Neutrophil antibody diagnostics and screening: review of the classical versus the emerging.

BACKGROUND AND OBJECTIVES  Severe transfusion-related acute lung injury (TRALI) events have been linked to donor-derived neutrophil antibodies. The journey to developing mass donor neutrophil antibody screening platforms is challenged by the fragility of neutrophils and their unique-specific antigenic characteristics. MATERIAL AND METHODS  This article critically evaluates the capabilities and potential of five emerging antibody screening platforms designed to detect neutrophil reactive antibodies relevant to TRALI. They are compared with established neutrophil serological methods. RESULTS  Data from two recombinant antigen platforms and a method using human neutrophil antigens-expressing KY cells indicated high specificity. Two mixed cellular flow cytometric assays have the advantage of presenting native conformation of the human polymorphonuclear neutrophil antigenic epitopes. CONCLUSIONS  To date, the number and specificity of test sera applied to each platform is small. This needs to be substantially increased and further rigorous serological evaluation is yet needed to compare the sensitivity and specificity limits of each new platform with classical methods. With a limited world supply of TRALI-relevant test sera, a collaborative effort of laboratories with neutrophil and TRALI investigation expertise is required.