Coomb's Test

Blood will be taken from a vein, usually from the inside of the elbow or the
back of the hand. First, the place where the needle will be inserted is cleaned
with a germ-killing product (antiseptic). An elastic band (tourniquet) is placed
around the upper arm to apply pressure. This causes the vein to swell with
blood.

The needle is inserted into the vein, and the blood is collected into a tube.
During the procedure, the band is removed to restore circulation. Once the
blood has been collected, the needle is removed, and the puncture site is
covered to stop any bleeding.

In infants and young children, the area is cleansed with antiseptic and
punctured with a sharp needle or object (lancet). The blood may be collected
in a pipette (small glass tube), on a slide, onto a test strip, or into a small
container. A bandage may be applied to stop any bleeding.

The direct test is performed using your red blood cells and a series of pre-
made antibodies. The indirect Coombs test uses the fluid that forms when
blood clots (serum) and a series of standardized red blood cells.

Why the test is performed?

There are two forms of the Coombs' test: direct and indirect.

The direct Coombs' test is used to detect antibodies that are already bound
to the surface of red blood cells. Many diseases and drugs (quinidine,
methyldopa, and procainamide) can lead to production of these antibodies.
These antibodies sometimes destroy red blood cells and cause anemia. This
test is sometimes performed to diagnose the cause of anemia or jaundice.

The indirect Coombs' test looks for unbound circulating antibodies against a
series of standardized red blood cells. The indirect Coombs' test is only rarely
used to diagnose a medical condition. More often, it is used to determine
whether a person might have a reaction to a blood transfusion.

Normal Results

There are two forms of the Coombs' test: direct and indirect.

The direct Coombs' test is used to detect autoantibodies on the surface of red
blood cells. Many diseases and drugs (quinidine, methyldopa, and
procainamide) can lead to production of these antibodies. These antibodies
sometimes destroy red blood cells and cause anemia. This test is sometimes
performed to diagnose the cause of anemia or jaundice.

The indirect test looks for anti-RBC antibodies that flow freely in blood serum,
which is the clear yellowish fluid left after red blood cells and clotting
materials are removed. The indirect Coombs' test is only rarely used to
diagnose a medical condition. More frequently, it is used to determine
whether a person might have a reaction to a blood transfusion.

Abnormal Results

An abnormal (positive) direct Coombs' test means you have antibodies that
act against your red blood cells. This may be due to:

-Autoimmune hemolytic anemia without another underlying cause

-Drug-induced hemolytic anemia (many drugs have been associated with this
complication) -Erythroblastosis fetalis (hemolytic disease of the
newborn)
-Infectious mononucleosis
-Mycoplasmal infection
-Syphilis
-Chronic lymphocytic leukemia or other lymphoproliferative disorder
-Systemic lupus erythematosus or another rheumatologic condition
-Transfusion reaction, such as one due to improperly matched units of blood
-The test is also abnormal in some people without any clear cause, especially
among the elderly. -Up to 3% of people who are in
the hospital without a known blood disorder will have an abnormal direct
Coombs' test.

An abnormal (positive) indirect Coombs' test means you have antibodies that
the body views as foreign. This may suggest:

-Erythroblastosis fetalis hemolytic disease

-Incompatible blood match (when used in blood banks)
-Autoimmune or drug-induced hemolytic anemia