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Tech Tip: Avoiding KNOWN interfering antibodies and other substances in antibody identification

An arcticle from Eric Ching

It has been a while since I posted something. Hope everyone is happy and healthy. A month or so ago, I was approached to expound on the subject of neutralization. After giving some thoughts on the topic, I would like to share the following table:
Challenges Possible solutions
Previously identified alloantibody(ies) Use antigen negative but positive for other required antigen positive reagent red cells to rule
out additional antibody(ies). One might be tipped off additional antibody(ies) when incompatible IAT crossmatch using known antigen negative donors.
Eg. when some or all R1R1 donors are incompatible with a patient who has known anti-c and anti-E.
Cold-reactive autoantibody Pre-warm; Cold Autoadsorption (enhanced by enzyme), Cold Hetero-adsorption using rabbit red cell stroma. Serial auto adsorption using enzyme-treated autologous red cells may be required for those “super-strong cold auto”
Warm reactive autoantibody Autologous or differential adsorption using “ZZAP” retreated red cell or in PEG dependent on history of recent red cell transfusion
Identified alloantibodies known to be neutralizable. Antibodies to:P1,Lea,Leb ,Sda Chido/Rogers, Cromer and many other blood group antigens such as K, k, Fya, Fyb, Inb, Yt, Sc, Doa, Dob, Kn and JMH Inhibition of known antibody(ies) using specific soluble substance.(commercially available  synthetic or recombinant or home-made) Please see my previous blog:Tech Tip TT20190615 AND Immunohematology 2019; 35(1):19-22
Therapeutic anti-CD38 Recombinant CD38, DTT treated antibody screen (beware of its limitation) ; conventional IAT with 4Xwash may be helpful (*Foothills Medical Centre Transfusion Medicine, personal communication)
Therapeutic anti-47(Hu5F9-G4) Adsorption of platelet with the use of anti-IgG without anti-igG4 Transfusion 2019; 59(2)730-737
Rouleaux Saline replacement, DIDS (Trans 33S:S250, 1993)
Extraneous substances causing non blood group specific agglutination:
Carbohydrates, antibiotics, anticoagulants, dyes etc.
Set up a system of various combinations of the external substances having just one ingredient being missed. The offending substance can be identified by non-reactivity in the absence of the causative substance.

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