Pretransfusion red blood cell immunology testing; the present and the future

Abstract

Over 100 years ago, shortly after the discovery of the ABO blood groups (Landsteiner, 1901) serological testing of blood compatibility between recipient and donor were introduced to the regular practice. The scope of pretransfusion testing expanded after the discovery of further blood groups. Apart from ABO and RhD conformity between recipient and blood donor a significant part of compatibility testing is the search for clinically relevant alloantibodies in recipient plasma and determination of their specificity if the patient is to receive relevant antigen negative blood. These studies are performed using a panel of human red blood cells specially selected for this purpose. The knowledge of the molecular basis of all DNA polymorphisms underlying the differentiation of red blood cell antigen allows to predict the blood group phenotype on the basis of DNA testing. This knowledge may also be used in the production of recombinant proteins of blood group antigens. In the cell cultures of prokaryotic and eukaryotic organisms multiple group antigens with protein structure have been obtained. In the future they could be used as reagents for tests based on the inhibition of the activity of antibodies to solid phase assays such as ELISA techniques, or protein-based microchips. Promising results have also been obtained using the recombinant proteins to identify antibodies against high frequency antigens. The increasing technological capabilities will allow in the future use of a single recombinant proteins of blood for a single step and direct identification of antibodies, the introduction of a test based on the technique of “one antigen per well”. Such procedure would simplify and accelerate the determination of alloantibody specificity which at the moment is quite a time-consuming process. This would shorten the time for compatibility testing in the recipient in whom alloantibodies were found.