Toro Espinosa Leidy Alejandra, Jaramillo Arbeláez Patricia, Gómez Mónica, Restrepo Restrepo Fabio, Franco John Querubín
Molecular Hemopathology Group, University of Antioquia, Medellín, Colombia.
Molecular Hemopathology Group, University of Antioquia, Medellín, Colombia.
Transfus Apher Sci. 2021 Oct;60(5):103177. doi: 10.1016/j.transci.2021.103177. Epub 2021 Jun 3.
The screening of umbilical cord blood samples by the Direct Antiglobulin Test (DAT) is the reference tool for the identification of maternal erythrocyte alloantibodies present in erythrocytes; however, its diagnostic usefulness is controversial.
To evaluate the diagnostic validity, safety, and efficiency of the eluate testing (detection of antibody in erythrocyte eluates by the Indirect Antiglobulin Test/IAT) in cord blood samples for detection of maternal erythrocyte alloantibodies in comparison with the DAT.
Evaluation study of diagnostic tests. DAT and eluate testing were performed in 306 cord blood samples from neonates born to mothers admitted at Clínica Somer in Rionegro, Colombia; then, antibodies present in the eluates were identified with erythrocyte panels. Percentage of positive results by DAT and IAT were compared with the Pearson's chi-square test and the agreement between both assays with the Cohen's kappa coefficient. The diagnostic sensitivity, specificity, safety, and efficiency of the eluate testing were calculated, taking into account the use of DAT as an imperfect reference test.
The DAT detected alloantibodies in 6.21% of samples and the eluate testing in 14.1 %; the strength of agreement between both tests was moderate (k = 0.56) due to 25 discrepancies. The eluate testing showed sensitivity and specificity of 98.83 % and 92.31 % respectively, and a negative predictive value of 99.9 %. The diagnostic efficiency was sufficient for detection of maternal erythrocyte alloantibodies. The antibodies identified in the erythrocyte eluates were anti-A or anti-B (79.5 %), anti-D (136%), anti-C (2,3%), and anti-Fya (2,3%).
The eluate testing in cord blood samples is a valid, safe, and efficient test for the diagnosis of maternal erythrocyte alloantibodies.
通过直接抗球蛋白试验（DAT）筛查脐带血样本是鉴定红细胞中存在的母体红细胞同种抗体的参考工具；然而，其诊断效用存在争议。
与DAT相比，评估洗脱液检测（通过间接抗球蛋白试验/IAT检测红细胞洗脱液中的抗体）在脐带血样本中检测母体红细胞同种抗体的诊断有效性、安全性和效率。
诊断试验的评估研究。对哥伦比亚里奥内格罗市索默诊所收治的母亲所生新生儿的306份脐带血样本进行DAT和洗脱液检测；然后，用红细胞谱鉴定洗脱液中存在的抗体。通过Pearson卡方检验比较DAT和IAT的阳性结果百分比，并使用Cohen卡方系数比较两种检测方法之间的一致性。考虑到将DAT用作不完善的参考检测，计算洗脱液检测的诊断敏感性、特异性、安全性和效率。
DAT在6.21%的样本中检测到同种抗体，洗脱液检测在14.1%的样本中检测到同种抗体；由于25处差异，两种检测方法之间的一致性强度为中等（k = 0.56）。洗脱液检测的敏感性和特异性分别为98.83%和92.31%，阴性预测值为99.9%。诊断效率足以检测母体红细胞同种抗体。在红细胞洗脱液中鉴定出的抗体为抗A或抗B（79.5%）、抗D（13.6%）、抗C（2.3%）和抗Fya（2.3%）。
脐带血样本中的洗脱液检测是诊断母体红细胞同种抗体的有效、安全且高效的检测方法。
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