Coombs test (also known as Coombs' test, antiglobulin test or AGT) refers to 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; ie, 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] Mechanism

Schematic showing the direct and indirect Coombs tests. The two Coombs tests are based on the fact that anti-human antibodies, which are produced by immunizing non-human species with human serum, will bind to human antibodies, commonly IgG or IgM. Animal anti-human 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 cross-matching, screening for atypical antibodies in the blood plasma of pregnant women as part of antenatal care, and detection of antibodies for the diagnosis of immune-mediated haemolytic anemias. Coombs tests are done on serum from venous blood samples which are taken from patients by venepuncture. The venous blood is taken to a laboratory (or blood bank), where trained scientific technical staff do the Coombs tests. The clinical significance of the result is assessed by the physician who requested the Coombs test, perhaps with assistance from a laboratory-based hematologist. [edit] Direct Coombs test The direct Coombs test (also known as the direct antiglobulin test or DAT) is used to detect if antibodies or complement system factors have bound to RBC surface antigens in vivo. The DAT is not currently required for pre-transfusion testing but may be included by some laboratories. [edit] Examples of diseases that give a positive direct Coombs test The direct Coombs test is used clinically when immune-mediated hemolytic anemia (antibody-mediated destruction of RBCs) is suspected. A positive Coombs test indicates that an immune mechanism is attacking the patient's own RBC's. This mechanism could be autoimmunity, alloimmunity or a drug-induced immune-mediated mechanism. [edit] Examples of alloimmune hemolysis Hemolytic disease of the newborn (also known as HDN or erythroblastosis fetalis) o Rh D hemolytic disease of the newborn (also known as Rh disease)

o ABO hemolytic disease of the newborn (the indirect Coombs test may only be weakly positive) o Anti-Kell hemolytic disease of the newborn o Rh c hemolytic disease of the newborn o Rh E hemolytic disease of the newborn o Other blood group incompatibility (RhC, Rhe, Kidd, Duffy, MN, P and others) Alloimmune hemolytic transfusion reactions

[edit] Examples of autoimmune hemolysis/immunohemolytic hemolysis Warm antibody autoimmune hemolytic anemia o Idiopathic o Systemic lupus erythematosus o Evans' syndrome (antiplatelet antibodies and hemolytic antibodies) Cold antibody immunohemolytic anemia o Idiopathic cold hemagglutinin syndrome o Infectious mononucleosis o Paroxysmal cold hemoglobinuria (rare)

[edit] Drug-induced immune-mediated hemolysis Methyldopa (IgG mediated type II hypersensitivity) Penicillin (high dose) Quinidine (IgM mediated activation of classical complement pathway and Membrane attack complex, MAC)

(A memory device to remember that the DAT tests the RBCs and is used to test infants for haemolytic disease of the newborn is: Rh Disease; R = RBCs, D = DAT.) [edit] Laboratory method The patient's red blood cells (RBCs) are washed (removing the patient's own serum) and then incubated with antihuman globulin (also known as Coombs reagent). If immunoglobulin or complement factors have been fixed on to the RBC surface in-vivo, the antihuman globulin will agglutinate the RBCs and the direct Coombs test will be positive. (A visual representation of a positive direct Coombs test is shown in the upper half of the schematic). [edit] Indirect Coombs test The indirect Coombs test (also known as the indirect antiglobulin test or IAT) is used to detect in-vitro antibody-antigen reactions. It is used to detect very low concentrations of antibodies present in a patient's plasma/serum prior to a blood transfusion. In antenatal care, the IAT is used to screen pregnant women for antibodies that may cause hemolytic disease of the newborn. The IAT can also be used for compatibility testing, antibody identification, RBC phenotyping, and titration studies. [edit] Examples of clinical uses of the indirect Coombs test [edit] Blood transfusion preparation Main articles: blood transfusion and cross-matching The indirect Coombs test is used to screen for antibodies in the preparation of blood for blood transfusion. The donor's and recipient's blood must be ABO and Rh D compatible. Donor blood for transfusion is also screened for infections in separate processes. Antibody screening

A blood sample from the recipient and a blood sample from every unit of donor blood are screened for antibodies with the indirect Coombs test. Each sample is incubated against a wide range of RBCs that together exhibit a full range of surface antigens (i.e. blood types).

