address:
Dr. Satyam Arora
Department of Transfusion Medicine, Post Graduate Institute of Medical Education and Research, Dr. Ram Manohar Lohia Hospital, New Delhi
India




How to cite this article:
Arora S, Doda V, Dogra M, Kotwal U. Hemolysis: A positive agglutination reaction while studying titration of anti A/B antibody for ABO-incompatible solid organ transplants.Asian J Transfus Sci 2015;9:115-116


How to cite this URL:
Arora S, Doda V, Dogra M, Kotwal U. Hemolysis: A positive agglutination reaction while studying titration of anti A/B antibody for ABO-incompatible solid organ transplants. Asian J Transfus Sci [serial online] 2015 [cited 2022 May 19 ];9:115-116
Available from: https://www.ajts.org/text.asp?2015/9/2/115/162682


Full Text

For a long time, it has been thought that matching of ABO blood groups is an absolute requirement for successful solid organ transplants (SOT). In the last few years, however, several centers have started to perform ABO-incompatible SOT with encouraging results. Today, transplant physicians [1] are confronted with ABO-incompatible grafts in for kidney and liver from living donors. Initial results of these kidney transplants (KT) achieved low graft survival due to high anti A and anti B isoagglutinin in the recipients but recently developed desensitization protocols have improved survival to levels that are comparable to ABO-compatible KT. However, isoagglutinin is still regarded as a major obstacle [2] to ABO-i KT.

Request for baseline isoagglutinin levels was received by the department of transfusion medicine for a patient planned for ABO-incompatible renal transplant. The patient was suffering from chronic renal failure for many years. ABO and D blood typing was performed routinely by both manual tube and column agglutination technology (CAT). Screening of irregular antibody was done using surgiscreen, ortho clinical diagnostics (USA) with polyspecific anti-human globulin (AHG) cards. Isoagglutinin titration was done in two phases: One was immediate spin (IS) using reverse diluent cards and the other was at AHG phase using CAT cards containing polyspecific AHG (Anti-immunoglobulin G [IgG] and anti-C3d). The antibody titration (isoagglutinin levels) was performed by doubling dilution technique of the patient's plasma and reagent cells used were A1 and B pooled cells (3-5% suspension) for anti A and anti B, respectively. The blood group of the patient was O Rh (D) positive. Antibody screen and auto control of the patient was negative.

On titration of both anti A and anti B, the strength of reaction of neat (N), 1:2 and 1:4 dilution showed reddish tinge in the reaction chamber [Figure 1]. The plasma was negative for any free hemoglobin. These reddish tinges were due to the hemolysis caused by the high antibody strength in the patient. The antibody titers were anti-A (IS - 1:64, AHG - 1:512) and anti-B (IS - 1:32, AHG - 1:512). On further dilution, the strength of the reaction decreased, and the reddish tinge disappeared [Figure 2].{Figure 1}{Figure 2}

The ABO antibodies are predominantly IgM, activate complement, and react at room temperature or colder. [3] The predominant Ig class of antibodies in group O serum is IgG. [3] Knowledge of the amount of IgG anti-A and anti-B in patients planned for ABO-incompatible SOT allows prediction of the graft survivals. [4] Both Ig classes of ABO antibodies react preferentially at room temperature (20-24°C) or below and efficiently activate complement at 37°C.

This illustration highlights the importance of keeping in mind that hemolysis must be regarded as a positive sign of an antigen-antibody reaction if the pretest serum was not hemolyzed and no hemolytic agent was added to the test. This phenomenon is particularly observed when dealing with anti-A and anti-B antibodies as both of them cause rapid in vitro lysis of the incompatible cells.

References

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2Won D, Choe W, Kim HJ, Kwon SW, Han DJ, Park SK. Significance of isoagglutinin titer in ABO-incompatible kidney transplantation. J Clin Apher 2014;29:243-50.
3Daniels G. Human Blood Groups. 2 nd ed. Malden, MA: Blackwell Science; 2002.
4Shimmura H, Tanabe K, Ishikawa N, Tokumoto T, Takahashi K, Toma H. Role of anti-A/B antibody titers in results of ABO-incompatible kidney transplantation. Transplantation 2000;70: 1331-5.