Predicting the clinical significance of red cell alloantibodies using a monocyte monolayer assay

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Abstract
Few data have been published that correlate in vitro monocyte monolayer assays (MMA) and red cell (RBC) survival in patients with alloantibodies of unknown significance. Over the past 6 years we gathered clinical correlations in 12 patients with the following antibodies: anti-Lan (three patients), -Ge (three patients), -Yta (five patients), and -Ytb (one patient). RBC survival was estimated using 51Cr studies in seven patients and follow-up of transfusion of incompatible blood in the other five. Six patients with no evidence of RBC destruction had negative MMA findings (anti-Lan [one patient], -Ge [two patients], and -Yta [three patients]). Five patients with evidence of in vivo RBC destruction had significant MMA results. The two clinically significant anti-Lans required fresh serum to give a meaningful MMA result. One patient (anti-Ytb) had an MMA result of borderline significance .sbd. normal 51Cr RBC survival at 1 hour - but a reduced T50Cr. The MMA we used appeared to predict the clinical outcome of transfusion in every patient with antibodies to high-frequency antigens whom we tested.