Predicting the clinical significance of red cell alloantibodies using a monocyte monolayer assay

Few data have been published that correlate in vitro monocyte monolayer assays (MMA) and red cell (RBC) survival in patients with alloantibodies of unknown significance. Over the past 6 years we gathered clinical correlations in 12 patients with the following antibodies: anti-Lan (three patients), -Ge (three patients), -Yta (five patients), and -Ytb (one patient). RBC survival was estimated using 51Cr studies in seven patients and follow-up of transfusion of incompatible blood in the other five. Six patients with no evidence of RBC destruction had negative MMA findings (anti-Lan [one patient], -Ge [two patients], and -Yta [three patients]). Five patients with evidence of in vivo RBC destruction had significant MMA results. The two clinically significant anti-Lans required fresh serum to give a meaningful MMA result. One patient (anti-Ytb) had an MMA result of borderline significance–normal 51Cr RBC survival at 1 hour–but a reduced T50Cr. The MMA we used appeared to predict the clinical outcome of transfusion in every patient with antibodies to high-frequency antigens whom we tested.     

单核细胞单层试验预判ABO新生儿溶血病的应用

目的应用单核细胞单层试验(MMA)在产前预测新生儿ABO溶血病(ABO-HDN)发生的可能性,寻找并确定预判ABO-HDN的MMA最终结果参考值。方法对30名孕妇血清做MMA试验,应用血清学技术对新生儿脐血进行ABO-HDN检查,确定新生儿发病与否。结果单核细胞单层试验预测新生儿溶血病其灵敏度为92.9%,特异性为81.3%,准确率为86.7%,确定MMA最终结果5%为参考值。结论通过试验证明MMA在预判ABO-HDN中具有临床意义。提示MMA最终结果≥5%有92.9%的可能发生ABO-HDN,<5%表示发生ABO-HDN的可能性较小。     

Gel test assay for IgG subclass detection by GM typing: application to hemolytic disease of the newborn

The gel test assay was evaluated for IgG subclass detection by GM typing of antibodies and compared to the classical inhibition agglutination method on slides or microtiter plates. We used a panel of 5 murine monoclonal antibodies directed against G1M(1), G1M(3), G1M(17), G2M(23), and G3M(21) and 1 human polyclonal anti-G3M(5) antibody. Eleven polyclonal antisera (of immunized women) directed against red blood cells were tested for the GM allotypes carried by their alloantibodies. We controlled the specificity of the gel test reaction using a panel of anti-RH(D) monoclonal antibodies. All reagents exhibited a good reactivity and specificity. They can be used for routine typing. The gel test assay for IgG subclass detection is a specific, simple, and low-cost technique for the detection and management of severe forms of diseases in alloimmunized pregnancies.     

微柱凝胶试验技术在新生儿溶血病检测中的应用

目的探讨采用微柱凝胶试验技术进行新生儿溶血病（HDN）血型血清学检测的可行性。方法采用微柱凝胶试验技术对疑为ABO型新生儿溶血病的153例黄疸患儿做“三项试验”,即：①红细胞抗球蛋白试验;②抗体放散试验;③血清游离抗体试验。结果①153例黄疸患儿与其母均为ABO血型不合。即母亲血型均为0型,Rh（D）阳性。母亲血清中ABO血型以外抗体筛查均为阴性。母-婴血型O-A者为78例,O-B者为75例。②共检出ABOHDN者为127例。其中,母-婴血型O-A者为66例,占84．62％（66／78）。O—B者为61例,占81．33％（61／75）。两组比较差异无显著性（x^2=0．0015,P〉0．01）。结论微柱凝胶试验技术进行HDN血型血清学检查,具有敏感性高,操作简便,标本用量少,结果易判定等优点,值得临床推广应用。     

微柱凝胶技术在新生儿溶血病血清学检查中的运用

目的 采用微柱凝胶技术进行新生儿溶血病血清学检查试验。方法 以微柱凝胶技术对116例患儿进行血型鉴定及直接抗球蛋白试验、血清游离IgG抗体测定、红细胞抗体释放试验。结果 试验时间缩短,判定直观,灵敏度及特异性显著提高。结论 该法效果好于试管法,具有快速、简便,试验样本量少,重复性好,结果一目了然,便于保存及事后复查等优点。     

Diagnosing hemolytic disease of the newborn.

A Rh negative, pregnant female presented to a major medical center for possible Rh alloimmunization. This female had nine previous pregnancies, including three spontaneous abortions, four live births, and two fetal demises. Because of poor prenatal care, the immunization Rh immune globulin was administered to only the first two pregnancies. After much laboratory testing and treatment, this tenth pregnancy also ended in fetal demise.     

Anti-Ata causing mild hemolytic disease of the newborn

We report here a case of moderately severe hemolytic disease of the newborn (HDN) due to anti-Ata. The gravida 5 proposita was group A rr and previously was found to have anti-Ata and -D. At the 35-week mark of this pregnancy, her anti-Ata demonstrated a titer of 256, score 79. Fluid obtained by amniocentesis at 36 weeks showed an optical density at 450 nm of 0.08 (midzone). The baby was delivered at 38 weeks by cesarean section. The cord cells were group A rr with a 3+ direct antiglobulin test. The dichloromethane eluate of the infant's cells demonstrated anti-Ata specificity only. At birth, the infant's total bilirubin (TB) was 2.1 mg per dl and the hematocrit level (Hct) was 33.8 percent. Within 8 hours, the TB had risen to 3.8 mg per dl. Phototherapy was initiated at 7-1/2 hours and maintained for 40 hours. The infant's TB rose to a maximum level of 10.5 mg per dl 24 hours after phototherapy was discontinued. At discharge 4 days postpartum, the infant's TB had dropped to 9.2 mg per dl, and the Hct value was 38 percent. On a visit 7 days postpartum, the infant's TB level had fallen to 6.5 mg per dl and the hct value was 38 percent. Transfusions were not necessary.