Ann Lab Med.  2014 Nov;34(6):456-462. 10.3343/alm.2014.34.6.456.

Standardization of ABO Antibody Titer Measurement at Laboratories in Korea

• Lim YA
• Kang SJ

• KMID: 2129571
• DOI: http://doi.org/10.3343/alm.2014.34.6.456

Abstract

BACKGROUND
Measurement of the ABO antibody (Ab) titer is important in ABO-incompatible transplantation. However, to the best of our knowledge, no standard protocol or external survey program to measure the ABO Ab titer has been established in Korea. We investigated the current status of ABO Ab titer measurements at various laboratories in Korea and the impact of the protocol provided to reduce interlaboratory variations in the methods and results of ABO Ab titers.
METHODS
The Korean external quality assessment of blood bank laboratories sent external survey samples with a questionnaire to 68 laboratories across Korea for the measurement of ABO Ab titers in May 2012. After 6 months, a second set of survey samples were sent with a standard protocol to 53 of the previously surveyed laboratories. The protocol recommended incubation at room temperature only and use of the indirect antihuman globulin method for the tube test as well as and the column agglutination test (CAT).
RESULTS
Several interlaboratory variations were observed in the results, technical procedures, and methods selected for measurement. We found that 80.4% laboratories hoped to change their protocol to the provisional one. Additionally, CAT showed significantly lower variation among laboratories (P=0.006) than the tube test.
CONCLUSIONS
Our study provides baseline data regarding the current status of ABO Ab titer measurement in Korea. The standard protocol and external survey were helpful to standardize the technical procedures and select methods for ABO Ab titer measurement.

Keyword

ABO blood group system; Antibody; Titer; Standard

MeSH Terms

ABO Blood-Group System/*immunology
Agglutination Tests/*standards
Antibodies/*analysis
Humans
Immunoglobulin G/analysis
Immunoglobulin M/analysis
Laboratories/*standards
Questionnaires
Republic of Korea
Temperature
ABO Blood-Group System
Antibodies
Immunoglobulin G
Immunoglobulin M

Figure

• 

  Fig. 1 Number of laboratories with distribution of the anti-A titers as per method and survey results in blood group O. Number of laboratories reading '1+' as the only end point; The asterisk (*) and empty circle (°) mean the acceptable range of the titers, which was defined as one dilution either side of the most common response plus an additional dilution in the direction of the log mean response among 10 or more responders, for RT or IS and AHG, respectively. There were no significant differences in the rate at which laboratory results were within acceptable range using the tube test between both surveys; the rates were 77.8% (33/45) and 87.8% (36/41) for Tube-RT including Tube-IS (P=0.110) and 78.6% (11/14) and 92.0% (23/25) for Tube-AHG (P=0.329).Abbreviations: IS, procedures with immediate spin; RT, procedures with room temperature incubation; 37℃, procedures with 37℃ incubation; AHG, procedures with indirect antihuman globulin test; CAT, column agglutination test; DTT-37℃, procedure with 37℃ incubationin dithiothreitol treated sample; DTT-AHG, procedures with indirect antihuman globulin test in dithiothreitol treated sample.

• 

  Fig. 2 Number of laboratories with distribution of the anti-B titer as per method and survey results, in blood group O. There were no significant differences in the rate at which laboratory results were within acceptable range using the tube test between both surveys; the rates were 88.9% (40/45) and 78.0% (32/41) for Tube-RT including Tube-IS (P=0.244) and 85.7% (12/14) and 88.0% (22/25) for Tube-AHG (P=1.000). Number of laboratories reading '1+' as the only end point; Asterisk (*), empty circle (°).Abbreviations: IS, procedures with immediate spin; RT, procedures with room temperature incubation; 37℃, procedures with 37℃ incubation; AHG, procedures with indirect antihuman globulin test; CAT, column agglutination test; DTT-37℃, procedure with 37℃ incubationin dithiothreitol treated sample; DTT-AHG, procedures with indirect antihuman globulin test in dithiothreitol treated sample.

• 

  Fig. 3 Number of laboratories with distribution of the anti-B titer as per method in the second survey, in blood group A. Number of laboratories reading '1+' as the only end point; Asterisk (*), empty circle (°).Abbreviations: IS, procedures with immediate spin; RT, procedures with room temperature incubation; 37℃, procedures with 37℃ incubation; AHG, procedures with indirect antihuman globulin test; CAT, column agglutination test; DTT-37℃, procedure with 37℃ incubationin dithiothreitol treated sample; DTT-AHG, procedures with indirect antihuman globulin test in dithiothreitol treated sample.

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