PMID- 33047855
OWN - NLM
STAT- MEDLINE
DCOM- 20210628
LR  - 20210628
IS  - 1537-2995 (Electronic)
IS  - 0041-1132 (Linking)
VI  - 60
IP  - 12
DP  - 2020 Dec
TI  - False-negative solid-phase platelet crossmatch results due to prozone phenomenon.
PG  - 3055-3059
LID - 10.1111/trf.16132 [doi]
AB  - Prozone is a known phenomenon affecting immunoassays causing falsely low or 
      negative results when excess target is present in the test system. For assays 
      used to evaluate immune-mediated platelet (PLT) transfusion refractoriness, 
      prozone-like phenomenon has been described in solid-phase human leukocyte antigen 
      (HLA) antibody testing and can be mitigated by diluting samples or pretreating 
      samples with ethylenediaminetetraacetic acid (EDTA) or dithiothreitol. Prozone 
      phenomenon has not yet been described in solid-phase red blood cell (RBC) 
      adherence PLT crossmatch assays. CASE REPORT: A 40-year-old female with myeloid 
      sarcoma and PLT transfusion refractoriness underwent repeated solid-phase PLT 
      crossmatches; however, crossmatch-compatible PLTs units did not yield adequate 
      PLT count responses. Class I HLA antibody testing with neat, diluted, and 
      EDTA-pretreated serum demonstrated significant prozone-like effect and the 
      presence of numerous high strength HLA antibodies. Based on this HLA antibody 
      profile, HLA antigen-negative PLTs gave an adequate PLT count response. It was 
      noted that the HLA types of her crossmatch-compatible PLTs were incompatible with 
      her HLA antibody profile (eg, HLA-A2). With ABO-identical, HLA-A2-positive PLT 
      units, a solid-phase PLT crossmatch was repeated using undiluted and diluted EDTA 
      plasma. Undiluted EDTA plasma demonstrated negative or weakly positive PLT 
      crossmatches while the diluted EDTA plasma demonstrated strongly positive PLT 
      crossmatches. CONCLUSION: The prozone phenomenon can cause false-negative results 
      in solid-phase RBC adherence PLT crossmatch assays, which can be mitigated with 
      sample dilution. In immune-mediated PLT transfusion-refractory patients with 
      high-strength HLA antibodies, sample dilution should be considered to correctly 
      identify compatible PLT inventory.
CI  - (c) 2020 AABB.
FAU - Horton, Rachel K
AU  - Horton RK
AD  - Division of Transfusion Medicine, Mayo Clinic, Rochester, Minnesota.
FAU - Zuccarelli, Micah D
AU  - Zuccarelli MD
AD  - Division of Transfusion Medicine, Mayo Clinic, Rochester, Minnesota.
FAU - Wakefield, Laurie L
AU  - Wakefield LL
AD  - Division of Transfusion Medicine, Mayo Clinic, Rochester, Minnesota.
FAU - DiGuardo, Margaret A
AU  - DiGuardo MA
AD  - Division of Transfusion Medicine, Mayo Clinic, Rochester, Minnesota.
FAU - Gandhi, Manish J
AU  - Gandhi MJ
AUID- ORCID: 0000-0001-7210-1909
AD  - Division of Transfusion Medicine, Mayo Clinic, Rochester, Minnesota.
FAU - Juskewitch, Justin E
AU  - Juskewitch JE
AUID- ORCID: 0000-0002-7868-2852
AD  - Division of Transfusion Medicine, Mayo Clinic, Rochester, Minnesota.
LA  - eng
PT  - Case Reports
DEP - 20201013
PL  - United States
TA  - Transfusion
JT  - Transfusion
JID - 0417360
RN  - 9G34HU7RV0 (Edetic Acid)
SB  - IM
MH  - Adult
MH  - *Blood Grouping and Crossmatching
MH  - Blood Platelets/*metabolism/pathology
MH  - Edetic Acid/pharmacology
MH  - Female
MH  - *Histocompatibility Testing
MH  - Humans
MH  - Platelet Count
MH  - Platelet Transfusion/*adverse effects
MH  - Sarcoma, Myeloid/*blood/therapy
EDAT- 2020/10/14 06:00
MHDA- 2021/06/29 06:00
CRDT- 2020/10/13 09:21
PHST- 2020/06/10 00:00 [received]
PHST- 2020/08/13 00:00 [revised]
PHST- 2020/08/25 00:00 [accepted]
PHST- 2020/10/14 06:00 [pubmed]
PHST- 2021/06/29 06:00 [medline]
PHST- 2020/10/13 09:21 [entrez]
AID - 10.1111/trf.16132 [doi]
PST - ppublish
SO  - Transfusion. 2020 Dec;60(12):3055-3059. doi: 10.1111/trf.16132. Epub 2020 Oct 13.