Cross matching

The indirect Coombs test is used to test a sample of the recipient's serum against a sample of the blood donor's RBCs. This is sometimes called cross-matching blood. [edit] Antenatal antibody screening The indirect Coombs test is used to screen pregnant women for IgG antibodies that are likely to pass through the placenta into the fetal blood and cause haemolytic disease of the newborn. [edit] Laboratory method The IAT is a two-stage test. (A cross match is shown visually in the lower half of the schematic as an example of an indirect Coombs test). [edit] First stage Washed test red blood cells (RBCs) are incubated with a test serum. If the serum contains antibodies to antigens on the RBC surface, the antibodies will bind onto the surface of the RBCs. [edit] Second stage The RBCs are washed three or four times with isotonic saline and then incubated with antihuman globulin. If antibodies have bound to RBC surface antigens in the first stage, RBCs will agglutinate when incubated with the antihuman globulin (also known Coombs reagent) in this stage, and the indirect Coombs test will be positive. [edit] Titrations By diluting a serum containing antibodies the quantity of the antibody in the serum can be gauged. This is done by using doubling dilutions of the serum and finding the maximum dilution of test serum that is able to produce agglutination of relevant RBCs. [edit] Coombs reagent Coombs reagent (also known as Coombs antiglobulin or antihuman globulin) is used in both the direct Coombs test and the indirect Coombs test. Coombs reagent is antihuman globulin. It is made by injecting human globulin into animals, which produce polyclonal antibodies specific for human immunoglobulins and human complement system factors. More specific Coombs reagents or monoclonal antibodies can be used. [edit] Enhancement media Both IgM and IgG antibodies bind strongly with their antigens. IgG antibodies are most reactive at 37C. IgM antibodies are easily detected in saline at room temperature as IgM antibodies are able to bridge between RBCs owing to their large size, efficiently creating what is seen as agglutination. IgG antibodies are smaller and require assistance to bridge well enough to form a visual agglutination reaction. Reagents used to enhance IgG detection are referred to as potentiators. RBCs have a net negative charge called zeta potential which causes them to have a natural repulsion for one another. Potentiators reduce the zeta potential of RBC membranes. Common potentiators include low ionic strength solution (LISS), albumin, polyethylene glycol (PEG), and proteolytic enzymes. [edit] History of the Coombs test The Coombs test was first described in 1945 by Cambridge immunologists Robin Coombs (after whom it is named), Arthur Mourant and Rob Race.[3] Historically, it was done in test tubes. Today, it is commonly done using microarray and gel technology.

Coombs test (juga dikenal sebagai, uji antiglobulin Coombs 'test atau AGT) mengacu pada dua klinis blood tests used in immunohematology and immunology . tes darah yang digunakan dalam immunohematology dan imunologi . 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 ). Kedua tes Coombs adalah tes Coombs langsung (DCT, juga dikenal sebagai tes antiglobulin langsung atau DAT), dan tes Coombs tidak langsung (juga dikenal sebagai tes antiglobulin langsung atau IAT). The Direct Coombs test is used to test for autoimmune hemolytic anemia ; ie, 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. Tes Coombs langsung digunakan untuk menguji autoimun anemia hemolitik , yaitu, suatu kondisi jumlah rendah sel darah merah (sel darah merah alias) yang disebabkan oleh lisis sistem kekebalan tubuh atau melanggar membran RBC menyebabkan kerusakan RBC. 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. Dalam penyakit tertentu atau kondisi darah individu mungkin berisi antibodi IgG yang secara khusus dapat mengikat antigen pada permukaan membran RBC, dan sel darah merah yang bersirkulasi dapat menjadi dilapisi dengan alloantibodies IgG dan / atau autoantibodi IgG. 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"). Protein komplemen selanjutnya dapat berikatan dengan antibodi terikat dan menyebabkan kerusakan sel darah merah. [1] Tes Coombs langsung digunakan untuk mendeteksi antibodi atau protein komplemen yang terikat pada permukaan sel darah merah, sampel darah diambil dan sel darah merah yang dicuci (menghapus plasma pasien sendiri) dan kemudian diinkubasi dengan globulin antihuman (juga dikenal sebagai "reagen Coombs"). 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 . Jika ini menghasilkan aglutinasi sel darah merah, tes Coombs langsung positif, indikasi visual yang antibodi (dan / atau protein komplemen) terikat pada permukaan sel darah merah . The indirect Coombs test is used in prenatal testing of pregnant women, and in testing blood prior to a blood transfusion . Tes Coombs tidak langsung digunakan dalam pengujian pralahir wanita hamil, dan dalam pengujian darah sebelum ke transfusi darah . It detects antibodies against RBCs that are present unbound in the patient's serum . Mendeteksi antibodi terhadap sel darah merah yang terikat hadir dalam pasien serum . In this case, serum is extracted from the blood sample taken from the patient. Dalam hal ini, serum diekstraksi dari sampel darah yang diambil dari pasien. Then, the serum is incubated with RBCs of known antigenicity ; that is, RBCs with known reference values from other patient blood samples. Kemudian, serum diinkubasi dengan sel darah merah yang diketahui antigenisitas , yaitu sel darah merah dengan nilai acuan diketahui dari sampel darah pasien lain. If agglutination occurs, the indirect Coombs test is positive. [2] Jika terjadi aglutinasi, tes Coombs langsung positif. [2] Mechanism Mekanisme

