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Immuno 2014 No. 1 Journal of Blood Group Serology and Molecular Genetics VOLUME 30, N UMBER 1, 2014 Immunohematology Journal of Blood Group Serology and Molecular Genetics Volume 30, Number 1, 2014 CONTENTS R EPORT 1 Indirect antiglobulin test-crossmatch using low-ionic-strength saline–albumin enhancement medium and reduced incubation time: effectiveness in the detection of most clinically significant antibodies and impact on blood utilization C.L. Dinardo, S.L. Bonifácio, and A. Mendrone, Jr. R EV I EW 6 Raph blood group system M. Hayes R EPORT 11 I-int phenotype among three individuals of a Parsi community from Mumbai, India S.R. Joshi C A SE R EPORT 14 Evans syndrome in a pediatric liver transplant recipient with an autoantibody with apparent specificity for the KEL4 (Kpb) antigen S.A. Koepsell, K. Burright-Hittner, and J.D. Landmark R EV I EW 18 JMH blood group system: a review S.T. Johnson R EPORT 24 Demonstration of IgG subclass (IgG1 and IgG3) in patients with positive direct antiglobulin tests A. Singh, A. Solanki, and R. Chaudhary I N M EMOR ia M 28 George Garratty, 1935–2014 Patricia A. Arndt and Regina M. Leger 30 A NNOUNCEMENTS 34 A DVERT I SEMENTS 39 I NSTRUCT I ONS FOR A UTHORS E D I TOR - I N -C H I EF E D I TOR ia L B OA RD Sandra Nance, MS, MT(ASCP)SBB Philadelphia, Pennsylvania Patricia Arndt, MT(ASCP)SBB Paul M. Ness, MD Pomona, California Baltimore, Maryland M A N AG I NG E D I TOR James P. AuBuchon, MD Thierry Peyrard, PharmD, PhD Cynthia Flickinger, MT(ASCP)SBB Seattle, Washington Paris, France Philadelphia, Pennsylvania Barbara J. Bryant, MD Mark Popovsky, MD TECHN I C A L E D I TORS Milwaukee, Wisconsin Braintree, Massachusetts Christine Lomas-Francis, MSc Lilian Castilho, PhD S. Gerald Sandler, MD New York City, New York Campinas, Brazil Washington, District of Columbia Joyce Poole, FIBMS Martha R. Combs, MT(ASCP)SBB Jill R. Storry, PhD Bristol, United Kingdom Durham, North Carolina Lund, Sweden Dawn M. Rumsey, ART(CSMLT) Geoffrey Daniels, PhD David F. Stroncek, MD Norcross, Georgia Bristol, United Kingdom Bethesda, Maryland Anne F. Eder, MD Nicole Thornton S EN I OR M ED I C A L E D I TOR Washington, District of Columbia Bristol, United Kingdom Ralph R. Vassallo, MD Philadelphia, Pennsylvania Brenda J. Grossman, MD St. Louis, Missouri E MER I TUS E D I TORS Delores Mallory, MT(ASCP) SBB A SSOC iaTE M ED I C A L E D I TORS Christine Lomas-Francis, MSc P. Dayand Borge, MD New York City, New York Supply, North Carolina Baltimore, Maryland Geralyn M. Meny, MD Marion E. Reid, PhD, FIBMS New York City, New York David Moolten, MD San Antonio, Texas Philadelphia, Pennsylvania M OLECUL A R E D I TOR Margaret A. Keller Philadelphia, Pennsylvania E D I TOR ia L A SS I STA NT Immunohematology is published quarterly (March, June, September, and December) by the Sheetal Patel American Red Cross, National Headquarters, Washington, DC 20006. Immunohematology is indexed and included in Index Medicus and MEDLINE on the P RODUCT I ON A SS I STA NT MEDLARS system. The contents are also cited in the EBASE/Excerpta Medica and Elsevier Marge Manigly BIOBASE/Current Awareness in Biological Sciences (CABS) databases. The subscription price is $50 for individual, $100 for institution (U.S.) and C OPY E D I TOR $60 for individual, $100 for institution (foreign) per year. Mary L. Tod Subscriptions, Change of Address, and Extra Copies: Immunohematology, P.O. Box 40325 P ROOFRE A DER Philadelphia, PA 19106 Lucy Oppenheim Wendy Martin-Shuma Or call (215) 451-4902 Web site: www.redcross.org/about-us/publications/immunohematology E LECTRON I C P UBL I SHER Copyright 2014 by The American National Red Cross Paul Duquette ISSN 0894-203X O N O UR C OVER Henri Rousseau, or Le Douanier (the customs officer), as he was nicknamed for his primary occupation as a toll collector, failed to impress either the art world or the public in his lifetime (1844–1910). Self- taught, he adhered to a simple, childlike style at odds with his contemporaries. Although he received little recognition from and was even ridiculed by critics, he became the darling of artists and writers such as Picasso, Brancusi, and Apollinaire and is now regarded as a genius. The Tabby, or Le Chat Tigre, exemplifies both the primitive and yet subtly dreamlike character of his work. The JMH blood group discussed by S.T. Johnson in this issue includes “The Cat” among its nicknames. David Moolten, MD R EPO R T Indirect antiglobulin test-crossmatch using low-ionic-strength saline–albumin enhancement medium and reduced incubation time: effectiveness in the detection of most clinically significant antibodies and impact on blood utilization C.L. Dinardo, S.L. Bonifácio, and A. Mendrone, Jr. Indirect antiglobulin test-crossmatch (IAT-XM) using Crossmatching of donor red blood cells (RBCs) and enhancement media such as