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1 Blood Grouping Reagent Anti-D (Anti-Rh o ) (Human Monoclonal-Polyclonal Blend) BioClone For Rapid Tube, Slide and Microplate Tests Qualitative Test for Recognition of the D(Rh o ) Antigen on Human Red Blood Cells Revised October Rx ONLY SUMMARY AND EXPLANATION The D(Rh o ) antigen was first recognized in 1939 and subsequently found to be present on the erythrocytes of approximately 85% of the Caucasian population. Human red blood cells are classified as Rh positive or Rh negative depending on the presence or absence of the D antigen. Accordingly, Anti-D reagent is used for routine Rh determination. Agglutination of the red blood cells with Anti-D reagent is a positive test result, which indicates the presence of the D antigen on the red blood cells. Absence of agglutination is a negative test result, which indicates the D antigen is not demonstrable. Red blood cells of donors that appear to be Rh negative by direct test methods must be further tested by performing the indirect antiglobulin weak D (D u ) test procedure. Testing of transfusion candidates for weak D (D u ) is at the discretion of the laboratory. PRINCIPLE OF PROCEDURE The procedures used with this reagent are based on the principle of agglutination. Normal human red blood cells, possessing antigens, will agglutinate in the presence of antibody directed toward the antigens. REAGENT Blood Grouping Reagent Anti-D (Anti-Rh o ) (Monoclonal-Polyclonal Blend) BioClone for Rapid Tube, Slide and Microplate Tests, as supplied by Ortho-Clinical Diagnostics, Inc., is a low-protein reagent prepared from human monoclonal IgM anti-d and human serum containing IgG anti-d. The monoclonal portion of this reagent may be prepared from a cell line produced by other licensed manufacturers. The monoclonal IgM anti-d (clone MAD2) causes direct agglutination of D positive red blood cells and in addition may, on occasion, cause direct agglutination of cells previously identified as weak D (D u ) positive. The IgG anti-d will detect weak D (D u ) positive and partial D red blood cells by the indirect antiglobulin weak D (D u ) test. This reagent contains sodium azide 0.1% as a preservative, sodium phosphate, sodium chloride and 6% to 8% bovine albumin with sodium caprylate as a stabilizer. Use as furnished. FOR IN VITRO DIAGNOSTIC USE WARNING: Contains sodium azide. Sodium azide may react with lead and copper plumbing to form highly explosive metal azide. On disposal, flush with a large volume of water to prevent azide buildup. This reagent does not contain potentiators which cause spontaneous agglutination of immunoglobulin-coated red cells beyond that seen with normal human serum. MEETS FDA POTENCY REQUIREMENTS. Do not use beyond expiration date. Store at 2 to 8 C. May be at room temperature (15 to 30 C) while in use. Replace cap when not in use. CAUTION: All blood products should be treated as potentially infectious. Source material from which this product was derived was found negative when tested in accordance with current FDA required tests. No known test methods can offer assurance that products derived from human blood will not transmit infectious agents. Do not pipette this reagent by mouth, as the absence of all viral antigens has not been determined for the monoclonal portion. The pipette bulbs used in the packaging of this product contain dry natural rubber. CONTROLS Turbidity due to the presence of soluble lipoproteins may occur. During the manufacturing process, a small amount of lipoproteins may remain in the product and become visible over time. These lipoproteins do not affect product performance. Efforts should be made to prevent contamination of the product. Turbidity may indicate microbial contamination. Quality control testing is required to confirm reactivity of the product prior to use. Positive control red blood cells known to possess the D antigen, preferably of phenotype R 1. Negative control red blood cells known to lack the D antigen. The routine use of an Rh control with this reagent is not required because false positive results with immunoglobulincoated red blood cells are rarely seen with low-protein reagents. When observed they usually indicate spontaneous red blood cell aggregation caused by the presence of immunoglobulin on the red blood cell surface. In such cases, O R T H O 1

