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Published on: September 21, 2011
Tube and column agglutination technology for autocontrol testing
J E Courtney1, J L Vincent, A J Indrikovs
1University of Texas Medical Branch, Galveston, TX 77555, USA.
Insights
Positive autocontrols in blood testing are common with column agglutination technology, particularly the gel test. Further investigation is needed to understand the clinical significance of these positive results.
Area of Science:
- Transfusion Medicine
- Immunology
- Clinical Pathology
Background:
- Positive autocontrol results in blood group serology can indicate alloimmunization or autoantibodies.
- Column agglutination technology (CAT) offers increased sensitivity compared to traditional methods.
- Variability in positive autocontrol rates between different CAT systems necessitates further study.
Purpose of the Study:
- To investigate the incidence and significance of positive autocontrols using the ID Micro Typing System (gel) and Gamma ReACT (ReACT) column agglutination technologies.
- To compare the frequency of positive autocontrols between gel, ReACT, and conventional tube methods.
- To evaluate the clinical relevance of positive autocontrols, especially when direct antiglobulin test (DAT) is negative.
Main Methods:
- Prospective study of 1021 patient and 95 donor samples.
- Autocontrol testing performed using ID Micro Typing System (gel), Gamma ReACT, and low-ionic-strength solution (LISS) tube methods.
- Direct antiglobulin test (DAT) performed via tube method, with elution studies as needed.
Main Results:
- A 7.74% incidence of positive autocontrols was observed in patient samples.
- The gel test showed the highest frequency of positive autocontrols (91.13% of positive cases), followed by ReACT (26.58%) and tube method (34.18%).
- Of 79 positive autocontrols, 44 had a negative DAT, and only one sample with a positive DAT had a clinically significant antibody (anti-D).
Conclusions:
- Column agglutination techniques, especially the gel method, exhibit higher sensitivity for detecting positive autocontrols than the conventional tube method.
- Significant differences exist in the frequency of positive autocontrols between ReACT and gel systems.
- Further investigation into the clinical significance of positive autocontrols in CAT, particularly when the tube method is also positive, is recommended.
Abstract:
The incidence of positive autocontrol test results with column agglutination technology is a concern. This study investigates the incidence and significance of positive autocontrols in the ID Micro Typing System (gel) and the Gamma ReACT (ReACT). The study encompassed a total of 1021 randomly selected samples from patients and 95 samples from donors collected during 1 month. The autocontrol testing was carried out according to the manufacturer's instructions for the column agglutination tests. The tube method was carried out using low-ionic-strength solution (LISS). The direct antiglobulin test (DAT) was performed using the tube method, and further investigated with elution studies if warranted. Seventy-nine patient's samples (7.74%) had a positive autocontrol: the gel test, 72 (91.13%); ReACT, 21 (26.58%); and the tube method, 27 (34.18%). Of the 79 positive autocontrols, 44 samples had a negative DAT. Of the samples with positive DAT results, only one possessed a clinically significant antibody, anti-D. Moreover, the same sample also tested positive in all three methods. Column agglutination techniques have increased sensitivity for a positive autocontrol beyond the conventional tube method. However, ReACT and gel tests differ significantly in their frequency of positives. Investigation of the significance of a positive autocontrol in column agglutination technology when the conventional tube method is also positive is suggested.
