(P-TS-100) Streamlining Antibody Workups: Avoiding Colds

In the current landscape of Transfusion Services, where financial pressures and staffing challenges are on the rise, the imperative to streamline processes has never been greater. Algorithms employed to determine antibody specificity or resolve ABO/Rh typing discrepancies should enhance the investigative process rather than burden it with unnecessary tasks. Over time, we have phased out cold workups from most antibody investigations, opting instead for IgG-specific technology (IgG-spec) as our primary antibody detection method. As per the current AABB Technical Manual, "cold reactive autoagglutinins rarely mask clinically significant alloantibodies when serum tests are conducted at 37°C and IgG-specific reagents are used for antiglobulin tests." Our study aims to ascertain whether cold antibodies (COLD) interfere with solid phase (IgG spec) technology, thereby confirming the efficacy of our streamlined processes.

Study

Design/Methods:

We conducted a review of antibody and other challenging workups from the year 2023. Specifically, we focused on investigations that definitively identified the presence of a COLD. For these cases, we examined the antibody detection assay to assess whether the COLD demonstrated any interference in the solid phase methodology.

Results/Findings:

At our facility, we rely on the Echo Lumena (Werfen, Norcross, GA) as our primary testing instrument, which integrates both hemagglutination and solid phase methods. Out of 320 workups, 13 (4%) showed COLDs.  Of these 4%, 5 had a COLD in addition to a clinically significant antibody, 7 showed COLD reactivity only, and 1 was shown to be a pathologic COLD with a broad thermal amplitude with different clinical presentation than the others.  Of the 7 showing clinically insignificant COLD reactivity only, the antibody detection on the Echo gave negative results yet hemagglutination (tube) antibody detection results showed some interference to varying degrees (Table 1).

Conclusions:

The results serve as evidence that the presence of COLD do not interfere with antibody detection assays on the Echo Lumena as expected.  This reaffirms that when working up reactivity on our solid phase platform, it is justified to eliminate cold workups from the investigational process.  As the majority of individuals have some degree of COLD as published in other studies, eliminating the search for these nuisance antibodies in Solid Phase technology is an acceptable practice. We acknowledge that there are rare cases when clinically significant, pathological cold antibodies reactive across a broad thermal amplitude may interfere with our platform.  However, they are rare in our experience. By refraining from routine cold workups in the antibody workup algorithm, we can prevent the erroneous assumption that COLD is the cause of reactivity observed in detection/identification assays and eliminate unnecessary work.