Schematic showing the direct and indirect Coombs tests . Skema menunjukkan Coombs langsung dan tidak langsung tes. The two Coombs tests are based on the fact that anti-human antibodies , which are produced by immunizing non-human species with human serum , will bind to human antibodies, commonly IgG or IgM . Kedua Coombs tes didasarkan pada kenyataan bahwa anti-manusia antibodi , yang diproduksi oleh imunisasi spesies non-manusia dengan manusia serum , akan mengikat antibodi manusia, umumnya IgG atau IgM . Animal anti-human 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 . Hewan anti-antibodi manusia juga akan mengikat antibodi manusia yang dapat tetap ke antigen pada permukaan sel darah merah (juga disebut sebagai sel darah merah), dan dalam kondisi tabung uji yang tepat ini dapat menyebabkan aglutinasi dari sel darah merah . 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. Fenomena aglutinasi sel darah merah yang penting di sini, karena penggumpalan sel darah merah yang dihasilkan dapat divisualisasikan, ketika menggumpal terlihat tes positif dan ketika menggumpal tidak terlihat tes negatif. Common clinical uses of the Coombs test include the preparation of blood for transfusion in cross-matching , screening for atypical antibodies in the blood plasma of pregnant women as part of antenatal care , and detection of antibodies for the

diagnosis of immune-mediated haemolytic anemias . Menggunakan klinis yang umum dari tes Coombs termasuk persiapan darah untuk transfusi di cross-matching , skrining untuk antibodi atipikal dalam plasma darah dari hamil perempuan sebagai bagian dari perawatan antenatal , dan deteksi antibodi untuk diagnosis kekebalan-dimediasi hemolitik anemia . Coombs tests are done on serum from venous blood samples which are taken from patients by venepuncture . Tes Coombs dilakukan pada serum dari sampel darah vena yang diambil dari pasien dengan venepuncture . The venous blood is taken to a laboratory (or blood bank), where trained scientific technical staff do the Coombs tests. Darah vena diambil ke laboratorium (atau bank darah), di mana staf teknis terlatih ilmiah melakukan tes Coombs. The clinical significance of the result is assessed by the physician who requested the Coombs test, perhaps with assistance from a laboratory-based hematologist . Signifikansi klinis hasilnya dinilai oleh dokter yang meminta tes Coombs, mungkin dengan bantuan dari laboratorium berbasis hematologi . [ edit ] Direct Coombs test [ sunting ] Direct Coombs tes The direct Coombs test (also known as the direct antiglobulin test or DAT) is used to detect if antibodies or complement system factors have bound to RBC surface antigens in vivo . Tes Coombs langsung (juga dikenal sebagai tes antiglobulin langsung atau DAT) yang digunakan untuk mendeteksi jika antibodi atau melengkapi sistem faktor telah terikat ke antigen permukaan RBC in vivo . The DAT is not currently required for pre-transfusion testing but may be included by some laboratories. DAT tersebut saat ini tidak diperlukan untuk pra-transfusi pengujian tetapi dapat dimasukkan oleh beberapa laboratorium. [ edit ] Examples of diseases that give a positive direct Coombs test [ sunting ] Contoh penyakit yang memberikan langsung positif Coombs tes The direct Coombs test is used clinically when immune-mediated hemolytic anemia (antibody-mediated destruction of RBCs) is suspected. Tes Coombs langsung digunakan secara klinis ketika sistem imun anemia hemolitik (antibodidimediasi penghancuran sel darah merah) diduga. A positive Coombs test indicates that an immune mechanism is attacking the patient's own RBC's. Sebuah tes Coombs positif menunjukkan bahwa mekanisme kekebalan tubuh menyerang pasien sendiri RBC. This mechanism could be autoimmunity , alloimmunity or a drug-induced immune-mediated mechanism. Mekanisme ini bisa menjadi autoimunitas , alloimmunity atau obat-induced kekebalan-dimediasi mekanisme. [ edit ] Examples of alloimmune hemolysis [ sunting ] Contoh hemolisis aloimun Hemolytic disease of the newborn (also known as HDN or erythroblastosis Hemolytic penyakit pada bayi baru lahir (juga dikenal sebagai HDN atau eritroblastosis fetalis ) fetalis) Rh D hemolytic disease of the newborn (also known as Rh disease) Rh D penyakit hemolitik pada bayi baru lahir (juga dikenal sebagai penyakit Rh) ABO hemolytic disease of the newborn (the indirect Coombs test may only be weakly positive) ABO hemolitik penyakit pada bayi baru lahir (tes Coombs tidak langsung mungkin hanya lemah positif) Anti- Kell hemolytic disease of the newborn Anti-Kell hemolytic penyakit pada bayi baru lahir Rh c hemolytic disease of the newborn Rh c penyakit hemolitik pada bayi baru lahir Rh E hemolytic disease of the newborn Rh E penyakit hemolitik pada bayi baru lahir Other blood group incompatibility ( RhC , Rhe , Kidd, Duffy, MN, P and others) Darah lainnya kelompok ketidakcocokan (RHC, Rhe, Kidd, Duffy, MN, P dan lain-lain)

