ABID3311Online02
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ABID3311Online02

Course Number: CLS 3311, Fall 2008

College/University: Weber

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CLS 3311 Advanced Clinical Immunohematology Identification Of Unexpected Antibodies Anti body I denti fi cati on When an unexpected antibody has been detected using an IAT or a previous record indicates its presence then... We need to perform an Antibody Identification to discover the unexpected antibody's specificity. We react a PANEL of reagent red blood cells (usually 11) with known phenotypes with the...

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3311 CLS Advanced Clinical Immunohematology Identification Of Unexpected Antibodies Anti body I denti fi cati on When an unexpected antibody has been detected using an IAT or a previous record indicates its presence then... We need to perform an Antibody Identification to discover the unexpected antibody's specificity. We react a PANEL of reagent red blood cells (usually 11) with known phenotypes with the patients serum or plasma, including an Auto Control Tube to rule in or out any auto antibodies. The next slide is an example of a panel reporting sheet for a Gamma Biologics panel. Anti body I denti fi cati on The next hope is that the antibody will actually react with the Panel cells. There are ways to enhance antibody reactivity that we discussed in the Ag/Ab reactions lecture. Remember? How about increasing the serum to cell ratio? Using enhancement media? Enzyme treatment of red blood cells? Etc. The following slides are a set of questions and approaches to basic antibody identification. These need to be mastered before we move on to enzyme treatment, absorptions, elutions, etc. General Questions that need to be answered prior to Ab I d 1. What is the ABO group of the patient? What is the patient's Rh type? What is the gender of the patient? Is there a previous record on this patient? 1. 1. 1. 5. Need to communicate with 1. What is the other members of the diagnosis or healthcare team - certain suspected diagnosis hemolytic anemia's can of your patient? result from an autoimmune process or medication. 1. What is the patient's 6. Has the patient been transfused with packed rbc's transfusion record? within the last three months? If so, accurate antigen typing of their red cells for an antigen to a corresponding antibody will not be possible. Why? I f you ar e r ecor di ng weak r eacti ons wi th many or al l cel l s i n the panel but N OT the auto-contr ol , you may be seei ng: A. A patient who has hypergammaglobulinemia or has recently received a volume expander. Rouleaux formation! Panel 1 B. High titer low avidity (HTLA) antibody. Panel 2 C. A patient who has an antibody to a high frequency b antigen. i.e. anti-Js , anti-k, etc. Panel 