Pre‐transfusion testing problems caused by anti‐lymphocyte globulin and their solution

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Abstract
Anti-lymphocyte globulin (ALG) is an antibody to human lymphocytes used to decrease T cells in renal transplant patients. Serologic problems in testing blood from patients treated with ALG were recently encountered. Thirty-nine patients undergoing acute kidney rejection developed positive direct and indirect antiglobulin tests following the administration of equine ALG. Sera from these patients reacted with all red cells (RBC) tested using both polyspecific and monospecific anti-IgG anti-human sera. Eluates prepared from the patients'' RBC showed similar reactivity. The ALG panagglutinin did not react by manual hexadimethrine bromide (Polybrene) technique. The ALG panagglutinin could be neutralized by anti-human globulin. These techniques were useful in distinguishing ALG panagglutinin from co-existing alloantibodies.