Example of Multiple Antibodies - LabCE.com, Laboratory Continuing Education

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The page below is a sample from the LabCE course Antibody Detection and Identification. Access the complete course and earn ASCLS P.A.C.E.-approved continuing education credits by subscribing online.

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Example of Multiple Antibodies

In this example, the patient's plasma tests positive with both screening cells at a strength of 4+.

Rh-Hr

Kell

Duffy

Kidd

Lewis

MNSs

Lutheran

Vial

Donor

C^w

Kp^a

Kp^b

Js^a

Js^b

Fy^a

Fy^b

Jk^a

Jk^b

Le^a

Le^b

Lu^a

Lu^b

AHG

R1R1

R2R2

In the panel below, reaction patterns show varying strengths, 2+ to 4+ (highlighted in blue):

4+ could indicate one strong antibody or a combination of several antibodies that increases the strength of the reaction.
3+ could indicate the presence of just one strong antibody.
2+ could indicate a weaker reaction of an antibody that commonly exhibits dosage if the panel cell is in the heterozygous state.

Since Cw, Kp^a, Js^a, and Lu^a are not present on the testing cells, they are probably not causing these reactions.

	Rh-Hr						Kell						Duffy		Kidd		Lewis		MNSs				P	Lutheran
Donor Cell Number	D	C	c	E	e	C^w	K	k	Kp^a	Kp^b	Js^a	Js^b	Fy^a	Fy^b	Jk^a	Jk^b	Le^a	Le^b	M	N	S	s	P₁	Lu^a	Lu^b	IS	AHG	CC
1	+	+	0	0	+	0	0	+	0	+	0	+	+	0	+	+	+	0	+	+	+	+	+	0	+	0	4+	NT
2	+	+	0	0	+	0	+	+	0	+	0	+	+	+	0	+	0	+	0	+	+	+	+	0	+	0	4+	NT
3	+	0	+	+	0	0	0	+	0	+	0	+	0	+	0	+	0	+	+	0	0	+	+	0	+	0	3+	NT
4	+	0	+	0	+	0	0	+	0	+	0	+	0	0	+	0	0	+	+	+	+	0	+	0	+	0	4+	NT
5	0	+	+	0	+	0	0	+	0	+	0	+	+	+	+	+	+	0	0	+	0	+	0	0	+	0	0	2+
6	0	0	+	+	+	0	+	+	0	+	0	+	0	+	+	+	0	+	+	+	+	+	0	0	+	0	2+	NT
7	0	0	+	0	+	0	0	+	0	+	0	+	+	0	0	+	+	0	+	0	0	+	+	0	+	0	0	2+
8	0	0	+	0	+	0	0	+	0	+	0	+	+	+	0	+	0	+	+	+	+	+	0	0	+	0	2+	NT
9	0	0	+	0	+	0	0	+	0	+	0	+	+	+	+	0	0	+	0	+	+	0	+	0	+	0	3+	NT
10	+	0	+	0	+	0	+	+	0	+	0	+	0	+	0	+	0	+	0	+	+	0	+	0	+	0	4+	NT
AC																										0	0	2+

Perform rule-outs using panel cells 5 and 7 (sample had no reaction in any phase with these panel cells).
Antibodies that can probably be ruled out at this point because the corresponding antigens are present on cell 5 and/or 7: c, e, k, Kp^b, Js^b, Fy^a, Jk^b, Le^a, M, N, s, P1, Lu^b
Antibodies that could not be ruled out with this panel: D, C, E, K, Fy^b, Jk^a, Le^b, S
Predominant pattern of 4+ in panel cells 1, 2, 4, and 10 matches anti-D.
Varying strengths in reactions indicate a possible second antibody so selected cells should be picked to aid in the identification.
Choose cells that do not contain D antigen (antibody you suspect) and are homozygous positive for the antibodies you are trying to rule out.