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Bài 1 Phân tích Coombs test – Phan Trúc
นอกจากการดูบทความนี้แล้ว คุณยังสามารถดูข้อมูลที่เป็นประโยชน์อื่นๆ อีกมากมายที่เราให้ไว้ที่นี่: ดูเพิ่มเติม
Đây là bài mở đầu của chuỗi bài giảng về chủ đề Ngân hàng máu, được thực hiện bởi nhóm Diễn đàn bác sĩ trẻ Việt Nam (VYPO Vietnam Young Physician Organization). Mọi người nhớ theo dõi page để cập nhật nhiều khoá học bổ ích và hoàn toàn miễn phí nhé.
Group: https://www.facebook.com/groups/diendanbacsitrevietnam
Facebook cá nhân: https://www.facebook.com/drtrucphan
Website: https://vypo.ykhoa.org
Kỹ thuật làm Coombs gián tiếp
The Antiglobulin Tests
Developed and produced for http://www.MechanismsInHematology.com by Mechanisms in Medicine Inc.
Animation description: The Antiglobulin Tests (also known as Coombs test). The direct antiglobulin test (DAT) is requested when immunemediated hemolytic anemia is suspected. A blood sample must be drawn.
The patient’s red blood cells may have antibodies (and other complement system factors) on the surface of some of the red blood cells (abbreviated as RBCs in this animation).
The blood sample is washed to remove the patient’s plasma while leaving the red blood cells intact with their attached antibodies.
These red blood cells are incubated with antihuman globulin containing both antiIgG and
anticomplement.
The antihuman globulin binds to the patient’s antibody, coating the red blood cells, resulting in agglutination.
A positive DAT indicates that the red cells have been coated in vivo with immunoglobulin or complement and may suggest the presence of an
immunemediated hemolytic process. The DAT is used in the investigation of transfusion reactions, autoimmune hemolytic anemia, hemolytic disease of the newborn and druginduced hemolysis. Rarely the DAT may be positive in a normal individual.
To detect whether human antired blood cell antibodies are present in the plasma of a patient, an indirect antiglobulin test (IAT) is used.
Unlike the DAT which relies on the red blood cells in the sample, the IAT only deals with the extracted plasma.
Unbound human antired blood cell antibodies remain in the plasma.
The plasma is then incubated with reagent red blood cells selected to detect specific antibodies that are considered clinically significant.
The antired blood cell antibodies of the patient’s plasma bind to reagent red blood cells to form antigenantibody complexes.
The addition of antihuman globulin to these complexes results in agglutination of the red blood cells. A positive IAT indicates the presence of a red cell antibody in the patient.
Direct Coombs Test
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Coombs Test Made Simple
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A Coombs test (also known as Coombs’ test, antiglobulin test or AGT) is either of two clinical blood tests used in immunohematology and immunology. The two Coombs tests are the direct Coombs test (DCT, also known as direct antiglobulin test or DAT), and the indirect Coombs test (also known as indirect antiglobulin test or IAT).
The direct Coombs test is used to test for autoimmune hemolytic anemia; i.e., a condition of a low count of red blood cells (aka RBCs) caused by immune system lysis or breaking of RBC membranes causing RBC destruction.
In certain diseases or conditions, an individual’s blood may contain IgG antibodies that can specifically bind to antigens on the RBC surface membrane, and their circulating RBCs can become coated with IgG alloantibodies and/or IgG autoantibodies. Complement proteins may subsequently bind to the bound antibodies and cause RBC destruction.[1] The direct Coombs test is used to detect these antibodies or complement proteins that are bound to the surface of red blood cells; a blood sample is taken and the RBCs are washed (removing the patient’s own plasma) and then incubated with antihuman globulin (also known as \”Coombs reagent\”). If this produces agglutination of RBCs, the direct Coombs test is positive, a visual indication that antibodies (and/or complement proteins) are bound to the surface of red blood cells.
The indirect Coombs test is used in prenatal testing of pregnant women and in testing blood prior to a blood transfusion. It detects antibodies against RBCs that are present unbound in the patient’s serum. In this case, serum is extracted from the blood sample taken from the patient. Then, the serum is incubated with RBCs of known antigenicity; that is, RBCs with known reference values from other patient blood samples. If agglutination occurs, the indirect Coombs test is positive.[2]The two Coombs tests are based on the fact that antihuman antibodies, which are produced by immunizing nonhuman species with human serum, will bind to human antibodies, commonly IgG or IgM. Animal antihuman antibodies will also bind to human antibodies that may be fixed onto antigens on the surface of red blood cells (also referred to as RBCs), and in the appropriate test tube conditions this can lead to agglutination of RBCs. The phenomenon of agglutination of RBCs is important here, because the resulting clumping of RBCs can be visualised; when clumping is seen the test is positive and when clumping is not seen the test is negative.
Common clinical uses of the Coombs test include the preparation of blood for transfusion in crossmatching, screening for atypical antibodies in the blood plasma of pregnant women as part of antenatal care, and detection of antibodies for the diagnosis of immunemediated haemolytic anemias.
Examples of alloimmune hemolysis[edit]Hemolytic disease of the newborn (also known as HDN or erythroblastosis fetalis)
Rh D hemolytic disease of the newborn (also known as Rh disease)
ABO hemolytic disease of the newborn (the indirect Coombs test may only be weakly positive)
AntiKell hemolytic disease of the newborn
Rh c hemolytic disease of the newborn
Rh E hemolytic disease of the newborn
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