low-ionic-strength saline (LISS) recipient’s serum is an important step required to complete and polyethylene glycol (PEG) usually requires 15 minutes of pretransfusion tests. Crossmatch can be performed incubation. These methods are necessary when testing samples from blood recipients who have a higher risk of alloimmunization. electronically or by an immediate-spin method, in which In emergency situations, IAT-XM can be time-consuming and no incubation or anti-human globulin (AHG) steps are can influence presurgery routine, resulting in more red blood cell performed. Those modalities of crossmatch are applied to (RBC) units being tested and stored to avoid the transfusion of uncrossmatched ones. The objective of this study was to evaluate nonalloimmunized recipients, with the detection of ABO the performance of a LISS-albumin enhancer to intensify mismatches their main goal. Whenever there is a positive antigen-antibody reaction after 5 minutes of 37°C incubation and antibody screen (current or past) or a history of pregnancy, compare this performance with that of other enhancers, gel, and crossmatch demands 37°C incubation and AHG steps conventional tube testing. Second, the study evaluated the impact of this method’s implementation in the C:T ratio (crossmatched (indirect antiglobulin test-crossmatch; IAT-XM), increasing to transfused RBC units) of a transfusion laboratory. Ninety the time needed for completion of pretransfusion tests, which serum samples containing alloantibodies of potential clinical can become critical in emergency situations. significance were tested against phenotyped RBCs using four In Brazil, legislation requires IAT-XM for all recipients different methods: (1) tube with LISS-albumin enhancer (5 minutes of incubation), (2) tube with LISS-albumin and PEG who have ever been transfused, pregnant, or alloimmunized, (15 minutes of incubation), (3) gel, and (4) conventional tube and as a consequence, the routine of performing a type and method (60 minutes of incubation). In parallel, the study compared screen on samples from surgical patients is frequently not the C:T ratio of a tertiary-hospital transfusion laboratory in two different periods: 3 months before and 3 months after the applied, as most transfusion laboratories perform IAT-XM implementation of the 5-minute IAT-XM protocol. The use of before the surgery and segregate all the units that may be used LISS-albumin with 5 minutes of incubation exhibited the same during the surgical procedure until its end. This obviously performance as LISS-albumin, PEG, and gel with 15 minutes increases the number of blood units in store and the costs of incubation. Conventional tube method results were equally comparable, but reactions were significantly less intense, except of the pretransfusion tests. Also, the implementation of any for anti-c (p = 0.406). Accuracy was 100 percent for all selected automation may be compromised. methods. After the implementation of the 5-minute IAT-XM Classic saline indirect antibody test (SIAT) demands 60 protocol, the C:T ratio fell from 2.74 to 1.29 (p < 0.001). IAT-XM minutes of incubation (37°C) and three wash steps before can have its incubation time reduced to 5 minutes with the use of LISS-albumin enhancement. We suggest this strategy should the addition of AHG and interpretation of the results. This be used to quickly prepare RBC units for surgical patients, method allows 99 percent of antibody uptake onto RBCs for keeping transfusion safety without compromising blood supplies. the detection of an immunoglobulin G (IgG) antibody present Immunohematology 2014;30:1–5. in the recipient’s serum.1 This length of incubation can be shortened with the help of enhancement media such as low- Key Words: crossmatch, alloantibody, antibody screening, ionic-strength saline (LISS), albumin, polyethylene glycol LISS, PEG, gel testing (PEG), and hexadimethrine bromide (Polybrene), whose IMMUNOHEMATOLOGY, Volume 30, Number 1, 2014 1 C.L. Dinardo et al. major functions are to speed up the rate of antigen-antibody Gel Microcolumn Assay Method association, promoting a higher rate of antibody uptake by RBCs were washed once in 0.9 percent saline and RBCs in a shorter time. suspended in LISS (ID-Diluent 2, DiaMed) to achieve a final In emergency situations, even when data referring to 0.8 to 1 percent concentration. Then 50 µL of 0.8 to 1 percent recipients’ previous alloimmunization is not known, saline RBC suspension and 25 µL of sera were added to LISS-Coombs immediate-spin crossmatch (IS-XM) is frequently chosen by gel cards (IgG/C3d, DiaMed), incubated for 15 minutes at laboratory analysts, as it allows fast availability of RBC units. For 37°C, and centrifuged (85g) for 10 minutes according to recipients who present a higher risk of alloimmunization, such manufacturer’s instructions.
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