Evaluation of kodecytes using function-spacer-lipid constructs as a survey material for external proficiency testing...

Area of Science:

• Blood group serology
• Immunochemistry
• Laboratory diagnostics

Background:

• Natural red blood cells (RBCs) with weak A (A_w) or weak B (B_w) phenotypes are scarce, posing challenges for quality control in ABO subgroup testing.
• The development of reliable survey materials is crucial for improving the accuracy of subgroup analysis in clinical laboratories.

Purpose of the Study:

• To create synthetic RBC kodecytes displaying A and/or B blood group antigens using function-spacer-lipid (FSL) constructs.
• To assess the suitability of these engineered kodecytes as proficiency test (PT) materials for external quality assessment in ABO subgrouping.

Main Methods:

• Three types of survey samples were prepared: O phenotype RBCs, A_w kodecytes, and B_w kodecytes.
• These samples were distributed to 53 laboratories for an educational PT trial using the manual tube technique for cell typing.

Main Results:

• Reactivity of survey samples varied against anti-A and anti-B monoclonal reagents (MoAbs).
• 67% of laboratories correctly identified B_w kodecytes. A_w kodecytes were correctly identified by 35% as A_w, 48% as A₂, and 13% as O.
• Monoclonal antibody clone choice impacted A_w kodecyte typing results; kodecyte stability was comparable to natural O RBCs.

Conclusions:

• The developed kodecytes demonstrated utility as survey materials for ABO subgrouping proficiency testing.
• The trial underscored the necessity for standardized PT materials to enhance the quality of laboratory subgroup analysis, irrespective of MoAb variations.