3 Panel 1 represents what may be seen in situation A above. Notice that the AHG phase is completely negative. Why? Panel #1 Rh D C E 1 2 3 4 5 6 7 8 9 0 + + + 0 0 0 0 0 + + + 0 0 0 0 0 0 0 + 0 0 0 + + 0 0 0 0 0 0 c + 0 0 e + + + f + 0 0 MNSs P Lewis Lutheran Kell K 0 0 + 0 0 0 + 0 0 0 0 k + + + + + + 0 + W + + Kpa Jsa 0 0 0 0 0 0 0 0 + 0 0 0 0 0 0 0 0 0 + 0 0 0 Duffy Fya Fyb + + 0 0 + + 0 0 + + + + 0 + 0 + 0 + 0 0 + + Kidd Xga RT 1+ 1+ 1+ 1+ 1+ 1+ 1+ 1+ 1+ 1+ 1+ 1+ 37 1+ 1+ 1+ 1+ 1+ 1+ 1+ 1+ 1+ 1+ 1+ 1+ AHG 0 0 0 0 0 0 0 0 0 0 0 0 CC 2+ 2+ 2+ 2+ 2+ 2+ 2+ 2+ 2+ 2+ 2+ 2+ V VS CW M N S s P1 Lea Leb Lua Lub 0 0 0 0 0 + 0 0 0 0 0 0 0 0 / / + 0 0 / 0 / 0 + 0 0 0 0 0 0 0 0 0 + + + 0 0 + 0 + + + 0 + + 0 0 + + 0 + + 0 + 0 + 0 + + + + + + + 0 0 0 0 0 0 + 0 + + + 0 + + 0 + 0 0 0 0 0 0 0 0 0 + + + + + + + + + + + + Jka + + 0 + + + + + + 0 0 Jkb Xga IS + + + 0 + 0 + 0 0 + + + + + + + 0 0 + + + + 1+ 1+ 1+ 1+ 1+ 1+ 1+ 1+ 1+ 1+ 1+ 1+ + O 0 + + + + + + 0 + + + + + + + + + + + + + / + 0 0 + W 0 + + 0 + + + + + 0 + 0 + + 0 + 0 + 0 + + 0 0 0 0 10 0 11 + Auto Control With Rouleaux the reaction strength may vary more than indicated and the auto control is positive. Confirmation of rouleaux involves performing a saline replacement test. Panel #2 Rh D C E 1 2 3 4 5 6 7 8 9 0 + + + 0 0 0 0 0 + + + 0 0 0 0 0 0 0 + 0 0 0 + + 0 0 0 0 0 0 c + 0 0 e + + + f + 0 0 MNSs P Lewis Lutheran Kell Duffy Kidd Xga AHG CC +/m+ 1+W 1+W 1+W 1+W 1+W m+ m+ m+ m+ 0 2+ V VS Cw M N S s P1 Lea Leb Lua Lub K 0 0 0 0 0 + 0 0 0 0 0 0 0 0 / / + 0 0 / 0 / 0 + 0 0 0 0 0 0 0 0 0 + + + 0 0 0 + 0 + + + + 0 + + + 0 0 + + + 0 + + + 0 + 0 + + + + 0 0 0 0 0 0 + 0 + + + 0 + + 0 + 0 0 0 0 0 0 0 0 0 + + + + + + + + + + + + 0 0 + 0 0 0 + 0 k Kpa Jsa Fya Fyb Jka Jkb Xga IS RT 37 + + + + + + 0 + 0 0 0 0 0 0 0 0 + 0 0 0 0 0 0 0 0 0 + 0 0 0 + + 0 0 + + 0 0 + + + + 0 + 0 + 0 + 0 0 + + + + 0 + + + + + + 0 0 + + + 0 + 0 + 0 0 + + + + + + + 0 0 + + + + 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 + O 0 + + + + + + 0 + + + + + + + + + + + + + / + 0 0 + W 0 + + 0 + + + + + + 0 0 + 0 + + + 0 + 0 + 0 0 0 0 0 W 0 0 + + 10 0 11 + This represents the reactivity of a H i gh Ti ter L ow Avi di ty (HTLA) antibody. Weak (Microscopic to 1+) reactions with all cells. Weak reactions that persist through many dilutions (titer: at least to 1:64). Auto Control Panel #3 Rh D C E 1 2 3 4 5 6 7 8 9 0 + + + 0 0 0 0 0 + + + 0 0 0 0 0 0 0 + 0 0 0 + + 0 0 0 0 0 0 c + 0 0 e + + + f + 0 0 MNSs Lewis Lutheran Kell Duffy Kidd AHG CC 1+ 1+ 1+ 1+ 1+ 1+ 1+ 1+ 1+ 1+ 1+ 0 2+ V VS Cw M N S s P1 Lea Leb Lua Lub K 0 0 0 0 0 + 0 0 0 0 0 0 0 0 / / + 0 0 / 0 / 0 + 0 0 0 0 0 0 0 0 0 + + + 0 0 0 + 0 + + + + 0 + + + 0 0 + + + 0 + + + 0 + 0 + + + + 0 0 0 0 0 0 + 0 + + + 0 + + 0 + 0 0 0 0 0 0 0 0 0 + + + + + + + + + + + + 0 0 + 0 0 0 + 0 k Kpa Jsa Fya Fyb Jka Jkb Xga IS RT 37 + + + + + + 