Journal Reading of Hematology 1

SHORTENED ANTIBODY SCREENING INTERVAL

HAS DECREASED THE INCIDENCE OF DELAYED
HEMOLYTIC TRANSFUSION REACTIONS

Abd. Rahim Mubarak

Program Pendidikan Dokter Spesialis-1 Ilmu Patologi Klinik
Fakultas Kedokteran Universitas Hasanuddin Makassar
 ABSTRACT
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Aims :
To ascertain the effects of allowable sampling
time prior to RBC transfusion when screening for
alloantibodies, we compared antibody detection
rates and frequencies of delayed hemolytic
transfusion reactions (DHTRs) among patients
drawn within two weeks versus patients drawn
within one week of transfusion.
 ABSTRACT
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Methods:
Alloantibody screening
 32,601 patients January 1997 - August 2006

within two weeks of transfusion (2W)

 44,896 patients September 2006 - March 2017
within one week.
 Among transfusion recipients, 6,234 screened within

two weeks and 8,066 screened within one week

were evaluated for DHTR.
 ABSTRACT
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Results:
 Alloantibodies were detected in 1.2% of cases

(2W) and 1.3% of cases (1W) with no statistical

difference.
 DHTRs significantly lower among those screened

(1W) than (2W), two cases (1 in 4,031) versus

eight (1 in 779), with (p <0.05).
 INTRODUCTION
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RBC alloantibody screening is essential to

prevent (DHTRs); Early screening might
precede alloantibody induction and late
screening might miss alloantibody levels
that have fallen below detection
sensitivity
 INTRODUCTION
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Screening alloantibody levels recommendation :

 British Committee for Standards in Haematology

(BCSH), AABB and Dutch Blood Transfusion

Guidelines recommends no more than 3 days prior
to the actual transfusion
 Canadian Society for Transfusion Medicine advises

that specimens be collected within 96 hours of

transfusion
 INTRODUCTION
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This study analyze a large body

of historical data in which
differences might emerge
between patients screened within
2 weeks versus 1 week of red cell
transfusion.
 MATERIALS AND METHODS
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Figure 1: Time course of the study periods.

 Clinical diagnosis of DHTR
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DHTR determined using (SHOT) criteria and Ness et al.

when hemolytic findings :
 DAT (+)
 Jaundice
 hemoglobin
 Kidney dysfunction
 Plus at least one of the followings confirmed between
24 hours and 90 days after transfusion:
 a new antibody or increase in the titers of pre-existing
antibodies;
 antibody elution from transfused red blood cells.
 Statistical analysis
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 Chi-squared), with p <0.05 as statistically

significant.
 The 95% confidence interval (95% CI) was

used to compare antibody detection rates

between the 2 groups and the frequency of
DHTR.
 StatMate IV for Windows (ATMS, Tokyo) was
used for analysis.
 RESULTS
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Alloantibody detection rate and antibody specificity

 RESULTS
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Comparison of frequency of DHTR

 RESULTS
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 DISCUSSION
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 Rarely, new antibodies are detected within the first

3 days, e.g. 0.4% (11 of 2,932 cases) or 2.3% of
all immunized patients including secondary immune
response
 Antibodies detection rate of anti-Fy b clearly and
anti-Di a tended to within 1W versus 2W,
probably because screening was done closer to the
time of transfusion.
 DISCUSSION
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 Detection frequency of anti-c significantly 2W vs

1W = (101.2  51.2 per 100,000).
 Anti-E + c among Japanese, usually emerging as a
single antibody
 DHTRs significantly within 1W VS 2W (p
=0.045).
 CONCLUSION
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By shortening allowable sampling period for red

cell alloantibody screening from (2W) to (1W), the
detection rate of clinically significant antibodies,
except for anti-c, increased, and the frequency of
DHTR recipients decreased.
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Thank you
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 Fig. 2: In the absence of a computer crossmatch system, a second verification of ABO
compatibility must occur before a unit of RBCs can be issued.

Mark H. Yazer CMAJ 2006;174:29-32

©2006 by Canadian Medical Association

 Fig. 1: Steps involved before a unit of red blood cells (RBCs) can be issued for transfusion.

Mark H. Yazer CMAJ 2006;174:29-32

©2006 by Canadian Medical Association

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Fase salin akan mengidentifikasi cold

antibodies (anti-M, anti-N, anti-Lea, anti-
Leb, anti-P). Fase enzim akan mendeteksi
anti-Rh, Lewis dan Kidd. Fase AHG
mengidentifikasi antibodi jenis IgG dan
komplemen ((Saluju and Singal, 2014).
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Pada fase apa reaksi ditemukan positif?

Antibodi kelas IgM umumnya bereaksi pada suhu
kamar atau suhu yang lebih rendah dan mampu
menyebabkan aglutinasi pada eritrosit yang disuspensi
pada medium salin (fase immediate spin). Termasuk
antibodi kelas IgM adalah anti-N, anti-I dan anti-P1
Antibodi kelas IgG bereaksi baik pada fase AHG..
Termasuk antibodi kelas IgG adalah antibodi Rhesus, Kell,
Kidd, Duffy dan Ss. Antibodi Lewis dan antibodi M
termasuk kelas IgG, IgM atau campuran (Friedman et al,
2016).
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 Tujuan pemeriksaan skrining dan identifikasi antibodi adalah

mendeteksi antibodi sel darah merah selain anti-A dan anti-B atau
mendeteksi unexpected antibody yang bermakna secara klinis.
Kondisi-kondisi yang membutuhkan pemeriksaan skrining dan
identifikasi antibodi, antara lain:
 1. Pasien yang membutuhkan transfusi,
 2. wanita yang sedang hamil atau melahirkan,
 3. pasien dengan kecurigaan mengalami reaksi transfusi,
 4. individu yang melakukan donor darah (Blaney and Howard,
2013). Pada pasien yang membutuhkan transfusi, skrining dan
identifikasi antibodi bertujuan untuk memastikan bahwa sel-sel
darah merah yang ditransfusikan bisa bertahan dalam waktu yang
lama dan aman bagi pasien (Saluju and Singal, 2014)
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 Ditemukan adanya auto immune antibody (DCT:

positif) juga anti IgG dan C3 yang coated pada sel
darah merah penderita.
 Ditemukan adanya irregular allo antibody yang
bebas di dalam serum (ICT: positif) yang reaktif
pada suhu 20 o C dan 37 o C.
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Rhesus
Rhesus positif Rh negatif adalah
Ditemukan dalam adalah seseorang seseorang yang
sel janin sejak yang mempunyai tidak mempunyai Rh
enam minggu Rh antigen pada antigen pada
setelah konsepsi eritrositnya eritrositnya

Antigen Rhesus
disebut antigen- Pembentukan antibodi IgG dapat
D antibodi hampir melewati plasenta &
selalu oleh suatu masuk dlm sirkulasi
Anti D merupakan eksposure dari
antibodi imun tipe janin, janin dapat
transfusi atau menderita HDN
IgG kehamilan
HDN adalah penyakit anemia hemolitik akut pada bayi yang
diakibatkan oleh imun /natural Antibodi IgG (seperti anti-
D atau IgG Ab gol darah ABO)

HDN Rh HDN ABO

 fhare
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