A proposal for compatibility testing incorporating the manual hexadimethrine bromide (Polybrene) test

Area of Science:

• Transfusion Medicine
• Immunology
• Clinical Pathology

Background:

• The American Association of Blood Banks Standards Committee updated pretransfusion testing requirements in 1984.
• Antiglobulin crossmatch became optional if antibody screening is negative, with ABO compatibility confirmation being the primary remaining crossmatch goal.

Purpose of the Study:

• To evaluate the manual Polybrene test (MPT) as a reliable and rapid crossmatch technique for pretransfusion testing when antibody screening is negative.
• To assess the MPT's efficacy in detecting ABO incompatibility and unexpected blood group antibodies.

Main Methods:

• The manual Polybrene test (MPT), a 1-minute room temperature procedure, was employed for crossmatching.
• Comparison with low-ionic-strength solution (LISS) immediate spin (IS) and room temperature techniques was performed.
• Serological testing involved randomly selected patient sera and specific red cell types (A1, A2, B, A2B).

Main Results:

• The MPT effectively detected ABO incompatibility, yielding expected results with A1, A2, and B red cells in 47 tested sera.
• 66% of 84 group B sera were incompatible with A2B red cells by MPT, comparable to LISS room temperature results (69%) but significantly higher than LISS IS (37%).
• Of 106 sera containing antibodies, 83 (78%) reacted with the MPT, indicating its sensitivity for detecting unexpected antibodies.

Conclusions:

• The manual Polybrene test (MPT) is a rapid, sensitive, and effective method for pretransfusion crossmatching when antibody screening is negative.
• MPT enhances transfusion safety by detecting ABO incompatibility and unexpected antibodies, potentially replacing the need for antiglobulin crossmatch.
• The reliability of the LISS immediate spin (IS) method is questioned based on its lower detection rate of incompatibilities.