Elution - Indikation, Ergebnisse und Fallbeispiele

Dr. Lisa Weidner, Blood Donation Center for Vienna, Lower Austria, and Burgenland, Austrian Red Cross In this presentation, Dr. Lisa Weidner explains the fundamentals of the direct antiglobulin test (DAT/Coombs test) and when elution is actually indicated in the case of a positive result. Using a practical algorithm—developed with inspiration from Swiss guidelines—she demonstrates how laboratories can systematically differentiate between alloantibodies and autoantibodies. Her own laboratory data confirm that clinically relevant alloantibodies are detectable in approximately one in 20–30 eluates, with anti-Kell and anti-E being particularly common. A complex case study of a 77-year-old patient with anti-Colton (a) and a delayed hemolytic transfusion reaction vividly illustrates the clinical relevance of a thorough immunohematological workup. Finally, the future, the introduction of the type-and-screen method, and the associated issue of overlooking antibodies against private antigens will be critically discussed in an expert dialogue. ... 0:00 Introduction & Fundamentals of the DAT (Direct Coombs Test) 1:00 Polyspecific & Monospecific DAT 2:00 Medical History in Cases of a Positive DAT 3:52 Causes: Medications, Stem Cell Transplantation, Passive Immunoglobulins 4:55 Influence of Sample Temperature on the DAT 5:48 DAT Frequency in Blood Donors 6:40 DAT Frequency in Hospitalized Patients 8:34 Elution: Methods & Principle 9:30 Elution Algorithm (ÖGBT Guidelines & Swiss Template) 10:43 Algorithm: Previous Transfusions More Than 14 Days Ago 11:44 Algorithm: Newborns 13:43 Further Applications of Elution 14:47 Case Study: Anti-G in ABO-MHN (Newborn) 15:59 Case Study: Passive Anti-D Administration (Pregnant Woman) 17:00 Own Data: Alloantibodies in Eluates 2018–2019 17:59 Current Data 2025/2026 & SHOT Report UK 2024 19:56 Causes of Negative Elution Results 20:57 Pros & Cons of the Elution Scheme 21:55 Case Study: Anti-Kolten A (77-year-old female patient) 23:48 Case Study: Delayed Hemolytic Transfusion Reaction (Anti-S) 25:43 Supply Problem: Rare Antibody Combinations 26:42 Discussion: International Comparison & Algorithm 27:40 Discussion: Future of Type and Screen 28:52 Discussion: Antibodies Against Private Antigens 29:43 Discussion: Practical Advice on Performing Elutions