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False-negative solid-phase platelet crossmatch results due to prozone phenomenon.

Rachel K Horton¹, Micah D Zuccarelli¹, Laurie L Wakefield¹

¹Division of Transfusion Medicine, Mayo Clinic, Rochester, Minnesota.

|October 13, 2020

Summary

The prozone phenomenon can cause false-negative results in platelet crossmatch assays. Diluting patient samples can help identify compatible platelet units in patients with high-strength antibodies.

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Area of Science:

Immunology
Transfusion Medicine

Background:

The prozone phenomenon, characterized by falsely low immunoassay results due to excess antigen, is known in human leukocyte antigen (HLA) antibody testing.
It has not been previously described in solid-phase red blood cell (RBC) adherence platelet (PLT) crossmatch assays.

Observation:

A patient with myeloid sarcoma and PLT transfusion refractoriness showed inadequate responses to crossmatch-compatible PLTs.
Initial HLA antibody testing revealed a significant prozone-like effect, indicating numerous high-strength HLA antibodies.

Findings:

Solid-phase PLT crossmatches using undiluted plasma yielded negative or weak results.
Diluted plasma samples demonstrated strongly positive crossmatches, confirming the prozone effect.
HLA antigen-negative PLTs, selected based on the corrected antibody profile, resulted in adequate PLT count responses.

Implications:

The prozone phenomenon can lead to false-negative results in solid-phase RBC adherence PLT crossmatch assays.
Sample dilution is a crucial mitigation strategy for accurate PLT crossmatching in patients with high-strength HLA antibodies.
This finding aids in selecting compatible PLT inventory for immune-mediated transfusion-refractory patients.