Red cell antibodies – clinical significance or just noise?

Red cell antibodies can cause mortality and morbidity in both transfusion and antenatal settings and also have relevance in transplantation. A clinically significant antibody can be defined as one capable of causing accelerated destruction of a significant proportion of transfused cells, or one capable of crossing the placenta and causing haemolytic disease of the fetus and newborn. The specificity, Ig class, thermal range and concentration of the antibody can predict clinical significance; however, the clinical situation and patient's individual immune response are also significant factors. The aim is to detect antibodies that are likely to cause problems in the clinical setting for which the antibody screening is designed, for example patient pretransfusion, antenatal or donor. Detection of ‘insignificant’ antibodies creates additional work and leads to potential delay in providing compatible blood for transfusion, or unnecessary repeat testing/interventions in pregnancy. The balance between sensitivity and specificity can be influenced by the methods and technologies selected. It is not possible to detect all potentially clinically significant antibodies, or to avoid detecting all clinically insignificant antibodies, that is ‘noise’. Antibody detection (screening) can be optimized by designing protocols appropriate to the population to be screened, utilizing knowledge of the characteristics of red cell antibodies, understanding of the principles, strengths and limi...
Source: ISBT Science Series - Category: Hematology Authors: Tags: Invited Review Source Type: research