0 + 0 0 0 0 0 0 0 0 + 0 0 0 0 0 0 0 0 0 + 0 0 0 + + 0 0 + + 0 0 + + + + 0 + 0 + 0 + 0 0 + + + + 0 + + + + + + 0 0 + + + 0 + 0 + 0 0 + + + + + + + 0 0 + + + + 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 + O 0 + + + + + + 0 + + + + + + + + + + + + + / + 0 0 + W 0 + + 0 + + + + + + 0 0 + 0 + + + 0 + 0 + 0 0 0 0 0 W 0 0 + + 10 0 11 + Auto Control This represents an antibody to a high incidence antigen (99% of the population). Rh D C E 1 2 3 4 5 6 7 8 9 0 + + + 0 0 0 0 0 + + + 0 0 0 0 0 0 0 + 0 0 0 + + 0 0 0 0 0 0 c + 0 0 e + + + f + 0 0 MNSs V VS CW M N S 0 0 0 0 0 + 0 0 0 0 0 0 0 0 / / + 0 0 / 0 / 0 + 0 0 0 0 0 0 0 0 0 + + + 0 + 0 + + 0 + 0 0 + 0 + 0 + 0 + 0 0 + + 0 + + + 0 + 0 + 0 + Lewis Lutheran Kell k + + + + + + 0 + Duffy Kidd AHG CC 0 2+ 2+ 2+ 2+w 2+ 2+ 2+ 1+s 2+ 0 0 2+ 2+ 2+ s P1 Lea Leb Lua Lub K 0 + + + + + 0 + + + + + + + 0 0 0 0 0 0 + 0 + + + 0 + + 0 + 0 0 0 0 0 0 0 0 0 + + + + + + + + + + + + 0 0 + 0 0 0 + 0 Kpa Jsa Fya Fyb Jka Jkb Xga IS RT 37 0 0 0 0 0 0 0 0 + 0 0 0 0 0 0 0 0 0 + 0 0 0 + + 0 0 + + 0 0 + + + + 0 + 0 + 0 + 0 0 + + + + 0 + + + + + + 0 0 + + + 0 + 0 + 0 0 + + + + + + + 0 0 + + + + 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 + O 0 + + + + + + 0 + + + + + + + + + + + + + / + W 0 + + + 0 + 0 + + 0 0 0 0 0 W 0 0 + + 10 0 11 + Are the Positive reactions of equal Strength with each cell? This would suggest that there is only one antibody specificity causing the reactions. Auto Control Rh D C E 1 2 3 4 5 6 7 8 9 0 + + + 0 0 0 0 0 + + + 0 0 0 0 0 0 0 + 0 0 0 + + 0 0 0 0 0 0 c + 0 0 e + + + f + 0 0 MNSs P Lewis Lutheran Kell Duffy Kidd AHG CC 2+ 2+ 2+ 0 1+s 2+ 2+ 2+ 2+ 2+ 2+ 0 2+ 2+ V VS CW M N S s P1 Lea Leb Lua Lub K 0 0 0 0 0 + 0 0 0 0 0 0 0 0 / / + 0 0 / 0 / 0 + 0 0 0 0 0 0 0 0 0 + + + 0 0 0 + 0 + + + + 0 + + + 0 0 + + + 0 + + + 0 + 0 + + + + 0 0 0 0 0 0 + 0 + + + 0 + + 0 + 0 0 0 0 0 0 0 0 0 + + + + + + + + + + + + 0 0 + 0 0 0 + 0 k Kpa Jsa Fya Fyb Jka Jkb Xga IS RT 37 + + + + + + 0 + 0 0 0 0 0 0 0 0 + 0 0 0 0 0 0 0 0 0 + 0 0 0 + + 0 0 + + 0 0 + + + + 0 + 0 + 0 + 0 0 + + + + 0 + + + + + + 0 0 + + + 0 + 0 + 0 0 + + + + + + + 0 0 + + + + 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2+ 2+ 2+ 0 1+ 2+ 2+ 2+ 2+ 2+ 2+ 0 + O 0 + + + + + + 0 + + + + + + + + + + + + + / + 0 0 + W 0 + + 0 + + + + + + 0 0 + 0 + + + 0 + 0 + 0 0 0 0 0 W 0 0 + + 10 0 11 + Does patient serum react with the same o Auto Control panel cells at 37 C and AHG? This, too would suggest that only ONE unexpected antibody is causing the observed reactions. Var i ati on i n Aggl uti nati on Str ength on Ab Panel s M ul ti pl e Anti bodi es pr esent Can cause variation in agglutination strength in a single phase. i.e. 1+ to 3+ reactions at 37oC phase Can cause variation in agglutination strength between phases: i.e. 1+ at 37oC and 3+ at AHG Dosage Can cause variation in agglutination