AI Article Synopsis

  • - New antibody investigation algorithm (AIA) significantly reduced potential false-positive warm autoantibody (WAA) cases from 11% to 6% by categorizing ambiguous cases as 'antibody of undetermined significance' (AUS).
  • - Analysis of patient data from 2017-2021 showed no transition from AUS to potential WAA with the new AIA, although some patients developed specific alloantibodies like anti-E and anti-C.
  • - Implementing the new AIA led to more efficient use of resources and less need for phenotypically matched red blood cells, but it remains important to rule out clinically significant antibodies before classifying cases as AUS.

Article Abstract

Background And Objectives: To reduce potential false-positive warm autoantibody (WAA) by solid-phase red cell adherence assay (SPRCA), our centre implemented a new antibody investigation algorithm (AIA) by classifying cases with panreactive SPRCA but negative saline-indirect antiglobulin test as 'antibody of undetermined significance' (AUS) after excluding clinically significant antibodies. We assessed the effects of the new AIA and subsequent alloantibody formation in patients with AUS.

Materials And Methods: Samples from patients with positive SPRCA screens between 1 September 2017 and 31 August 2021 were selected for the study. Frequencies of antibodies classified by the old and new AIAs were compared using Fisher's exact test. Patient demographics, transfusion history and antibody formation in cases of AUS were collected.

Results: A significant reduction in potential WAA frequencies from 127/1167 (11%) to 53/854 (6%) was observed (p < 0.001) when compared between the old and new AIAs among 2021 positive SPRCA antibody screens. While no patients with AUS later transitioned to potential WAA using the new AIA, four patients developed alloantibodies, including anti-E, anti-C, both anti-C and anti-E, and anti-Wr .

Conclusion: A significant reduction in the frequencies of potential false-positive WAA detection at our centre was observed after implementing the new AIA, leading to less resource and phenotypically matched red blood cell (RBC) use. Some patients still developed subsequent RBC alloimmunization, so clinically relevant alloantibodies should be carefully excluded before determining AUS, taking forming or evanescent antibodies into consideration.

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Source
http://dx.doi.org/10.1111/vox.13552DOI Listing

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