2 similar phenomena would be likely to occur in the ABO grouping tests. When the cells under test are found reactive with Anti-A, Anti-B and Anti-D and the DAT is positive, the use of an additional control may be desired. A 6% to 8% solution of bovine albumin in isotonic saline may be used. If the control test gives a positive reaction, a valid interpretation of the results obtained in red blood cell testing cannot be made. NOTE: ORTHO Rh-hr Control is not an appropriate control for this reagent. SPECIMEN COLLECTION AND PREPARATION No special preparation of the patient is required prior to specimen collection. Blood should be collected by approved techniques. The sample should be tested as soon as possible following collection. If a delay in testing occurs, the sample should be stored at 2 to 8 C. Blood drawn into heparin or oxalate should be tested within two days. Clotted specimens or blood drawn into sodium citrate or EDTA should be tested within 14 days. Donor blood may be tested up to date of expiration. Blood obtained by finger puncture may be tested directly by the slide method but, to avoid clotting, blood collected in this manner should be mixed quickly with the reagent. PROCEDURE Material Provided Blood Grouping Reagent Anti-D (Anti-Rh o ) (Monoclonal-Polyclonal Blend) BioClone for Rapid Tube, Slide and Microplate Tests Required Supplementary Materials Microplate Method 1. Rigid U-bottom microplates 2. Laboratory centrifuge adaptable to microplate carriers 3. Centrifuge microplate carriers 4. Microplate shaker (optional) 5. Microplate test reading mirror (optional) 6. Transfer pipettes 7. Isotonic saline, % sodium chloride Tube Method 1. Test tubes, 10 x 75 mm or 12 x 75 mm 2. Transfer pipettes 3. Applicator sticks 4. Centrifuge 5. Isotonic saline, % sodium chloride Slide Method 1. Glass slides 2. Transfer pipettes 3. Applicator sticks 4. Rh viewbox, 40 to 50 C surface temperature 1. Test tubes, 10 x 75 mm or 12 x 75 mm 2. Transfer pipettes 3. Centrifuge 4. Incubator, 37 C 5. Isotonic saline, % sodium chloride 6. Anti-human globulin containing anti-igg (such as Anti-Human Globulin [Rabbit and Murine Monoclonal] BioClone Anti-IgG, -C3d; polyspecific or ORTHO Anti-IgG) 7. Antiglobulin control cells (such as ORTHO Coombs Control) Directions for Use Microplate Method New, unused plastic microplates should be used for each assay. 1. Prepare a 3% to 5% suspension of red blood cells in isotonic saline. 2. Add one drop of Anti-D BioClone to each test well. 3. Using a transfer pipette, add one drop of the cell suspension to the appropriate test well. 4. Mix the contents of each well thoroughly by manually tapping the plate or by using a microplate shaker.* 5. Centrifuge the plate. 6. Position plate for reading. (See Reading Methods and Interpretation.) 7. Read and record test results. 8. If no agglutination is observed and if a weak D (D u ) determination is desired, proceed to the Indirect Antiglobulin Weak D (D u ) Test Method. * Suggested times for mechanical shaker: (1) mixing seconds on a medium agitation setting; (2) resuspension seconds on a medium setting or at a time and speed that allows complete resuspension of the entire cell button without destroying positive reactions. Suggested centrifugation time: 1 2 minutes at approximately 70 rcf or a time appropriate for the centrifuge used that produces the strongest reaction of antibody with antigen positive red blood cells, yet allows easy resuspension of antigen negative cells. 2

3 Microplate Reading Methods and Interpretation Reactions should be read from underneath the plate so that the bottom of the wells can be viewed. A special reading mirror which enlarges and illuminates the entire bottom of the plate is available or an optical aid such as a hand lens may be used to view each well separately. In the gentle agitation method, a positive reaction is indicated by the presence of agglutination, whereas a negative reaction will appear as a smooth cell suspension in the microwell. In the tilt and stream method the plate is tilted at a 60 to 90 angle to the bench top for 2 to 4 minutes and then examined from the bottom so that the dispersion pattern of the cell button can be viewed. If the reaction is negative, the button will flow as a uniform stream down the side of the well. A positive reaction usually remains at the bottom of the well as an intact button; however, the intact button may occasionally slide down the side of a well. Doubtful results may be confirmed by gently resuspending the cells by hand or with an appropriate device, while observing the reaction mixture to detect weak agglutination. Tube Method 1. Prepare a 3% to 5% suspension of red blood cells in isotonic saline or in their own serum or plasma. 