In search of the Holy Grail: comparison of antibody screening methods

Currently, the goal of testing for RBC antibodies is to use a method that will detect, if possible, all antibodies that are considered clinically significant and yet not detect antibodies of little clinical importance in transfusion or pregnancy. The focus of test method development has been on the more controllable variables of the first and second stages of agglutination. Tube test methods have been developed over the years to achieve shorter turnaround times for quicker test results and improved sensitivity,with the occasional negative impact on relevant results. The focus on improving efficiency through automation, and personnel resourcing challenges of the transfusion service, have led laboratories to select methods tailored to meet their needs. This review compares the newer methods used in the gel test and solid phase test with commonly used tube methods. Both of the newer methods were developed with future adaptation to automation in mind. Further literature reviews about antibodies detected in only one or two methods and their general lack of clinical relevance as well as the occasional rare examples that produce significant clinical effects on transfused patients are also discussed.