PRESENTATION OF PARTIALLY NEGATIVE INDIRECT ANTIGLOBULIN TEST WITHOUT ENHANCING REAGENTS IN A PREGNANT WOMAN CARRYING ANTI-IgM PLUS ANTI-IgG TYPE ANTI-M

DOI 1 Citations
  • Yamada Marie
    Department of Laboratory Medicine, Saga University Hospital
  • Yamada Naotomo
    Department of Laboratory Medicine, Saga University Hospital
  • Kubota Yasushi
    Department of Transfusion Medicine, Saga University Hospital Division of Hematology and Oncology, Department of Internal Medicine, Saga University Hospital
  • Kimura Shinya
    Division of Hematology and Oncology, Department of Internal Medicine, Saga University Hospital
  • Higashitani Takanori
    Department of Laboratory Medicine, Saga University Hospital
  • Sueoka Eisaburo
    Department of Laboratory Medicine, Saga University Hospital Department of Transfusion Medicine, Saga University Hospital

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  • 抗M（IgM＋IgG）において抗体価測定時に反応増強剤無添加間接抗グロブリン試験で一部陰性を示した妊婦の1例

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Abstract

The indirect antiglobulin test (IAT) often registers as a false positive with enhancing reagents in screening test for irregular antibodies and cross-match test in response to the presence of cold antibodies. Since cold antibodies do not cause a transfusion reaction, IAT without enhancing reagents, 60-min IAT is useful in distinguishing clinically significant antibodies. We recently experienced a rare case in which 1×and 2×-diluted samples showed negative results, while 4×-diluted samples showed positive results on 60-min IAT. IgM type anti-M was produced at a patient's first pregnancy, and IgM+IgG type anti-M was produced after the first child delivery. At the third pregnancy, anti-M titer was monitored every two weeks until the day before delivery. Titer of anti-M increased to 1: 64, but findings for 1: 1-2 dilution serum of the patient were negative on 60-min IAT at 37 weeks into the pregnancy. Flow cytometry analysis revealed that IgM type anti-M reacted more strongly at 37°Cthan at lower temperatures. These findings suggested that anti-IgG globulin serum was unable to be used to build bridges, resulting in the negative results on IAT because IgM type anti-M, which reacted at 37°C, inhibited the binding of IgG type anti-M. The present case has shown the importance of using dithiothreitol or 2-mercaptoethanol, which destroys IgM type antibody, for the detection of clinically significant antibodies.

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