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Journal of Blood Group Serology and Molecular Genetics Volume 34, Number 1, 2018 CONTENTS

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Journal of Blood Group Serology and Molecular Genetics Volume 34, Number 1, 2018 CONTENTS Journal of Blood Group Serology and Molecular Genetics VOLUME 34, N UMBER 1, 2018 This issue of Immunohematology is supported by a contribution from Grifols Diagnostics Solutions, Inc. Dedicated to advancement and education in molecular and serologic immunohematology Immunohematology Journal of Blood Group Serology and Molecular Genetics Volume 34, Number 1, 2018 CONTENTS S EROLOGIC M ETHOD R EVIEW 1 Warm autoadsorption using ZZAP F.M. Tsimba-Chitsva, A. Caballero, and B. Svatora R EVIEW 4 Proceedings from the International Society of Blood Transfusion Working Party on Immunohaematology Workshop on the Clinical Significance of Red Blood Cell Alloantibodies, Friday, September 2, 2016, Dubai A brief overview of clinical significance of blood group antibodies M.J. Gandhi, D.M. Strong, B.I. Whitaker, and E. Petrisli C A S E R EPORT 7 Management of pregnancy sensitized with anti-Inb with monocyte monolayer assay and maternal blood donation R. Shree, K.K. Ma, L.S. Er and M. Delaney R EVIEW 11 Proceedings from the International Society of Blood Transfusion Working Party on Immunohaematology Workshop on the Clinical Significance of Red Blood Cell Alloantibodies, Friday, September 2, 2016, Dubai A review of in vitro methods to predict the clinical significance of red blood cell alloantibodies S.J. Nance S EROLOGIC M ETHOD R EVIEW 16 Recovery of autologous sickle cells by hypotonic wash E. Wilson, K. Kezeor, and M. Crosby TO THE E DITOR 19 The devil is in the details: retention of recipient group A type 5 years after a successful allogeneic bone marrow transplant from a group O donor L.L.W. Cooling, M. Herrst, and S.L. Hugan 23 32 36 37 A NNOUNCE M ENT S A DVERTI S E M ENT S I N S TRUCTION S S UB S CRIPTION FOR A UTHOR S I NFOR M AT I O N E DITOR - IN -C HIEF E DITORIAL B OARD Sandra Nance, MS, MT(ASCP)SBB Philadelphia, Pennsylvania Patricia Arndt, MT(ASCP)SBB Geralyn M. Meny, MD Pomona, California San Antonio, Texas M ANAGING E DITOR Cynthia Flickinger, MT(ASCP)SBB Barbara J. Bryant, MD Paul M. Ness, MD Wilmington, Delaware Galveston, Texas Baltimore, Maryland Lilian M. Castilho, PhD Thierry Peyrard, PharmD, PhD TECHNICAL E DITOR S Campinas, Brazil Paris, France Janis R. Hamilton, MS, MT(ASCP)SBB Detroit, Michigan Martha R. Combs, MT(ASCP)SBB S. Gerald Sandler, MD Durham, North Carolina Washington, District of Columbia Christine Lomas-Francis, MSc New York City, New York Geoffrey Daniels, PhD Ira A. Shulman, MD Bristol, United Kingdom Los Angeles, California Joyce Poole, FIBMS Bristol, United Kingdom Anne F. Eder, MD Jill R. Storry, PhD Washington, District of Columbia Lund, Sweden Dawn M. Rumsey, ART(CSMLT) Norcross, Georgia Melissa R. George, DO, FCAP Nicole Thornton Hershey, Pennsylvania Bristol, United Kingdom Tiffany Walters, MT(ASCP)SBBCM Julie K. Karp, MD Charlotte, North Carolina Philadelphia, Pennsylvania E M ERITU S E DITOR S S ENIOR M EDICAL E DITOR Jose Lima, MD Delores Mallory, MT(ASCP)SBB David Moolten, MD Douglassville, Georgia Supply, North Carolina Philadelphia, Pennsylvania Christine Lomas-Francis, MSc Marion E. Reid, PhD, FIBMS A ss O C I AT E M EDICAL E DITOR S New York City, New York Bristol, United Kingdom P. Dayand Borge, MD Philadelphia, Pennsylvania Corinne L. Goldberg, MD Durham, North Carolina M OLECULAR E DITOR Margaret A. Keller, PhD Immunohematology is published quarterly (March, June, September, and December) by the Philadelphia, Pennsylvania American Red Cross, National Headquarters, Washington, DC 20006. Immunohematology is indexed and included in Index Medicus and MEDLINE on the E DITORIAL A ss I S TA N T MEDLARS system. The contents are also cited in the EBASE/Excerpta Medica and Elsevier Linda Frazier BIOBASE/Current Awareness in Biological Sciences (CABS) databases. P RODUCTION A ss I S TA N T The subscription price is $50 for individual, $100 for institution (U.S.), and Marge Manigly $60 for individual, $100 for institution (foreign), per year. Subscriptions, Change of Address, and Extra Copies: C OPY E DITOR Frederique Courard-Houri Immunohematology, P.O. Box 40325 Philadelphia, PA 19106 P ROOFREADER Or call (215) 451-4902 Wendy Martin-Shuma Web site: www.redcrossblood.org/hospitals/immunohematology E LECTRONIC P UBLI S HER Copyright 2018 by The American National Red Cross Paul Duquette ISSN 0894-203X O N O UR C OVER A Wheatfield on a Summer’s Afternoon is a backdrop, one of four that Marc Chagall executed in 1942 for the premier of Rachmaninoff’s Carmenesque ballet, Aleko, based on the Pushkin poem, The Gypsies. Both the ballet and the poem confront the romantic notion of the “noble savage” who rejects an oppressive society for a truer life apart from it. Aleko, the hero, is a fugitive who, despite his yearning for sanctuary, brings with him a violence and rigidity of thought that drives the narrative to its tragic end. Chagall’s four works largely fail to match events on stage, instead