Antibody Detection and Identification

Author: Margaret Alba, DOM, CLS(NCA), BB(ASCP)
Reviewer: Chelsey Geurkink, MS, MLS(ASCP)CMSBBCM
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Continuing Education Credits

P.A.C.E.® Contact Hours: 2 hour(s)

Florida Board of Clinical Laboratory Science CE Credit Hours

Florida Board of Clinical Laboratory Science CE - General (Blood Banking / Immunohematology): 2 hour(s)

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Do you find detective work exciting? Do you want to improve those skills? Our Antibody Detection and Identification course will guide you through the processes that will help you to expose the antibody that is the culprit. Antibodies must be identified so that appropriate blood products are selected for transfusion and the risk of adverse reaction is minimized. Clinically significant antibodies are capable of causing transfusion reactions, hemolytic disease of the newborn and in severe cases, death. Learning how to be a skilled detective is essential so that you, the clinical laboratory scientist, can prevent those situations from occurring.

Objectives

  • Discuss methods that are used to facilitate antibody identification.
  • Discuss the reactions that would be seen on an antibody panel if any of the following antibodies are present: homozygous, heterozygous, antibody to high-prevalence antigen or low-prevalence antigen, and an antibody exhibiting dosage.
  • Outline the process that should be followed to identify the unknown antibodies that are present in the given examples.
  • Assess antibody panels to determine if multiple antibodies, cold antibodies, or warm autoantibodies are present.
  • Determine how to interpret the strengths of panel reactions, how to choose selected cell panels, and when to run enzyme panels.

Course Outline

  • Introduction
    • Course Introduction
    • Antibody Detection and Identification
  • Methods Used for Antibody Detection and Identification
    • Indirect Antiglobulin Test (IAT)
    • Tube Method
    • Gel Method
    • Solid Phase Method
    • Significance of Reactions at Different Phases of Testing
    • Products Used to Facilitate Antibody Identification
    • Effect of Enzymes and Dithiothreitol (DTT)
    • Clinically significant antibodies react best at which phase of testing?
  • Antibody Detection and Identification
    • Initial Steps for Identifying an Antibody
    • Initial Observations of Antibody Panel
    • Rule-Out Procedures
    • Rule-Out Procedures, continued
    • Ruling Out Example
    • Ruling Out Example, continued
    • Ruling Out Example, continued
    • Case Study: Immune Alloantibody
    • Case Study: Immune Alloantibody, continued
    • Case Study: Immune Alloantibody, continuedUsing the information from the case study on the previous two pages, what antibody matches the pattern of reactivity?Rh-HrKellDuffyKiddLewisMNSsP1LutheranDonor Cell NumberDCcEeCwKkKpaKpbJsaJsbFyaFybJkaJkbLeaLebMNSsP1LuaLubIS37AHGCC1++00+00+0+0++0+++0+++++0+002+NT2++00++++0+0+++0+0+0++++0+000+3+0++000+0+0+0+0+0++00++0+000+4+0+0+00+0+0+00+00++++0+0+003+NT50+
    • Rule Out Procedures: Selecting Additional Rule-Out Cells
    • Example of Selecting Additional Rule-Out Cells
    • Based on initial serologic testing, a patient is suspected to have an anti-K, but anti-E cannot be ruled out. In this case, which of the following is the best cell to select to rule out anti-E?
    • Picking Selected Panel Cells Conservatively
    • Rule-Out Procedure Summary Guidelines
    • These antibody panel results were obtained on a patient sample. Which of the following antibodies could account for all of the reactions?Rh-HrKellDuffyKiddLewisMNSsP1LutheranXgDonor Cell NumberRhDCcEeCwKkKpaJsaFyaFybJkaJkbLeaLebMNSsP1LuaLubXgaIS37AHGCC1r'r0++0+00+00++++0++00++0+0001+NT2R1R1++00++0+00+0+++00+0++0++002+NT3R1R1++00+0++000+0+0+++0++0++000+4R2R2+0++000+0000+000+00++0++003+NT5r"r00+++00
  • Differentiate Between Naturally Occurring and Immune Antibodies
    • Naturally Occurring Antibodies vs. Immune Antibodies
    • Example of Naturally Occurring Antibody
    • Example of Clinically Significant Immune Antibody
    • Alloantibodies vs. Autoantibodies
    • Naturally occurring antibodies may be due to exposure to which of the following?
  • Advanced Antibody Identification
    • When to Suspect Multiple Antibodies
    • Example of Dosage and/or Multiple Antibodies Influencing the Strength of Reactions
    • Example of Multiple Antibodies
    • Example of Multiple Antibodies, continued: Selected Cell Rule-Out Panel
    • Example of Multiple Antibodies, continued: Explanation of Varying Strengths of Reactions
    • When to Suspect an Autoantibody
    • Cold Antibodies
    • Example of Cold Autoantibody
    • Example of Warm Autoantibody
    • Is It a Cold or a Warm Autoantibody?
    • What is an advanced technique that can help to determine the identity of other clinically significant antibodies that are present if a patient has an autoantibody?
  • Antibodies to High Prevalence and Low Prevalence Antigens
    • Antibodies to Low- and High-Prevalence Antigens
    • Examples of Antibodies to Low-Prevalence Antigens
    • Examples of Antibodies to High-Prevalence Antigens
  • Conclusion
    • Conclusion
  • References
    • References

Additional Information

Level of Instruction: Intermediate
Intended Audience: Medical laboratory scientists, technicians, and pathologists. This course is also appropriate for medical laboratory science students and pathology residents.
Author Information: Margaret Alba, DOM, CLS(NCA), BB(ASCP) is a Lecturer in Clinical Immunohematology at the University of New Mexico in Albuquerque, New Mexico, and a Medical Technologist at Tricore-University Hospital, also located in Albuquerque. She holds a Master's in Oriental Medicine from the International Institute of Chinese Medicine and a Bachelor of Science degree in Medical Technology from the University of Texas at El Paso.
Reviewer Information: Chelsey Geurkink, MS, MLS(ASCP)CMSBBCM, is an instructor for the Specialist in Blood Banking and Medical Laboratory Science program within the College of Health Sciences at RUSH University. She completed her Bachelor of Science at the University of Wisconsin-Madison in Biology and Bachelor of Science in Medical Laboratory Science at RUSH University. She completed her graduate degree in Clinical Laboratory Management at RUSH University. Chelsey received the Teaching Assistant of the Year award in the Medical Laboratory Science Department at RUSH University in 2015 and was recognized for her accomplishment in education and training in the field of transfusion medicine by the American Association of Blood Banks in 2019. She is currently the Manager of RUSH University Medical Center's Blood Bank.
Course Description: This course will take you through methods that can be used in the process of identifying an antibody in transfusion medicine. Many examples are presented that take you step-by-step through these procedures and provide you with appropriate panel results.