Alloimmune hemolytic transfusion reactions Aloimun hemolitik reaksi transfusi

[ edit ] Examples of autoimmune hemolysis/immunohemolytic hemolysis [ sunting ] Contoh hemolisis autoimun / hemolisis immunohemolytic Warm antibody autoimmune hemolytic anemia Antibodi anemia hemolitik autoimun hangat Idiopathic Idiopatik Systemic lupus erythematosus Sistemik lupus erythematosus Evans' syndrome ( antiplatelet antibodies and hemolytic antibodies) Evans syndrome (antibodi antiplatelet dan antibodi hemolitik) Idiopathic cold hemagglutinin syndrome Idiopathic dingin hemagglutinin sindrom Infectious mononucleosis Infeksi mononucleosis

Cold antibody immunohemolytic anemia Antibodi anemia dingin immunohemolytic

Paroxysmal cold hemoglobinuria (rare) Paroksismal dingin hemoglobinuria (jarang)

[ edit ] Drug-induced immune-mediated hemolysis [ sunting ] Obat-diinduksi kekebalan-mediated hemolisis Methyldopa ( IgG mediated type II hypersensitivity) Metildopa (IgG dimediasi hipersensitivitas tipe II) Penicillin (high dose) Penisilin (dosis tinggi) Quinidine ( IgM mediated activation of classical complement pathway and Membrane attack complex, MAC) Quinidine (IgM dimediasi aktivasi komplemen jalur klasik dan kompleks Membran serangan, MAC)

