Performing antibody panels using both enzyme (ficin, bromelin, and/or papain)-treated and routine panel cells may be necessary to detect most clinically significant antibodies
- Regular (LISS) panels are to be performed using AHG reagents whereas enzyme panels done by the gel technology must use the saline (NaCl)-enzyme card.
- Perform BOTH enzyme and routine panels in the following situations
- All patients with sickle cell anemia and thalassemia
- Antibody pattern of panreactivity with a negative autocontrol (see attached examples)
- Antibody workup that does not show a specific pattern with the regular panel alone
- Any case with a previous history of antibodies with a current negative antibody screen
- Any other case that you are directed to do so by the transfusion medicine consultant, supervisor, or senior technologist.
- Remember the reactivities of the following antibody specificities with enzyme-treated cells:
- Reactions may not be the same with papain vs ficin-treated cells!
- Enzyme-labile with both papain- and ficin-treated cells: Fya, Fyb, M, N, Ge2, Yta, Rg, Ch, Pr, Tn, Mg, Mia, Cla, Jea, Nya, JMH, Inb
- Variable, enzyme-labile or weakened, some unchanged with both papain and ficin-treated cells: S, s, U
- Variable reactions with papain (labile, weakened, unchanged, or increased) but usually increased or unchanged with ficin-treated cells: Kell system (K, k, Kpa, Kpb)
- Reactions are increased or unchanged with both papain and ficin-treated cells: Rh (D, C, c, E, e), Jka, Jkb, Lea, Leb, Lua, Lub, P1, H, most cold antibodies, autoantibodies, Tja (PP1Pk)
Antibody to High-Incidence/Prevalence or Public Antigen:
Reactions destroyed by enzyme (typical of anti-Ge2):
Antibody to high-incidence antigen, reactions unchanged or enhanced by enzyme—VERY DANGEROUS PATTERN: Examples: Anti-H, Anti-Tja (PP1Pk), anti-k (cellano), anti-U