strength in a single phase. i.e. 1+ to 3+ reactions at 37oC phase Rh D C E 1 2 3 4 5 6 7 8 9 0 + + + 0 0 0 0 0 + + + 0 0 0 0 0 0 0 + 0 0 0 + + 0 0 0 0 0 0 c + 0 0 e + + + f + 0 0 MNSs P Lewis Lutheran Kell Duffy Kidd AHG CC W+ 2+ 0 2+ 1+ 2+ 0 W+ 2+ W+ W+ 0 2+ 2+ 2+ V VS CW M N S s P1 Lea Leb Lua Lub K 0 0 0 0 0 + 0 0 0 0 0 0 0 0 / / + 0 0 / 0 / 0 + 0 0 0 0 0 0 0 0 0 + + + 0 0 0 + 0 + + + + 0 + + + 0 0 + + + 0 + + + 0 + 0 + + + + 0 0 0 0 0 0 + 0 + + + 0 + + 0 + 0 0 0 0 0 0 0 0 0 + + + + + + + + + + + + 0 0 + 0 0 0 + 0 k Kpa Jsa Fya Fyb Jka Jkb Xga IS RT 37 + + + + + + 0 + 0 0 0 0 0 0 0 0 + 0 0 0 0 0 0 0 0 0 + 0 0 0 + + 0 + + + 0 + + + + + 0 + 0 + 0 + + 0 + + + + 0 + + + + + + 0 0 + + + 0 + 0 + 0 0 + + + + + + + 0 0 + + + + 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 + O 0 + + + + + + 0 + + + + + + + + + + + + + / + 0 0 + W 0 + + 0 + + + + + + 0 0 + 0 + + + 0 + 0 + 0 0 0 0 0 W 0 0 + + 10 0 11 + Auto Control Look at the reaction strengths and how they correlate to the zygosity of the Anti-Fya antibody. How strong is the agglutination with the Homozygous cells compared to the Heterozygous cells? DOSAGE can account for this. Rh D C E 1 2 3 4 5 6 7 8 9 0 + + + 0 0 0 0 0 + + + 0 0 0 0 0 0 0 + 0 0 0 + + 0 0 0 0 0 0 c + 0 0 e + + + f + 0 0 MNSs P Lewis Lutheran Kell Duffy Kidd CC V VS CW M N S s P1 Lea Leb Lua Lub K 0 0 0 0 0 + 0 0 0 0 0 0 0 0 / / + 0 0 / 0 / 0 + 0 0 0 0 0 0 0 0 0 + + + 0 0 0 + 0 + + + + 0 + + + 0 0 + + + 0 + + + 0 + 0 + + + + 0 0 0 0 0 0 + 0 + + + 0 + + 0 + 0 0 0 0 0 0 0 0 0 + + + + + + + + + + + + 0 0 + 0 0 0 + 0 k Kpa Jsa Fya Fyb Jka Jkb Xga IS RT 37 AHG + + + + + + 0 + 0 0 0 0 0 0 0 0 + 0 0 0 0 0 0 0 0 0 + 0 0 0 + + 0 0 + + 0 0 + + + + 0 + 0 + 0 + 0 0 + + + + 0 + + + + + + 0 0 + + + 0 + 0 + 0 0 + + + + + + + 0 0 + + + + 0 0 0 0 1+ 1+ 1+ 1+ 3+ 0 0 0 2+ 0 0 0 1+ 0 0 1+ 2+ 0 0 0 0 0 0 0 0 0 + O 0 + + + + + + 0 + + + + + + + + + + + + + / 2+ 2+ 2+ + 0 0 + W 0 + + 0 + + + + + + 0 0 + 0 + + + 0 + 0 + 0 0 0 0 0 1+ 2+ 0 0 0 0 0 0 0 0 0 0 0 0 0 1+ 0 2+ 2+ 2+ 0 W 0 0 + + 10 0 11 + Auto Control 2+ This panel appears to be demonstrating the presence of Multiple Antibody specificities. There is variation in reaction strength within each phase and between phases. RUL I NG OUT!! Look at each Panel Cell that has a NEGATI VE reaction with the serum being tested. 1. Rule out by drawing 1 line through Antigen the specificity at the top of the sheet. 2. Repeat the process for each negative cell in the panel. 3. At the end of the process count the number of mark through lines in each specificity. 