81:, adsorptions, and enzyme treatment. Some patients produce antibodies to high frequency antigens. That is, the red cell antigens are present in a significant portion of the human population. It may be questionable and very difficult to assess if the antibody is considered clinically significant or not. A clinically significant antibody is an antibody that is capable of causing in vitro hemolysis or a decreased survival of transfused donor red blood cells. Antibodies to high frequency antigens can be assessed for clinical significance using the monocyte monolayer assay.
20:
106:(ISBT), 43 blood group systems containing hundreds of different red blood cell antigens have been described. With some exceptions, many non-ABO blood group system antigens require a sensitizing event to stimulate antibody production. In other words, the immune system must be exposed to the antigen in order to illicit antibody production. Exposure to antigens can occur through blood transfusion, stem cell/bone marrow transplant, and pregnancy.
93:. This is an immune mediated reaction where recipient antibodies attack donor red blood cell antigen(s), causing hemolysis of donor cells. The reaction may occur during, immediately after, or up to 28 days later. An acute reaction is observed within the first 24 hours, whereas a delayed reaction will be observed between 24 hours and 28 days after transfusion.
101:
When talking about the ABO blood group system, Landsteiner's Law states that if an individual possesses the A and/or B antigen, they will not form antibodies to these antigens. However, if an individual does not have either A or B antigens, they will naturally produce anti-A and anti-B antibodies.
113:
antibody subclass, reactivity at body temperature, and ability to cause red blood cell agglutination in the presence of anti-human globulin (AHG) in an indirect antiglobulin test. Sometimes, clinical significance of an antibody can be difficult to determine. Antibodies to high prevalence red cell
35:
when incompatible cellular blood products are transfused to the anemic patient. When donor cells possess substances that are not produced by the recipient, the recipient's immune system produces antibodies against the substance; these are called alloantibodies. Specific white blood cells, called
114:
antigens can sometimes mask the detection of clinically significant alloantibodies because the corresponding antigen is present on most, if not all, of the screening red blood cells used to detect these antibodies possess the antigen. This is where the monocyte monolayer assay may be useful.
60:
is a concentration within a clinical laboratory that analyzes specimens from potential transfusion recipients and provides compatible blood products to the healthcare team in charge of that patient's care. Several routine tests are performed including blood typing (determination of
172:
If the positive or negative controls fail, than the entire testing procedure is invalid and must be repeated. Criteria for a positive MMA will vary by laboratory, though the originally established threshold set by Sandra Nance et al., is >20% phagocytic activity observed.
73:, direct antiglobulin testing, and antibody identification. Beyond the presence of naturally occurring antibodies (isohemagglutinins) to the ABO and Rh(D) blood group antigens, additional immune-stimulated antibodies are considered unexpected alloantibodies.
222:
76:
The identification of unexpected antibodies is a labor-intensive process, and sometimes requires the addition of special laboratory techniques to aid in the proper identification of the antibody. Among these techniques are
23:
The image on the left shows a monocyte actively phagocytizing an antibody-sensitized red blood cell. The image on the right shows multiple RBC that have been phagocytized by a single monocyte.
109:
The clinical significance of an alloantibody depends on its ability to cause a decrease in donor red blood cell survival. Characteristics of clinically significant alloantibodies include:
1044:
801:
379:
318:
31:(MMA) is used to determine the clinical significance of alloantibodies produced by blood transfusion recipients. The assay is used to assess the potential for
668:"Prevalence and specificity of clinically significant red cell alloantibodies in pregnant women - a study from a tertiary care hospital in Southeast Michigan"
176:
Clinically, a positive MMA would indicate that the patient's serum used in the assay contains clinically significant antibodies that are capable of causing
44:(ingestion) and destroy the donor red blood cells. If monocytes destroy the RBC, the antibody attached to those RBC is considered clinically significant.
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1049:
922:
103:
441:
526:"A retrospective analysis of the value of monocyte monolayer assay results for predicting the clinical significance of blood group alloantibodies"
89:
There are many different varieties of abnormal reactions to blood transfusion. Among these, a potentially life-threatening reaction is known as a
1065:
135:
The PBMC's are washed using a phosphate-buffered saline (PBS) and then suspended in tissue culture media in order to keep the monocytes viable.
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The PBMC-media mixture is then added to a tissue culture chamber slide. Monocytes will adhere to the glass slide forming a monocyte monolayer.
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Serum is mixed and incubated at body temperature (37°C) with a 5% group O RBC suspension. (This step sensitizes or coats RBC with antibody)
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At least 600 (200 if positivity is greater than 20%) monocytes are observed under the microscope for evidence of RBC phagocytosis.
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monocytes, are tasked with ingesting foreign material and become activated during certain inflammatory events. These activated
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The MMA is a very labor-intensive, manual laboratory testing method. The following steps are performed in this assay:
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Makroo, Raj Nath; Arora, Bhavna; Bhatia, Aakanksha; Chowdhry, Mohit; Luka, Rosamma
Nakamatathil (July 2014).
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A positive and negative control is also performed in tandem with the patient specimen for quality assurance.
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After a 60-minute, 37°C incubation, the supernatant is removed from the chamber slides and rinsed with PBS.
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Anticoagulated blood is collected from normal, healthy individuals. Acid citrate dextrose is preferred.
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730:"Predicting the clinical significance of red cell alloantibodies using a monocyte monolayer assay"
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The sensitized RBC's are washed with PBS to remove any unbound antibody or interfering substances.