(A memory device to remember that the DAT tests the RBCs and is used to test infants for haemolytic disease of the newborn is: R h D isease ; R = RBCs, D = DAT.) (Sebuah perangkat memori untuk mengingat bahwa DAT yang menguji sel darah merah dan digunakan untuk menguji bayi untuk penyakit hemolitik pada bayi baru lahir adalah: R h D isease, R = RBCs, D = DAT.) [ edit ] Laboratory method [ sunting ] Laboratorium metode The patient's red blood cells (RBCs) are washed (removing the patient's own serum ) and then incubated with antihuman globulin (also known as Coombs reagent). Para pasien sel darah merah (sel darah merah) yang dicuci (menghapus pasien sendiri serum ) dan kemudian diinkubasi dengan globulin antihuman (juga dikenal sebagai reagen Coombs). If immunoglobulin or complement factors have been fixed on to the RBC surface in-vivo , the antihuman globulin will agglutinate the RBCs and the direct Coombs test will be positive. Jika imunoglobulin atau komplemen faktor telah diperbaiki pada permukaan RBC in-vivo , globulin antihuman akan mengaglutinasi sel darah merah dan tes Coombs langsung akan positif. (A visual representation of a positive direct Coombs test is shown in the upper half of the schematic). (Sebuah representasi visual dari tes Coombs positif langsung ditampilkan di bagian atas skema). [ edit ] Indirect Coombs test [ sunting ] Indirect Coombs tes The indirect Coombs test (also known as the indirect antiglobulin test or IAT) is used to detect in-vitro antibody-antigen reactions. Tes Coombs tidak langsung (juga dikenal sebagai tes antiglobulin langsung atau IAT) yang digunakan untuk mendeteksi in-vitro reaksi antigen-antibodi. It is used to detect very low concentrations of antibodies present in a patient's plasma/serum prior to a blood transfusion. Hal ini digunakan untuk mendeteksi konsentrasi yang sangat rendah dari antibodi hadir dalam plasma pasien / serum sebelum transfusi darah. In antenatal care, the IAT is used to screen pregnant women for antibodies that may cause hemolytic disease of the newborn . Dalam perawatan antenatal, IAT digunakan untuk layar wanita hamil untuk antibodi yang dapat menyebabkan penyakit hemolitik pada bayi baru lahir . The IAT can also be used for compatibility testing , antibody identification, RBC phenotyping, and titration studies. IAT juga dapat digunakan untuk pengujian kompatibilitas , identifikasi antibodi, fenotip RBC, dan studi titrasi. [ edit ] Examples of clinical uses of the indirect Coombs test [ sunting ] Contoh penggunaan klinis tes Coombs tidak langsung [ edit ] Blood transfusion preparation [ sunting ] Blood persiapan transfusi Main articles: blood transfusion and cross-matching Artikel utama: transfusi darah dan cross-matching The indirect Coombs test is used to screen for antibodies in the preparation of blood for blood transfusion . Tes Coombs tidak langsung digunakan untuk layar untuk antibodi dalam penyusunan darah untuk transfusi darah . The donor's and recipient's blood must be ABO and Rh D compatible. Para donor dan penerima darah yang harus ABO dan Rh D kompatibel. Donor blood for transfusion is also screened for infections in separate processes. Donor darah untuk transfusi juga diperiksa untuk infeksi dalam proses terpisah. Antibody screening Antibodi skrining A blood sample from the recipient and a blood sample from every unit of donor blood are screened for antibodies with the indirect Coombs test. Sebuah sampel darah dari penerima dan sampel darah dari setiap unit donor darah disaring untuk antibodi dengan tes Coombs tidak langsung. Each sample is incubated against a wide range of RBCs that together exhibit a full range of surface antigens (ie blood types ). Setiap sampel diinkubasi terhadap berbagai sel darah merah yang bersamasama menunjukkan berbagai macam antigen permukaan (yaitu tipe darah ). Cross matching Silang pencocokan The indirect Coombs test is used to test a sample of the recipient's serum against a sample of the blood donor's RBCs. Tes Coombs tidak langsung digunakan untuk menguji sampel serum penerima terhadap sampel dari donor darah sel darah merah. This is sometimes called cross-matching blood. Hal ini kadang-kadang disebut cross-matching darah. [ edit ] Antenatal antibody screening [ sunting ] skrining antibodi Antenatal