1. Each specificity that has 2 or more strikes are considered RULED OUT! They are statistically eliminated as the antibody causing those reactions. Ci r cl e al l speci fi ci ty's whi ch have NOT been RUL ED OUT! Gener al Rul e For some antibody specificity's which are known to show dosage you cannot Rul e Out the antibody as being absent unless 2 H omozygous Cel l s fail to react with the patient serum. Antibody specificity's that are a included under this rule are: Duffy (Fy , b a b Fy ), Ki dd (Jk , Jk ), M , N, S, and s. Rh D C E 1 2 3 4 5 6 7 8 9 0 + + + 0 0 0 0 0 + + + 0 0 0 0 0 0 0 + 0 0 0 + + 0 0 0 0 0 0 c + 0 0 e + + + f + 0 0 MNSs P Lewis Lutheran Kell Duffy Kidd AHG CC 0 0 0 0 1+ 1+ 1+ 1+ 1+ 1+ 1+ 0 2+ 2+ 2+ 2+ 2+ V VS CW M N S s P1 Lea Leb Lua Lub K 0 0 0 0 0 + 0 0 0 0 0 0 0 0 / / + 0 0 / 0 / 0 + 0 0 0 0 0 0 0 0 0 + + + 0 0 0 + 0 + + + + 0 + + + 0 0 + + + 0 + + + 0 + 0 + + + + 0 0 0 0 0 0 + 0 + + + 0 + + 0 + 0 0 0 0 0 0 0 0 0 + + + + + + + + + + + + 0 0 + 0 0 0 + 0 k Kpa Jsa Fya Fyb Jka Jkb Xga IS RT 37 + + + + + + 0 + 0 0 0 0 0 0 0 0 + 0 0 0 0 0 0 0 0 0 + 0 0 0 + + 0 0 + + 0 0 + + + + 0 + 0 + 0 + 0 0 + + + + 0 + + + + + + 0 0 + + + 0 + 0 + 0 0 + + + + + + + 0 0 + + + + 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 + O 0 + + + + + + 0 + + + + + + + + + + + + + / + 0 0 + W 0 + + 0 + + + + + + 0 0 + 0 + + + 0 + 0 + 0 0 0 0 0 W 0 0 + + 10 0 11 + Ruling out using Homozygous cells: Panel cells 1-4 have no reactivity at any phase. These can be used to rule out. Each highlighted box represents a homozygous cell enabling us to rule out one of the blood groups that meet that requirement: Kidd, Duffy and MNSs. Auto Control RUL I NG OUT!! The next slide is a panel that has animated the ruling out process. As you click the mouse button lines will indicate a strike against a blood group specificity. Two strike through's statistically eliminate that antibody specificity from causing the observed panel reactions. Each Circled Specificity indicates an antibody that could possibly be causing the reactions observed on the panel. Rh D C E 1 2 3 4 5 6 7 8 9 0 + + + 0 0 0 0 0 + + + 0 0 0 0 0 0 0 + 0 0 0 + + 0 0 0 0 0 0 c + 0 0 e + + + f + 0 0 MNSs Lewis Lutheran Kell Duffy Kidd AHG CC 1+ 1+ 1+ 0 0 0 0 0 0 0 1+ 0 2+ 2+ 2+ 2+ 2+ 2+ 2+ 2+ V VS Cw M N S s P1 Lea Leb Lua Lub K 0 0 0 0 0 + 0 0 0 0 0 0 0 0 / / + 0 0 / 0 / 0 + 0 0 0 0 0 0 0 0 0 + + + 0 0 0 + 0 + + + + 0 + + + 0 0 + + + 0 + + + 0 + 0 + + + + 0 0 0 0 0 0 + 0 + + + 0 + + 0 + 0 0 0 0 0 0 0 0 0 + + + + + + + + + + + + 0 0 + 0 0 0 + 0 k Kpa Jsa Fya Fyb Jka Jkb Xga IS RT 37 + + + + + + 0 + 0 0 0 0 0 0 0 0 + 0 0 0 0 0 0 0 0 0 + 0 0 0 + + 0 0 + + 0 0 + + + + 0 + 0 + 0 + 0 0 + + + + 0 + + + + + + 0 0 + + + 0 + 0 + 0 0 + + + + + + + 0 0 + + + + 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 + O 0 + + + + + + 0 + + + + + + + + + + + + + / + 0 0 + W 0 + + 0 + + + + + + 0 0 + 0 + + + 0 + 0 + 0 0 0 0 0 W 0 0 + + 10 0 11 + Auto Control Rule out by drawing 1 line through the Ag specificity at the top of the sheet for each negative cell with a + in the box. For example Cell #4 is the first negative cell. Moving from left to right