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The washed, sensitized RBC are then added to the monocyte monolayer tissue culture chamber slide.
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come in contact with antibody-sensitized red blood cells (RBC) and may or may not exhibit
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467:"Clinical significance of antibody specificities to M, N and Lewis blood group system"
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132:(PBMC) are harvested from the blood sample using a Ficoll-Paque® density gradient.
289:. Christine A. Gleason, Sandra E. Juul (Tenth ed.). Philadelphia, PA. 2018.
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Marshall, William J.; Lapsley, Márta; Day, Andrew; Ayling, Ruth (5 March 2014).
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237:"https://www.cancer.gov/publications/dictionaries/cancer-terms/def/monocyte"
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442:"Mastering the monocyte monolayer assay | Canadian Blood Services"
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350:. Denise Harmening (Seventh ed.). Philadelphia, PA. 2019.
612:. Maria Rios, Marion E. Reid. San Diego, CA: Academic Press.
666:
Moinuddin, Imran; Fletcher, Craig; Millward, Peter (2019).
642:
16:
Laboratory test for clinically significant alloantibodies
728:
Nance, S. J.; Arndt, P.; Garratty, G. (November 1987).
524:
Arndt, Patricia A.; Garratty, George (September 2004).
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Once the slide is completely dry, it is stained with a
399:"Use of the enzyme method for antibody identification"
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223:"Through the Microscope: Monocyte Monolayer Assays"
643:"International Society of Blood Transfusion |ISBT"
1045:Transfusion-associated graft versus host disease
347:Modern blood banking & transfusion practices
97:Alloantibody formation and clinical significance
795:
8:
1040:Transfusion associated circulatory overload
609:Molecular protocols in transfusion medicine
1050:Febrile non-hemolytic transfusion reaction
923:International Society of Blood Transfusion
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780:
378:: CS1 maint: location missing publisher (
317:: CS1 maint: location missing publisher (
104:International Society of Blood Transfusion
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69:status), antibody screening, serologic
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190:Acute hemolytic transfusion reaction
130:Peripheral blood mononuclear cells
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1078:Transfusion transmitted infection
543:10.1111/j.1537-2995.2004.03427.x
286:Avery's diseases of the newborn
178:antibody-mediated phagocytosis
91:hemolytic transfusion reaction
85:Hemolytic transfusion reaction
1:
967:Intraoperative blood salvage
606:Denomme, Gregory A. (2000).
585:. Elsevier Health Sciences.
983:Blood compatibility testing
1349:
1030:Transfusion hemosiderosis
672:Journal of Blood Medicine
1010:Monocyte monolayer assay
484:10.4103/0973-6247.137442
29:monocyte monolayer assay
885:Granulocyte transfusion
397:Strobel, Erwin (2004).
33:intravascular hemolysis
24:
1020:Transfusion reactions
382:) CS1 maint: others (
321:) CS1 maint: others (
195:Antibody opsonization
22:
1328:Transfusion medicine
1000:Kleihauer–Betke test
962:Exchange transfusion
841:Platelet transfusion
815:transfusion medicine
1088:Blood group systems
1023:and adverse effects
858:Fresh frozen plasma
685:10.2147/JBM.S214118
403:Clinical Laboratory
25:
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892:Blood substitutes
880:White blood cells
811:Blood transfusion
619:978-0-12-209370-8
409:(9–10): 575–580.
357:978-0-8036-9462-0
296:978-0-323-40172-2
263:External link in
102:According to the
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1005:Antibody elution
952:plateletpheresis
918:Blood management
901:General concepts
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449:. Retrieved
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245:. Retrieved
243:. 2011-02-02
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42:phagocytosis
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1333:Blood tests
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995:Coombs test
831:Whole blood
734:Transfusion
678:: 283–289.
530:Transfusion
1322:Categories
908:Blood bank
652:2022-10-05
451:2023-01-09
366:1048659017
305:1013816550
247:2023-01-09
206:References
48:Background
1113:Augustine
1057:reaction
1055:Hemolytic
944:Apheresis
836:Platelets
754:0041-1132
694:1179-2736
628:162129287
552:0041-1132
493:0973-6247
415:1433-6510
374:cite book
313:cite book
118:Principle
38:monocytes
1238:Lutheran
1143:Dombrock
928:ISBT 128
770:21638521
712:31692490
568:24871062
560:15318848
511:25161347
423:15481633
256:cite web
184:See also
79:elutions
1277:Scianna
1163:Gerbich
1066:delayed
937:Methods
762:3686653
703:6708388
502:4140072
1188:Indian
1133:Cromer
1128:Colton
853:Plasma
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1307:Other
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1203:KANNO
1148:Duffy
1138:Diego
1061:acute
976:Tests
766:S2CID
564:S2CID
1287:T-Tn
1272:RHAG
1270:and
1263:Raph
1258:P1PK
1218:Kidd
1208:Kell
1173:GLOB
1158:FORS
1118:CD59
863:PF24
813:and
758:PMID
750:ISSN
708:PMID
690:ISSN
624:OCLC
614:ISBN
587:ISBN
556:PMID
548:ISSN
507:PMID
489:ISSN
419:PMID
411:ISSN
384:link
380:link
362:OCLC
352:ISBN
323:link
319:link
301:OCLC
291:ISBN
271:help
27:The
1292:Vel
1282:Sid
1248:MNS
1228:Lan
1198:JMH
1168:GIL
1101:ABO
742:doi
698:PMC
680:doi
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479:doi
63:ABO
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273:)
269:(
250:.
225:.
65:/
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