Lab 4

Practical Blood Bank

Weak expression of the RhD antigen (Du) The term DU is widely used to describe cells

which have :

a quantitative reduction in the expression of their RhD antigen.

Or qualitative variation in RhD antigen expression, these are referred to as partial Dpartial D.

There are 5 phenotypes D (D+, D-, Weak D, partial D)

Weak D : all D antigen epitopes are present but are underexpressed It is typically caused by a single amino acid switch in the

transmembrane region of the RhD protein. 

Partial D some D antigen epitopes are missing

Rhnull phenotype

The Rh antigens are thought to play a role in maintaining

the integrity of the RBC membrane -The absence of the

Rh complex alters the RBC shape, increases its osmotic

fragility, and shortens its lifespan, resulting in a hemolytic

anemia that is usually mild in nature.

Rh antigens may also be involved in the transport of

ammonium across the RBC membrane

When Du Test should be done

1. When weak or 1+ reactions are found. Microscopic readings should only be done if mixed field agglutination* mixed field agglutination* is suspected.

2. When Rh typing discrepancies are found between current and previous results.

3. When Rh negative neonates born to Rh negative mothers. If the weak D testing is positive, the neonatal Rh type would be reported as "D positive" and the mother would be a candidate for Rh Immune Globulin (RhIG).

PRINCIPLEPRINCIPLE

To test for a weak expression of the D antigen.

Red cells that react weakly or not at all in direct

agglutination tests with anti-D may react with anti-D by

the indirect antiglobulin test (IAT).

Red cells that fail to react 2+ in direct agglutination tests

with anti-D are incubated with anti-D at 37° C and

examined for agglutination. The red cells are washed to

remove unbound antibody (IgG anti-D), then tested with

anti-IgG.

Specimens Clotted or anticoagulated whole blood

Reagents & Equipments o 37oC incubator o Wash bottle with normal saline o Coombs serum - either polyspecific or anti-IgG o Coombs control cells (IgG coated control cells ).o All reagents, equipment, and supplies used in the Rh testing

procedure

Recommended techniques

SLIDE TECHNIQUE1.Add to a clean, labeled slide:

One drop of anti-D IgM and IgG blend. One drop of the test red cells suspension.

2.Mix well by gently and continuously rocking the slide for approx. 30 seconds and incubate the slide for 5 minutes at room temperature, with occasional mixing, we can put the slide on source of light as heat source (Box Lamp)

3.Examine macroscopically for agglutination. A diffuse light source may aid reading.

2. TUBE TECHNIQUE – IMMEDIATE SPIN1. Prepare a suspension of test washed red cells 2-

3% or 1.5 - 2% in LISS.2. Place in a small, labelled test tube:

1 volume of anti-D IgM & IgG blend.1 volume of suspended red cells.

3. Mix well.4. Centrifuge immediately for 10 seconds at 1000g

or for a suitable alternative force and time.5. Agitate the tube gently to dislodge the cell button

and examine macroscopically for agglutination.6. Apparently negative tests which are to be tested

for DU should be further tested by the DU test method.

3. TUBE TECHNIQUE – LISS

1. Place in a small, labelled test tube: 1 volume of Anti-D blood grouping reagent 1 volume of red cells suspended 1.5-2% in

LISS.2. Mix well and incubate for 15-20 minutes at 37°C.3. Centrifuge immediately for 10 seconds at 1000g

or for a suitable alternative force and time.4. Agitate the tube gently to dislodge the cell

button and examine macroscopically for agglutination.

4. DU TEST METHOD (indirect antiglobulin test (IAT). )

After reading the immediate spin results, re-incubate the test for a further 20 minutes at 37°C before completing the DU test method described below.

OROR After reading the LISS tube test, complete the DU

test, without further incubation, following the procedure given below.

DU TEST METHOD1. Wash the test 4 times with a large excess of PBS (e.g. 4

ml of PBS per 12 (or 10) x 75mm glass tubes).NOTE: NOTE: Allow adequate spin time to sediment the red cells

make sure that most of the residual saline is removed at the end if each wash to leave a ‘dry’ cell button.

2. Add two drops of anti-human globulin reagent to each tube.

3. Mix thoroughly. 4. Centrifuge at 1000g for 10 seconds or for a suitable

alternative force and time.5. Agitate the tube gently to dislodge the cell button and

examine macroscopically and microscopically for agglutination.

6. Add 1 drop of IgG-coated control cells to the tube(s) with negative results. Centrifuge, resuspend cells, read macroscopically and record results. Agglutination (2+) shall be present or the test shall be repeated.

Procedural Notes Tests should be read immediately after

centrifugation. Delay may cause bound IgG to dissociate from red cells and either leave too little IgG to detect or neutralize AHG reagent causing false negative results.

Interpretation Interpretation A negative result in the immediate spin phase but

agglutination in the D tube following incubation (with no agglutination in the DC tube) indicates a positive test for weak D.

Lack of agglutination is a negative test and the patient is considered truly D negative. Agglutination in the DC tube invalidates the test.