The Laboratory Scientist’s lament: “Oh, no! There’s an isolated reaction that we can’t explain on this guy’s antibody detection tests, and they need blood right away!” This episode will help blood bankers and clinicians understand what these reactions represent, and what they might or might not become.
Dr. Brenda Grossman has been there, and she feels your pain! Brenda was trying to explain these isolated reactions to one of her residents a few years back, and it dawned on her that solid data on these “antibodies of undetermined specificity” (as she came to describe them) was pretty much nonexistent. So, she and that resident (and later colleague), Dr. Chang Liu, put together a study describing the frequency of these irritating “stray” reactions in a large cohort of patients at their hospital in St. Louis. What they found may surprise you (put it this way: The most common antibody they identified in their study was not anti-D, anti-E, or anti-K, as you might guess!). Brenda also outlines some possible management strategies for patients impacted by antibodies of undetermined specificity.
About My Guest:
Brenda Grossman, MD, MPH is a professor in the Department of Pathology and Immunology and the Department of Medicine at Washington University in St. Louis, MO. She is board-certified in Internal Medicine, Hematology, and Blood Banking/Transfusion Medicine. She serves as Medical Director of Transfusion Medicine Services at Barnes-Jewish Hospital, and is the program director for both the Clinical Pathology Residency Program and Transfusion Medicine Fellowship at Washington University. Brenda served as associate editor for the 16th, 17th, and (current) 18th editions of the AABB Technical Manual. She has won numerous teaching awards, and has numerous publications in peer-reviewed journals including Transfusion, JAMA, Vox Sanguinis, and the Annals of Internal Medicine.
DISCLAIMER: The opinions expressed on this episode are those of my guest and I alone, and do not reflect those of the organizations with which either of us is affiliated. Neither Dr. Grossman nor I have any relevant financial disclosures.
The images below are generously provided by Brenda Grossman.
- Dr. Grossman and Liu’s article discussed in this interview: Liu C and Grossman BJ. Antibody of undetermined specificity: frequency, laboratory features, and natural history. Transfusion 2013;53:931-938.
- Editorial accompanying the above article: Tormey CA and Hendrickson JE. Antibodies of undetermined significance: nuisance or near miss? Transfusion 2013;53:926-928.
- Study Dr Grossman mentioned, using ficin treatment to resolve AUS: Hill BC et al. Ficin-Treated Red Cells Help Identify Clinically Significant Alloantibodies Masked as Reactions of Undetermined Specificity in Gel Microtubes. Laboratory Medicine 2017;48:24-28.
- Later study with similar results in solid-phase testing: Miller NM et al. Patient factors associated with unidentified reactivity in solid- phase and polyethylene glycol antibody detection methods. Transfusion 2017;57;1288–1293.