beginning with the D antigen is a + on cell #4, this is where we begin by drawing a single line through the D. It now has one strike. RUL I NG OUT!! The next slide is the same panel without the rule out strikes or circles. Go through the rule out process by yourself and compare results with the ruled out panel. Remember, begin with a negative cell, homozygous cells are required for Kidd, Duffy and MNSs to rule out. Circle all specificities that cannot be ruled out. Rh D C E 1 2 3 4 5 6 7 8 9 0 + + + 0 0 0 0 0 + + + 0 0 0 0 0 0 0 + 0 0 0 + + 0 0 0 0 0 0 c + 0 0 e + + + f + 0 0 MNSs Lewis Lutheran Kell Duffy Kidd AHG CC 1+ 1+ 1+ 0 0 0 0 0 0 0 1+ 0 2+ 2+ 2+ 2+ 2+ 2+ 2+ 2+ V VS Cw M N S s P1 Lea Leb Lua Lub K 0 0 0 0 0 + 0 0 0 0 0 0 0 0 / / + 0 0 / 0 / 0 + 0 0 0 0 0 0 0 0 0 + + + 0 0 0 + 0 + + + + 0 + + + 0 0 + + + 0 + + + 0 + 0 + + + + 0 0 0 0 0 0 + 0 + + + 0 + + 0 + 0 0 0 0 0 0 0 0 0 + + + + + + + + + + + + 0 0 + 0 0 0 + 0 k Kpa Jsa Fya Fyb Jka Jkb Xga IS RT 37 + + + + + + 0 + 0 0 0 0 0 0 0 0 + 0 0 0 0 0 0 0 0 0 + 0 0 0 + + 0 0 + + 0 0 + + + + 0 + 0 + 0 + 0 0 + + + + 0 + + + + + + 0 0 + + + 0 + 0 + 0 0 + + + + + + + 0 0 + + + + 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 + O 0 + + + + + + 0 + + + + + + + + + + + + + / + 0 0 + W 0 + + 0 + + + + + + 0 0 + 0 + + + 0 + 0 + 0 0 0 0 0 W 0 0 + + 10 0 11 + Auto Control Panel Wr i te-Up #1. List all of the circled specificities: D, C, V, VS, Cw, S, L ea, L ua, K, Kpa, J sa, Fyb, J kb These represent all of POSSI BI L I TI ES of antibodies that could be causing the reactions on this panel. These are the ones that have not been ruled out. #2. List those antibody specificity's that cannot be ruled out but which were so RARE that either no cell on the panel was positive for them or only one cell was positive and does not appear to be the cause of the reactions: V, VS, Cw, Panel Wr i te-Up #3. List the antibodies that are not the probable cause because their typical PH ASE OF REACTI VI TY does not match the observed phase of reactivity: L ea, L ua On this panel all the reactions occurred at AHG phase (using Monospecific -IgG AHG). What is the optimal phase of reactivity for Lea and Lua? Both are cold reacting antibodies. They should demonstrate reactivity at IS or Room Temp. Panel Wr i te-Up #4. List the M OST L I KEL Y ANTI BODY based on pattern of reactivity. Anti -C Look at the pattern of the agglutination reactions and compare them to each remaining antibody specificity. Begin at the left with Anti-D. Is there a reaction between the serum and the antigen specificity EACH TIME the antigen is present on the panel cells? Is there NO reaction between the serum and the panel cells each time the antigen is NOT present on the panel cells? Does this antibody normally react at this Phase? Is th...
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