Nayak Sweta, Makroo Raj Nath, Prakash Bindu, Chandra Trilok, Agrawal Soma, Chowdhry Mohit, Mohapatra Archisman
Transfusion Medicine, Indraprastha Apollo Hospital, New Delhi, India.
Ther Apher Dial. 2019 Feb;23(1):86-91. doi: 10.1111/1744-9987.12745. Epub 2018 Aug 20.
The accurate estimation of ABO antibody titers is of the utmost importance in organ transplants involving ABO incompatibility. We aim to compare five different methods of titration and analyze the data. Samples of 48 O group blood donors who donated during the month of December 2015 to January 2016 in our institution were subjected to ABO antibody titration by five different methods: immediate spin (IS) tube titer, antihuman globulin phase tube titer, Coomb's gel card titer, gel card titer after dithiotreitol (DTT) treatment of plasma, and the solid phase red cell adherence method. The mean number of titer serial dilution steps in the different titer estimation methods was compared using the paired t-test and McNemar test. A correlation between the methods was tested using Spearman's rho and kappa statistics. The median antiglobulin (AHG) phase tube titers were found to be the highest anti-A (128) and anti-B (192) titers. Significant differences in the ABO antibody titer readings among the five different methods were noted. Titers were reduced by DTT treatment in nearly 50% samples tested for both anti-A and anti-B titers. Average agreements between the DTT-applied AHG phase gel card titers and the solid phase red cell adherence (SPRCA) titers was observed for anti-A (κ = 0.473) and anti-B (κ = 0.530). The AHG phase tube and gel cards titers showed poor agreements. There are differences in the interpretability of the ABO antibody titer among different techniques. Consistent and uniform application of the method for titration throughout the treatment of a patient is highly essential.
在涉及ABO血型不相容的器官移植中，准确估计ABO抗体效价至关重要。我们旨在比较五种不同的滴定方法并分析数据。选取了2015年12月至2016年1月期间在我们机构献血的48名O型血捐献者的样本，采用五种不同方法进行ABO抗体滴定：即刻离心（IS）管滴定法、抗人球蛋白相管滴定法、库姆斯凝胶卡滴定法、二硫苏糖醇（DTT）处理血浆后的凝胶卡滴定法以及固相红细胞黏附法。使用配对t检验和McNemar检验比较不同滴定估计方法中效价系列稀释步骤的平均数量。使用Spearman秩相关系数和kappa统计量检验各方法之间的相关性。发现抗球蛋白（AHG）相管滴定法的抗A（128）和抗B（192）效价中位数最高。注意到五种不同方法之间ABO抗体效价读数存在显著差异。在检测的近50%的抗A和抗B效价样本中，DTT处理使效价降低。观察到应用DTT的AHG相凝胶卡滴定法与固相红细胞黏附（SPRCA）滴定法之间抗A（κ = 0.473）和抗B（κ = 0.530）的平均一致性。AHG相管滴定法和凝胶卡滴定法的一致性较差。不同技术对ABO抗体效价的可解释性存在差异。在患者的整个治疗过程中，始终如一地统一应用滴定方法非常重要。
