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Comparative study of two automated pre-transfusion testing systems (microplate and gel column methods) with standard tube technique
Takako Ono1, Hitoshi Ohto1, Hiroyasu Yasuda1, Rie Hikichi1, Kinuyo Kawabata1, Keiji Minakawa1, Satoshi Ono1, Masami Kikuchi1, Akiko Sugawara1, Shunnichi Saito1, Nozomi Takano1, Kenneth E. Nollet1
1Department of Blood Transfusion and Transplantation Immunology, Fukushima Medical University Hospital, Fukushima, Japan

Article ID: 100030IJBTITO2017
doi:10.5348/ijbti-2017-30-OA-3

Address correspondence to:
Hitoshi Ohto
MD, PhD, Department of Blood Transfusion and Transplantation Immunology
Fukushima Medical University Hospital, Hikariga-oka, Fukushima City
Fukushima 960-1295 Japan

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How to cite this article:
Ono T, Ohto H, Yasuda H, Hikichi R, Kawabata K, Minakawa K, Ono S, Kikuchi M, Sugawara A, Saito S, Takano N, Nollet KE. Comparative study of two automated pre-transfusion testing systems (microplate and gel column methods) with standard tube technique. Int J Blood Transfus Immunohematol 2017;7:15–25.


ABSTRACT
Aims: Clinically significant antibodies may become undetectable and still provoke transfusion reactions. Hemolysis has been reported among transfusion recipients with anti-Kidd that was undetectable by gel column but detectable by other methods.
Methods: We compared two automated technologies - microplate (MP) and gel column (GC) methods - with manual methods in ABO/RhD typing, irregular antibody screening, identification, titration, and detection threshold of mixed-field agglutination. Results: Automated systems agreed generally with tube results in 98% or more of ABO forward and RhD groupings, but showed weaker reactions in ABO reverse testing against A1 (K=0.88 with MP and K=0.77 with GC) and B cells (K=0.66 with MP and K=0.68 with GC) and failed to detect some anti-A (2 of 273 samples with MP) and anti-B (2 of 273 with MP and 1 of 272 with GC). MP missed 2 (anti-E and –Fyb) of 8 antibodies and GC missed 5 (2 anti-E and 1 each of -Fyb, -Jka and –Lea) of 10 antibodies, which manual PEG-IAT detected. Among 11 known alloantibodies, MP detected 7 antibodies at higher dilution than tube PEG-IAT, whereas GC showed lower scores in 7 samples than tube PEG-IAT and missed 2 clinically significant antibodies (anti-C and anti-Fyb).
Conclusion: Automated systems, comparable to manual tube technique for forward grouping of ABO and RhD, are less sensitive in ABO reverse testing. As GC more often failed to detect clinically significant antibodies of low-titer, users should be especially mindful of possible post-transfusion hemolysis.

Keywords: ABO grouping, Gel column method, Irregular antibody, Microplate method, Tube technique



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Author Contributions
Takako Ono – Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Hitoshi Ohto – Substantial contribution to conception and design, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Hiroyasu Yasuda – Substantial contribution to conception and design, Acquisition of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Rie Hikichi – Acquisition of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Kinuyo Kawabata – Substantial contribution to conception and design, Acquisition of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Keiji Minakawa – Acquisition of data, Drafting the article, revising it critically for important intellectual content, Final approval of the version to be published
Satoshi Ono – Acquisition of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Masami Kikuchi – Acquisition of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Akiko Sugawara – Acquisition of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Shunnichi Saito – Acquisition of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Nozomi Takano – Acquisition of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Kenneth E. Nollet – Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
Source of support
None
Conflict of interest
Authors declare no conflict of interest.
Copyright
© 2017 Takako Ono et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. PLease see the copyright policy on the journal website for more information.

About the Authors

Takako Ono served as a medical technologist in Fukushima Medical University’s Department of Blood Transfusion and Transplantation Immunology. She graduated from Fukushima Prefectural General Hygiene Institute. Her main research interests lie in hematology, and in laboratory techniques for transfusion and transplantation. She is now pursuing advanced training in the United States.
Email: takako.ono.medtech@gmail.com


Hitoshi Ohto MD, PhD, is General Vice President of Fukushima Medical University, Japan. He has published more than 500 research papers in Japanese and international academic journals and authored 100 books. In addition to transfusion medicine, his research interests include disaster- and raDiation-related issues.
Email: hit-ohto@fmu.ac.jp



Hiroyasu Yasuda graduated from Tohoku University and was the senior medical technologist in Fukushima Medical University’s Department of Blood Transfusion and Transplantation Immunology until shifting full-time into education at the Fukushima Prefectural General Hygiene Institute. His main research interests lie in immunohematology, and in laboratory techniques for transfusion and transplantation.
Email: hyasuda@fmu.ac.jp



Rie Hikichi graduated from Fukushima Prefectural General Hygiene Institute and is a medical technologist in the Department of Blood Transfusion and Transplantation Immunology at Fukushima Medical University in Fukushima, Japan. Her main research interests lie in hematology, and in laboratory techniques for transfusion and transplantation.



Kinuyo Kawabata graduated from Tohoku University and is a chief medical technologist in the Department of Blood Transfusion and Transplantation Immunology at Fukushima Medical University in Fukushima, Japan. Her main research interests lie in immunehematology, and in laboratory techniques for transfusion and transplantation.
Email: kawabata@fmu.ac.jp



Keiji Minakawa is a medical technologist in the Department of Blood Transfusion and Transplantation Immunology at Fukushima Medical University in Fukushima, Japan. He earned an undergraduate degree in health science from Tohoku University.
Email: m-keiji@fmu.ac.jp



Satoshi Ono is a medical technologist in the Department of Blood Transfusion and Transplantation Immunology, Fukushima Medical University Hospital, Fukushima, Japan.



Masami Kikuchi graduated from Fukushima Prefectural General Hygiene Institute and joined the Department of Blood Transfusion and Transplantation Immunology at Fukushima Medical University in Fukushima, Japan, as a medical technologist



Akiko Sugawara is a medical technologist in the Department of Blood Transfusion and Transplantation Immunology, and a research associate in the Center for Medical Education and Career Development at Fukushima Medical University, Fukushima, Japan. She received a PhD in Medicine from Fukushima Medical University. Her research interests include patient-provider communication, medical education, and transfusion medicine.



Shunnichi Saito graduated from Fukushima Prefectural General Hygiene Institute and served as a medical technologist in the Department of Blood Transfusion and Transplantation Immunology at Fukushima Medical University in Fukushima, Japan.



Nozomi Takano graduated from Fukushima Prefectural General Hygiene Institute and is a medical technologist in the Department of Blood Transfusion and Transplantation Immunology at Fukushima Medical University in Fukushima, Japan. Her main research interests lie in hematology, and in laboratory techniques for transfusion and transplantation.



Kenneth E. Nollet Professor, Department of Blood Transfusion and Transplantation Immunology, Fukushima Medical University Hospital, Fukushima, Japan.