The indirect Coombs test is used to screen pregnant women for IgG Tes Coombs tidak langsung digunakan untuk layar wanita hamil untuk IgG antibodies that are likely to pass through the placenta into the fetal blood and cause haemolytic disease of the newborn . antibodi yang mungkin melewati plasenta ke dalam darah janin dan menyebabkan penyakit hemolitik pada bayi baru lahir . [ edit ] Laboratory method [ sunting ] Laboratorium metode The IAT is a two-stage test. IAT adalah tes dua tahap. (A cross match is shown visually in the lower half of the schematic as an example of an indirect Coombs test). (Sebuah pertandingan silang ditampilkan secara visual di bagian bawah skema sebagai contoh tes Coombs tidak langsung). [ edit ] First stage [ sunting ] Tahap Pertama Washed test red blood cells (RBCs) are incubated with a test serum. Dicuci tes sel darah merah (sel darah merah) yang diinkubasi dengan serum tes. If the serum contains antibodies to antigens on the RBC surface, the antibodies will bind onto the surface of the RBCs. Jika serum mengandung antibodi untuk antigen pada permukaan RBC, antibodi akan mengikat ke permukaan sel darah merah. [ edit ] Second stage [ sunting ] Kedua tahap The RBCs are washed three or four times with isotonic saline and then incubated with antihuman globulin. Sel darah merah dicuci tiga atau empat kali dengan saline isotonik dan kemudian diinkubasi dengan globulin antihuman. If antibodies have bound to RBC surface antigens in the first stage, RBCs will agglutinate when incubated with the antihuman globulin (also known Coombs reagent) in this stage, and the indirect Coombs test will be positive. Jika antibodi telah terikat ke antigen permukaan RBC di tahap pertama, sel darah merah akan mengaglutinasi ketika diinkubasi dengan globulin antihuman (juga dikenal Coombs reagen) di tahap ini, dan tes Coombs tidak langsung akan positif. [ edit ] Titrations [ sunting ] Titrasi By diluting a serum containing antibodies the quantity of the antibody in the serum can be gauged. Dengan menipiskan suatu antibodi serum yang mengandung jumlah antibodi dalam serum dapat diukur. This is done by using doubling dilutions of the serum and finding the maximum dilution of test serum that is able to produce agglutination of relevant RBCs. Hal ini dilakukan dengan menggunakan pengenceran dua kali lipat dari serum dan menemukan dilusi maksimal serum tes yang mampu menghasilkan aglutinasi sel darah merah yang relevan. [ edit ] Coombs reagent [ sunting ] Coombs reagen Coombs reagent (also known as Coombs antiglobulin or antihuman globulin ) is used in both the direct Coombs test and the indirect Coombs test. Coombs reagen (juga dikenal sebagai antiglobulin Coombs atau globulin antihuman) digunakan dalam kedua tes Coombs langsung dan tes Coombs tidak langsung. Coombs reagent is antihuman globulin . Reagen Coombs antihuman globulin . It is made by injecting human globulin into animals, which produce polyclonal Hal ini dilakukan dengan menyuntikkan globulin manusia ke hewan, yang menghasilkan poliklonal antibodies specific for human immunoglobulins and human complement system factors. antibodi spesifik untuk manusia imunoglobulin manusia dan melengkapi sistem faktor. More specific Coombs reagents or monoclonal antibodies can be used. Lebih spesifik Coombs reagen atau antibodi monoklonal dapat digunakan. [ edit ] Enhancement media [ sunting ] Peningkatan Media Both IgM and IgG Kedua IgM dan IgG antibodies bind strongly with their antigens . IgG antibodies are most reactive at 37C. antibodi mengikat kuat dengan mereka antigen . IgG antibodi yang paling reaktif pada suhu 37 C. IgM antibodies are easily detected in saline at room temperature as IgM antibodies are able to bridge between RBCs owing to their large size, efficiently creating what is seen as agglutination . IgM antibodi mudah terdeteksi dalam garam pada suhu kamar sebagai antibodi IgM dapat menjembatani antara RBC s karena ukurannya yang besar, efisien menciptakan apa yang dilihat sebagai aglutinasi . IgG antibodies are smaller and require assistance to bridge well enough to form a visual agglutination reaction. Antibodi IgG lebih kecil dan membutuhkan bantuan untuk menjembatani cukup baik untuk membentuk visual aglutinasi reaksi. Reagents used to enhance IgG detection are referred to as potentiators. Reagen yang digunakan untuk meningkatkan deteksi IgG disebut sebagai potensiator. RBCs have a net negative charge called zeta potential which causes them to have a natural repulsion for one another. Sel darah merah memiliki muatan negatif bersih disebut potensial zeta yang menyebabkan mereka memiliki tolakan alami untuk satu sama lain. Potentiators reduce the zeta potential of RBC membranes. Potensiator mengurangi potensi zeta dari membran RBC. Common potentiators include low ionic strength solution (LISS), albumin , polyethylene glycol (PEG), and proteolytic enzymes . Potensiator umum termasuk solusi kekuatan rendah ion (LISS), albumin , polietilen glikol (PEG), dan proteolitik enzim . [ edit ] History of the Coombs test [ sunting ] Sejarah tes Coombs

The Coombs test was first described in 1945 by Cambridge Tes Coombs pertama kali dijelaskan pada 1945 oleh Cambridge immunologists immunologists Robin Coombs (after whom it is named), Arthur Mourant and Rob Race. [3] Historically, it was done in test tubes . Robin Coombs (setelah yang dinamai), Arthur Mourant dan Rob Ras. [3] Secara historis, hal itu dilakukan dalam tabung reaksi . Today, it is commonly done using microarray and gel technology. Hari ini, itu biasanya dilakukan dengan menggunakan microarray dan teknologi gel.