Hemolytic transfusion reaction due to Rh antibodies detectable only by manual polybrene and polyethylene glycol technique.

The authors report two cases of severe hemolytic transfusion reaction (HTR) attributable to Rh antibodies, which were not detectable by the saline indirect antiglobulin test (SIAT), low ionic strength saline solution technique (LISS), or two-stage enzyme (Enz) indirect antiglobulin test (IAT), but were readily detectable by the manual polybrene technique (MPT), MPT-IAT, and polyethylene glycol (PEG) IAT. With rare exceptions, Rh antibodies can usually be easily detected by the SIAT or Enz-IAT, and seldom cause intravascular HTR. The two cases in this report illustrate the value of the MPT and PEG-IAT in the detection of clinically significant Rh antibodies that would not otherwise be detectable by conventional methods.