2. To a test tube, add one drop of Anti-D BioClone. 3. Using a transfer pipette, add one drop of the cell suspension to the test tube. If preferred, an equivalent quantity of cells may be transferred from a whole blood sample with an applicator stick. 4. Mix well and centrifuge. The test may be centrifuged immediately or allowed to stand at room temperature (15 to 30 C) for up to 15 minutes before centrifugation. Suggested centrifugation: approximately seconds at 3400 rpm ( rcf) or 1 minute at 1000 rpm ( rcf). 5. Resuspend the cells by gentle agitation and examine macroscopically for agglutination. 6. If no agglutination is observed and if a weak D (D u ) determination is desired, proceed to Step 4 of the Indirect Antiglobulin Weak D (D u ) Test Method. Slide Method 1. Use whole blood. 2. On a prewarmed glass slide (40 to 50 C surface temperature) place one drop of Anti-D BioClone. 3. Using a transfer pipette, add two drops of whole blood to the slide. If preferred, an equivalent quantity of cells may be transferred from a whole blood sample with an applicator stick. 4. With an applicator stick, mix the cell/serum mixture well. 5. Tilt the slide back and forth and observe for agglutination. Tests that show no agglutination within 2 minutes are considered negative. Do not interpret peripheral drying or fibrin strands as agglutination. 6. If no agglutination is observed and if a weak D (D u ) determination is desired, proceed to the Indirect Antiglobulin Weak D (D u ) Test Method. 1. Prepare a 3% to 5% suspension of red blood cells in isotonic saline or in their own serum or plasma. 2. To a test tube, add one drop of Anti-D BioClone. 3. Using a transfer pipette, add one drop of the cell suspension to the test tube. If preferred, an equivalent quantity of cells may be transferred from a whole blood sample with an applicator stick. Mix well. 4. Incubate the test at 37 C ± 1 C for a minimum of 15 minutes and a maximum of 60 minutes. 5. After incubation, wash the cells three times with tubes full of isotonic saline. Decant completely after the last washing. 6. Add two drops of anti-human globulin containing anti-igg. 7. Mix the contents of the tube gently and centrifuge. (See Step 4 of Tube Method for suggested centrifugation.) 8. Resuspend the cells by gentle agitation and examine macroscopically for agglutination. CAUTION: Positive test results are valid only if it can be shown that the red cells exhibit a negative direct antiglobulin test. A negative test result requires no further confirmation. (See limitation #7.) 9. To control negative tests, add red blood cells sensitized with IgG antibody, e.g., ORTHO Coombs Control (see package insert for procedure). RESULTS Interpretation Tube, Slide and Microplate Methods 1. Agglutination of the red blood cells is a positive test result and indicates the presence of the D antigen. 2. No agglutination of the red blood cells is a negative test result and indicates the D antigen is not demonstrable. Red blood cells that appear to be Rh negative by this test method may be further tested for weak D (D u ) antigen, if desired. 1. When agglutination appears in the antiglobulin phase, the red blood cells are weak D (D u ), providing they do not give a positive direct antiglobulin test. CAUTION: Mixed-field agglutination in the indirect antiglobulin weak D (D u ) test on a woman recently delivered may indicate an admixture of maternal Rh negative and fetal Rh positive blood. 2. If there is no agglutination, the red blood cells should be classified as Rh negative. 3

