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

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Variations in Antibody Strength

The antibody in the pretransfusion specimen (prior to the patient being transfused with unmatched group O Rh-negative RBC) reacted 2+ and 3+ with antibody screen and donor cells.

If Jk(a+), the transfused donor red blood cells would have stimulated increased antibody production and the patient's plasma would be expected to react even more strongly with Jk(a+) red cells than in the pretransfusion specimen.

However, the expected increase in antibody strength did not happen. Because Jk(a+) donor cells "mopped up" (adsorbed) the patient's anti-Jka initially, the anti-Jka decreased in strength. Later, once donor red blood cells are no longer present to adsorb the antibody, the anti-Jka would be expected to become stronger.

Currently, (2-weeks post-transfusion) the patient's plasma is only reacting 1+ with Jk(a+b-) red blood cells and w+ with Jk(a+b+) red blood cells.

This effect is called dosage.

Learning points

  • When a secondary immune response occurs, antibody first decreases before it increases.
  • The expected increase in antibody strength will vary depending on the amount of excess antibody available in the patient's plasma at the time of testing versus the amount that had adsorbed to donor red cells and been removed by extravascular hemolysis.