Eluted blood group antigens: A diagnostic challenge in red cell antibody identification - A case series.

Authors

Sampreeta Pradhan, Shamee Shastry, Ganesh Mohan, Deepika Chenna, Deep Madkaiker

Published in

Transfusion and apheresis science : official journal of the World Apheresis Association : official journal of the European Society for Haemapheresis. Volume 65. Issue 4. Pages 104473. Jun 19, 2026. Epub Jun 19, 2026.

Abstract

Accurate red cell antibody identification is central to immunohematology, yet reagent red cell variability can compromise test reliability. Factors such as manufacturing differences, reagent composition, and cold-chain instability may alter assay sensitivity and obscure result interpretation. This study, for the first time, reports elution of Lewis antigens from reagent red cell panels, highlighting its role in antibody identification errors and diagnostic ambiguity.
Over one year, five cases with inconclusive antibody identification due to reagent variability were analyzed. Comprehensive immunohematology workup was performed using commercially available panels. Root cause analysis, including Ishikawa chart evaluation, examined patient, technical, external, and reagent-related factors. Retesting was done with panels from an alternate manufacturer, and papain-treated reagent cells were assessed for antigenic alterations.
Panels from Manufacturer 1 yielded atypical, non-specific reactions. Retesting with Manufacturer 2's panels identified anti-Leᵃ and/or anti-Leᵇ antibodies in all cases. Phenotyping showed absence of Leᵃ and Leᵇ antigens on reagent cells 4-6, contrary to their antigram, leading to false-negative reactions. Papain treatment did not affect reactivity, confirming Lewis antigen loss as the root cause of misidentification.
Lewis antigen expression on reagent red cells should be routinely verified, as these plasma-derived antigens may dissociate under variable conditions. Incorporating this check into quality control protocols can enhance assay reliability, reduce diagnostic errors, and improve turnaround time.

PMID:
42330569
Bibliographic data and abstract were imported from PubMed on 23 Jun 2026.

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