4 Stability of Final Reaction Mixture Microplate Method All results should be interpreted immediately following centrifugation and resuspension. Tube Method All results should be interpreted immediately following centrifugation and resuspension. Slide Method All results must be interpreted within 2 minutes. All results should be interpreted immediately following centrifugation and resuspension. LIMITATIONS OF PROCEDURE 1. Red blood cells demonstrating a positive direct antiglobulin test cannot be accurately tested for weak D (D u ) antigen. 2. Aged red blood cells may yield weaker reactions than those obtained with fresh red cells. 3. Contaminated blood specimens and/or supplementary materials used in the procedures described may interfere with the test results. 4. Cord cells heavily sensitized with anti-d may demonstrate a false-negative immediate spin test result. 5. Ratios of whole blood to anticoagulant less than that recommended may cause weaker than expected results. 6. Reactions with red blood cells exhibiting weakened expressions of the D antigen may show varied reactivity as compared to those obtained with other Anti-D reagents. 7. Red blood cells coated with alloantibodies or autoantibodies of the same or similar specificity as the reagent (i.e., cells that are DAT positive) may give weak reactions. This is due to decreased availability of antigen sites because of antigen blocking or steric hindrance. In extreme cases, false-negative results may occur. 8. When using test methods other than those described in this package insert, laboratories must follow their institution s approved validation procedures to demonstrate the compatibility of these products with predicate methods. 9. No one speed and time of centrifugation can be recommended which will cover the wide variety of centrifuges available; each laboratory must calibrate its own equipment and determine the time required at a given speed to achieve the desired result. SPECIFIC PERFORMANCE CHARACTERISTICS When properly stored and used according to the procedures described under Directions for Use, this reagent will agglutinate red cells which have the D antigen. The potency of this reagent meets FDA requirements. The reactivity of each lot is demonstrated in tests with the recommended procedure using heterozygous and homozygous cells from several donors. Each lot is tested by the recommended tube method with Bg(a+) cells from at least three donors. The specificity of each lot is shown by the recommended tube method using a panel of cells which lack the antigen against which the reagent is directed but contain as many other antigens having a frequency of 1% or greater as possible. Antibodies to Le c, Le d, C w, Yt b, Co b, Mg and Wr a are not excluded in routine specificity tests. However, tests for these antibodies are performed if test cells containing the corresponding antigen become available. Specificity test results submitted to the FDA for release of an individual lot of product will be furnished upon request. Additional information regarding the cell line used in this product or other technical questions concerning this reagent may be obtained by contacting Customer Technical Support at The centrifugal force applied to cell/serum mixtures should be the minimum required to produce a button of red blood cells and a clear supernate. Overcentrifugation, i.e., the application of forces in excess of the minimum, causes the cells to adhere to the bottom of the test tube or microplate well so that vigorous agitation is necessary before they can be resuspended. During such agitation, weak agglutination may be dispersed causing a positive reaction to be missed. Undercentrifugation, i.e., the failure to apply forces necessary to cause the cells to form a button and a clear supernate, may result in a weak or negative reaction. No one speed and time of centrifugation can be recommended which will cover the wide variety of centrifuges available; each laboratory must calibrate its own equipment and determine the time required at a given speed to achieve the desired result. SUMMARY OF REVISIONS Section Front Page Back Page Revision Added Rx ONLY. Updated corporate logo. 4

5 BIBLIOGRAPHY Race RR, Sanger R. Blood groups in man, 6th ed. Oxford: Blackwell Scientific Publications, 1975:178. Stroup M. Advances in blood group antigens & antibodies: complexities of the Rh o (D) antigen. Raritan, NJ: Ortho Diagnostic Systems, Thompson KM, Melamed MD, Eagle K et al. Production of human monoclonal IgG and IgM antibodies with anti-d (rhesus) specificity using heterohybridomas. Immunology 1986;58: Tracy M. Impact of new technologies on Rh typing. Raritan, NJ: Ortho Diagnostic Systems Inc., Technical Manual. 15th ed. Bethesda, MD: American Association of Blood Banks,

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