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The page below is a sample from the LabCE course Antibody Detection and Identification. Access the complete course and earn ASCLS P.A.C.E.-approved continuing education credits by subscribing online.

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Multiple Antibodies: Example

In this example the patient's plasma tests positive with both screening cells at a strength of 4+.

In the panel below, reaction patterns show varying strengths, 2+ to 4+ (highlighted in green).

4+ could indicate one strong antibody or a combination of several antibodies that increases the strength of the reaction.

3+ could indicate the presence of just one strong antibody.

2+ could indicate a weaker reaction of an antibody that commonly exhibits dosage if the panel cell is in the heterozygous state.

Since Cw, Kpa, Jsa, Lua are not present on the testing cells, they are probably not causing these reactions.

  • Perform rule outs using panel cells 5 and 7 (sample had no reaction in any phase with these panel cells)
  • Antibodies that can probably be ruled out at this point because the corresponding antigens are present on cell 5 and/or 7: c, e, k, Kpb, Jsb, Fya, Jkb, Lea, M, N, s, P1, Lub
  • Antibodies that could not be ruled out with this panel: D, C, E, K, Fyb, Jka, Leb, S
  • Predominant pattern of 4+ in panel cells 1,2,4, and 10 matches anti-D
  • Varying strengths in reactions indicates a possible second antibody so selected cells should be picked to aid in identification
  • Choose cells that do not contain D antigen (antibody you suspect) and are homozygous positive for the antibodies you are trying to rule out.