Serial Panels’ Reactivity: A Fresh Specimen and New Reagents

2nd Mar 202215th Nov 2021 drzeyd

If you get nonspecific reactions in your antibody workup, always check:

Are the reagents near expiry (i.e. less than 1-2 weeks before the manufacturer’s listed date)?
Is the specimen fresh?

In the Middle East and other locations with extreme environmental conditions, some reagents, especially antisera and reagent red cells may be suboptimal for use near their expiration date. Likewise, an old specimen may show nonspecific reactions due to bacterial contamination.

My advice: Consider repeating the testing with fresh reagents and a fresh specimen. If there is an emerging antibody, it may be stronger in the new specimen and less likely that contamination is affecting the results.

The following antibody panels show how different the reactions are with a new specimen and fresh reagents versus the original workup, and how much easier it is to evaluate then.

Original specimen with antibody panel one week before expiry:

Repeating the workup with new antibody panel (five weeks until expiration) and a fresh specimen:

Anti-Jka only reacting with polyspecific reagents

28th Feb 202213th Nov 2021 drzeyd

I periodically repost this panel because it is so important not to miss an anti-Jka since it may cause severe hemolysis. Routinely, I use gamma-heavy-chain-specific antiglobulin AHG reagent; but to the best of my knowledge, I have not missed an anti-Jka. In this case, there were nonspecific reactions in the panels—many panels were performed with inconclusive results. As a last resort, I used a polyspecific AHG reagent and found the antibody. I have only encountered two such antibodies in many years of practice in the Middle East.

My advice: if you have only nonspecific reactions with multiple panels and suspect hemolysis, I would do a polyspecific AHG panel to look for this. Be sure to include HOMOZYGOUS Jka+ and Jkb+ cells.

I want to thank Mr. Stephen Fuentes, SBB(ASCP) for his handling of this workup.