finding within themselves similar primal elements. Here, the sickle in the grain, the fish out of water beneath it, the two suns: one childish, the other a bulls-eye target, and the white branch falling upside down near the couple in the boat whom fish surround, create a wildly liberated dream-like idiom, absurdly comic, and yet tender in its tone. The article by Wilson et al. in this issue of Immunohematology addresses the recovery of autologous sickle cells by hypotonic wash. David Moolten, MD ii IMMUNOHEMATOLOGY, Volume 34, Number 1, 2018 Warm autoadsorption using ZZAP F.M. Tsimba-Chitsva, A. Caballero, and B. Svatora The masking of clinically significant alloantibodies by warm Reagents/Supplies autoantibodies presents challenges in pretransfusion testing. The adoption of transfusion practices such as the issuing of “least Reagents Supplies incompatible” red blood cells (RBCs) without a complete antibody workup is potentially unsafe for patients. Several autoadsorption • 0.2 M DTT • 1-mL graduated pipettes methods can be used to remove autoantibody reactivity. ZZAP • 1% cysteine-activated • 37°C water bath papain or 1% ficin treatment of autologous RBCs is an efficient way to prepare the • Large-bore test tubes cells for autoadsorption. Autoadsorbed serum or plasma can then • Isotonic saline • Calibrated centrifuge be used to remove autoantibody reactivity and identify clinically • Patient’s autologous RBCs significant alloantibodies. Immunohematology 2018;34: • Filter paper (optional) 1–3. DTT = dithiothreitol; RBCs = red blood cells. SEROLOGIC METHOD REVIEW Key Words: warm autoadsorption, warm autoantibodies, Procedural Steps ZZAP-treated RBCs, autoimmune hemolytic anemia • Mix 2 volumes of ZZAP and 1 volume of packed RBCs. Principle RBC • Incubate mixture. treatment • Wash to remove ZZAP. Warm autoantibodies (WAAs) present serologic challenges • Centrifuge to pack RBCs. • Remove supernatant. in pretransfusion compatibility testing. These autoantibodies, • Mix serum/plasma and ZZAP-treated packed which are optimally reactive at 37°C, may mask the presence RBCs. of clinically significant alloantibodies by agglutinating most Adsorption • Incubate mixture. or all red blood cells (RBCs) tested. Studies have shown that • Centrifuge to pack RBCs. the incidence of clinically significant alloantibodies is higher • Harvest serum/plasma. in patient sera containing WAAs than in multiply transfused RBCs = red blood cells. patients without autoimmune hemolytic anemia (AIHA).1–4 Some blood banks have implemented the policy of transfusing “least incompatible” non-phenotypically matched RBCs, and others transfuse least incompatible RBCs that are preferred because of the risk of adsorbing an alloantibody to a phenotypically matched for either the full phenotype or only high-prevalence antigen onto allogeneic adsorbing RBCs. for the common antigens in the Rh blood group system and for K. The transfusion of least incompatible non-phenotypically Indications matched units without exclusion of other alloantibodies poses a major risk to patients with WAAs because hemolysis To effectively achieve the autoadsorption of WAAs, secondary to undetected alloantibodies can be falsely initial preparation of the patient’s RBCs is required. In vivo attributed to an increasing severity of AIHA.2 adsorptions occur at 37°C, and all the antigen sites on the The detection of clinically significant alloantibodies can patient’s RBCs may be blocked with immunoglobulin.5 be achieved through the removal of autoantibody from the Methods for immunoglobulin dissociation may include partial patient’s plasma or serum. Autoantibody removal can be heat elution at 45°C, gentle heat elution at 56°C, treatment achieved by adsorbing the plasma or serum onto autologous with proteolytic enzymes (papain and/or ficin), treatment with RBCs (provided the patient has not been transfused in the chloroquine diphosphate, or treatment with a ZZAP reagent last 3 months).5 Alternatively, if the patient has been recently (mixture of a proteolytic enzyme and the sulfhydryl reagent transfused or autologous RBCs are limited, allogeneic RBC dithiothreitol [DTT]).5,8 adsorption may be performed.5–7 Autologous adsorption is IMMUNOHEMATOLOGY, Volume 34, Number 1, 2018 1 F.M. Tsimba-Chitsva et al. Treatment of the adsorbing RBCs with ZZAP has been the plasma or serum during adsorption.10 Suctioning with a shown to be one of the most effective methods for pretreating small-bore pipette or using filter paper may be helpful. adsorption RBCs. It simultaneously removes bound IgG and enhances autoantibody uptake during the adsorption process. Autologous Adsorption In addition to removing IgG from coated RBCs, ZZAP also Combine plasma or serum with ZZAP-treated autologous removes bound IgM and complement (approximately 35% of RBCs at a 1:1 ratio (equal volumes of both); the volume of patients with WAAs present with cold autoantibodies reactive ZZAP-treated autologous RBCs may be increased, however, at room temperature).7,9 to enhance antibody uptake. Incubate the mixture at 37°C for ZZAP will destroy some antigen sites on RBCs.
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