Miller Nichole M, Johnson Susan T, Carpenter Erica, Naczek Christine A, Karafin Matthew S
Diagnostic Laboratories, BloodCenter of Wisconsin, Milwaukee, Wisconsin.
Medical College of Wisconsin, Milwaukee, Wisconsin.
Transfusion. 2017 May;57(5):1288-1293. doi: 10.1111/trf.14079. Epub 2017 Mar 14.
Several publications have reported an increase in nonspecific reactions when automated technologies such as solid phase are used for the detection of red blood cell alloantibodies. However, there is little known about patient-specific factors associated with these reactions and the clinical importance of these nonspecific reactions.
We performed a 6-year retrospective review of our blood bank records and all newly reported unidentified (UID) reactivity using a test tube polyethylene glycol (t-PEG) and solid-phase method for the detection and identification of alloantibodies was recorded. Patient factors, such as underlying diagnosis, age, sex, ABO, Rh type, ethnicity, and subsequent antibody formation were recorded in each case.
We determined that there was a significant increase in new UID reactions recorded in solid phase (20 per 10,000 tests) when compared to the t-PEG (1.8 per 10,000 tests) method for the detection of antibodies (p ≤ 0.0001). Solid-phase UID reactions were significantly associated with female sex (p = 0.04) and certain diagnoses, such as chronic or autoimmune disease, cancer, pregnancy, surgery, and trauma. Approximately 16% of patients developed a new auto- or alloantibody subsequent to their detected UID using solid phase.
When solid phase is used for antibody identification, there is greater sensitivity toward nonspecific reactivity when compared to the t-PEG method. Patient sex and underlying diagnosis may explain the increased incidence of new UID reactivity in the solid-phase technology. Finally, UID reactivity should not be overlooked due to a notable percentage of subsequent clinically significant antibodies after UID detection.
有几篇文献报道，当使用诸如固相检测技术来检测红细胞同种抗体时，非特异性反应会增加。然而，对于与这些反应相关的患者特异性因素以及这些非特异性反应的临床重要性却知之甚少。
我们对血库记录进行了为期6年的回顾性研究，记录了所有新报告的无法识别（UID）的反应性，采用试管聚乙二醇（t-PEG）和固相方法检测和鉴定同种抗体。记录每个病例的患者因素，如基础诊断、年龄、性别、ABO血型、Rh血型、种族以及随后的抗体形成情况。
我们确定，与t-PEG方法（每10000次检测中有1.8例）相比，固相检测新的UID反应显著增加（每10000次检测中有20例）（p≤0.0001）。固相UID反应与女性性别（p = 0.04）以及某些诊断显著相关，如慢性或自身免疫性疾病、癌症、妊娠、手术和创伤。在使用固相检测到UID后，约16%的患者出现了新的自身抗体或同种抗体。
与t-PEG方法相比，当使用固相进行抗体鉴定时，对非特异性反应性的敏感性更高。患者性别和基础诊断可能解释了固相技术中新的UID反应性增加的发生率。最后，由于在UID检测后有相当比例的后续临床显著抗体，因此不应忽视UID反应性。
