Features of the anti-erythrocyte antibodies screening results interpretation in patients with ­hematological diseases

Background. Screening for anti-erythrocyte alloantibodies is a mandatory pre-transfusion test. The correct interpretation of the screening results plays a key role in ensuring the immunological safety of hemotransfusion therapy.

Aim. To study the features of anti-erythrocyte antibodies detection in patients with hematological diseases.

Material and methods. The study was performed with blood samples of 1269 patients with hematological diseases (569 male and 700 female patients aged 18–85 with a median of 63 years). Screening and identification were carried out in indirect antiglobulin test using ID Coombs Anti-IgG gel cards with 4 and 15 samples of test erythrocytes as well as the salt agglutination method. The results were evaluated visually. The Pearson chi-squared test was used to check the statistical significance of differences in the alloimmune anti-erythrocyte antibodies frequency detection. The differences were considered statistically significant at p ≤0.05.

Results. Interpretation of the anti-erythrocyte alloantibodies screening results was difficult in 6.55% of cases and was associated with the presence of autoantibodies in plasma (0.6%) and cross-reactive antibodies (5.9%). Аnti-erythrocyte alloantibodies were detected in 2.05% of cases which required further identification of antibody specificity. Antibodies to Rh system antigens were detected in 68.2% of cases, to antigens of other erythrocyte systems — in 31.8% of cases. In Rh-negative patients only anti-D or anti-DC antibodies were detected. Rh-positive patients were more likely to have anti-K antibodies (30%). Anti-E antibodies were discovered in 20% of cases, anti-Cw and anti-Fya — in 10% each. Alloantibodies were detected most frequently in patients with β-thalassemia (20%), aplastic anemia (13%), hemophilia (9.2%) and thrombophilia (6.9%) and less frequently in patients with hemoblastosis and hematopoiesis depression (0.3–2.4%). Cross-reacting antibodies were detected more frequently in patients with multiple myeloma (74.7%; p ≤0.05) than in patients with chronic lymphocytic leukemia (17.3%), myelodysplastic syndrome (5.3%), and acute leukemia (2.7%).

Conclusion. The reasons for the difficulties in interpreting the alloantibody screening results in hematological patients were the presence of autoantibodies (0.6%), alloantibodies (2.05%) and cross-reacting antibodies (5.9%).