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      A prospective observational study to evaluate effect of heat inactivation on ABO titers performed by column agglutination technology and conventional tube technique

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          Abstract

          BACKGROUND AND AIMS:

          When determining ABO antibody titers, immunoglobulin G (IgG) antibodies can be masked by immunoglobulin M (IgM) antibodies. Hence, the measurement of actual concentration of IgG requires methods like heat inactivation (HI) of plasma. This study was aimed at determining the effects of HI on IgM and IgG titers performed by conventional tube technique (CTT) and column agglutination technique (CAT).

          MATERIALS AND METHODS:

          This was a prospective, observational study conducted from October 2019 to March 2020. All consecutive A, B, and O group donors who gave consent for participation were included. All samples were consecutively tested by CTT and CAT, before and after HI (pCTT, pCAT).

          RESULTS:

          A total of 300 donors were included. IgG titers were found to be more than IgM titers. For group O, IgG titer results were higher for both anti-A and anti-B compared to group A and B. For group A, B, and O, pretreatment results were higher than posttreatment IgG titer results. Median anti-A titers were similar to median anti-B titers across all categories. Median IgM and IgG titers were higher for group O individuals than nongroup O individuals. There was reduction in IgG and IgM titers after HI of plasma. One log reduction in median titers was observed when ABO titers were performed by CAT and CTT.

          CONCLUSION:

          There is one log difference between median antibody titers estimated using heat inactivated and nonheat inactivated plasma. The use of HI for ABO isoagglutinin titer estimation can be considered in low resource settings.

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          Most cited references31

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          The ABO blood group system revisited: a review and update.

          The antigens of the ABO system were the first to be recognized as blood groups and actually the first human genetic markers known. Their presence and the realization of naturally occurring antibodies to those antigens lacking from the cells made sense of the erratic failure of blood transfusion hitherto and opened up the possibility of a safe treatment practice in life-threatening blood loss. Although initially apparently simple, the ABO system has come to grow in complexity over the years. The mass of knowledge relating to carbohydrate chemistry, enzymology, molecular genetics, and structural and evolutionary biology is now enormous thanks to more than a century of research using ABO as a principal model. This has provided us with data to form a solid platform of evidence-based transfusion and transplantation medicine used every day in laboratories and clinics around the globe. This review aims to summarize key findings and recent progress made toward further understanding of this surprisingly polymorphic system.
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            Clinical guide to ABO-incompatible allogeneic stem cell transplantation.

            The independent genomic inheritance of the human leukocyte antigen (HLA) and the ABO-blood group system allows for HLA-matched hematopoietic progenitor cell transplantation (HCT) to occur in donors who are not matched for ABO blood groups. In fact, nearly one-half of all HCT will involve recipient-donor ABO incompatibility. This places the recipient at increased risk for acute and delayed hemolytic reactions, delayed RBC engraftment, and pure red blood cell aplasia. Additionally, clinical and laboratory evaluation for potential non-ABO, minor RBC antigen-antibody discrepancies may be beneficial to facilitate safe transfusions before, during, and after transplantation. In addition to posing potential clinical risks, analyses of outcomes in ABO-incompatible HCT have yielded inconsistent results with respect to overall survival, relapse risk, incidence of acute or chronic graft-versus-host disease, and engraftment of platelets and granulocytes. As such, pretransplantation donor-recipient evaluation and management for ABO-incompatible HCT requires adopting unique strategies when major, minor, and bidirectional differences exist. These strategies have the potential to improve patient outcomes and allow for effective management of the blood bank inventory. The purpose of this article is to describe practical approaches to screening for and managing ABO-incompatible HCT, with the goal of reducing preventable morbidity and mortality after transplantation.
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              The effect of heat inactivation of serum on aggregation of immunoglobulins.

              Heating serum at 56 degrees is used to inactivate complement in several immunological assays. During heating, both heat-labile and heat-stable anticomplementary activity (ACA) develop. While heat-labile ACA can be completely inactivated, heat-stable ACA increases progressively with continued heating. Heat-stable ACA develops in deaggregated IgG and in normal, but not in hypogammaglobulinaemic, human and porcine serum heated at 56 degrees suggesting that this ACA is due to formation of immunoglobulin aggregates. These aggregates would produce false-positive tests for immune complexes and could inhibit a variety of cell-mediated reactions in assays which incorporate heat-inactivated serum. Other temperatures were tested to determine whether endogenous haemolytic activity could be destroyed without forming immunoglobulin aggregates. At 53 degrees both endogenous haemolytic activity and heat-labile ACA were inactivated and formation of heat-stable ACA in normal serum was minimal. ACA, however, could be induced in deaggregated IgG at 53 degrees. Moreover, the degree of heat-induced aggregation of IgG in vitro at either temperature was directly proportional to IgG concentrations and inversely related to albumin concentrations. Thus, pathological sera with these protein alterations might form more aggregates during heating than normal sera. These data suggest the following: (1) heat inactivation of complement at 53 degrees for 90 min is preferable to the traditional 56 degrees; (2) in any assay where immunoglobulin aggregates might interfere, normal serum may be an inadequate control and correlations will need to be made between serum IgG and albumin concentrations and the results obtained in these assays.
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                Author and article information

                Journal
                Asian J Transfus Sci
                Asian J Transfus Sci
                AJTS
                Asian Journal of Transfusion Science
                Wolters Kluwer - Medknow (India )
                0973-6247
                1998-3565
                Jan-Jun 2023
                01 March 2023
                : 17
                : 1
                : 41-47
                Affiliations
                [1] Department of Transfusion Medicine, Histocompatibility and Molecular Biology, Jaypee Hospital, Noida, Uttar Pradesh, India
                [1 ] Department of Transfusion Medicine, Jaypee Hospital, Noida, Uttar Pradesh, India
                Author notes
                Address for correspondence: Dr. Prashant Pandey, Department of Transfusion Medicine, Histocompatibility and Molecular Biology, Jaypee Hospital, Sector-128, Noida - 201 304, Uttar Pradesh, India. E-mail: pkpandey2007@ 123456gmail.com
                Article
                AJTS-17-41
                10.4103/ajts.ajts_175_20
                10180805
                170cda70-149e-4734-84ec-5f573418f304
                Copyright: © 2023 Asian Journal of Transfusion Science

                This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

                History
                : 04 November 2020
                : 16 July 2021
                : 25 July 2021
                Categories
                Original Article

                Hematology
                abo,column agglutination technology,conventional tube technique,heat inactivation,titration

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