234:
124:
690:
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
99:
attached to the surface of red blood cells. To perform the test, a blood sample is taken and the red blood cells are washed (removing the patient's plasma and unbound antibodies from the red blood cells) and then incubated with anti-human globulin ("Coombs reagent"). If the red cells then
475:
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
80:; this test can help clarify the condition. The indirect Coombs test detects antibodies that are floating freely in the blood. These antibodies could act against certain red blood cells; the test can be carried out to diagnose reactions to a
606:
The RBCs are washed three or four times with isotonic saline solution 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
107:
The indirect Coombs test is used in prenatal testing of pregnant women and in testing prior to a blood transfusion. The test detects antibodies against foreign red blood cells. In this case,
197:. 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
531:
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.
104:, the test is positive, a visual indication that antibodies or complement proteins are bound to the surface of red blood cells and may be causing destruction of those cells.
76:. The direct Coombs test detects antibodies that are stuck to the surface of the red blood cells. Since these antibodies sometimes destroy red blood cells they can cause
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of RBCs and allowing for visualisation of the resulting clumps of RBCs. If clumping is seen, the Coombs test is positive; if not, the Coombs test is negative.
463:
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).
1256:
193:
Coombs tests are performed using RBCs or serum (direct or indirect, respectively) from venous whole blood samples which are taken from patients by
1544:
1013:
1800:
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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).
245:(antibody-mediated destruction of RBCs) is suspected. A positive Coombs test indicates that an immune mechanism is attacking the patient's
221:
surface antigens. The DAT is not required for pre-transfusion testing but may be carried out by some laboratories. Before transfusion, an
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897:. Joint United Kingdom (UK) Blood Transfusion and Tissue Transplantation Services Professional Advisory Committee. 4 October 2023.
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By diluting a serum containing antibodies the quantity of the antibody in the serum can be gauged. This is done by performing
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594:(RBCs) with known antigens are incubated with patient serum containing unknown antibody content. If the serum contains
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is extracted from a blood sample taken from the patient. The serum is incubated with foreign red blood cells of known
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of the serum and finding the maximum dilution of test serum that is able to produce agglutination of relevant RBCs.
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as IgM antibodies are able to bridge between RBC's owing to their large size, efficiently creating what is seen as
477:
266:
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The direct Coombs test, also referred to as the direct antiglobulin test (DAT), is used to detect if antibodies or
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The indirect Coombs test is used to test a sample of the recipient's serum for antibodies against a sample of the
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specific for human immunoglobulins and human complement system factors. More specific Coombs reagents or
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and Rh D compatible. Donor blood for transfusion is also screened for infections in separate processes.
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115:. Finally, anti-human globulin is added. If agglutination occurs, the indirect Coombs test is positive.
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The indirect Coombs test, also referred to as the indirect antiglobulin test (IAT), is used to detect
151:. Additionally, these anti-human antibodies will also bind to human antibodies that may be fixed onto
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639:) is used in both the direct Coombs test and the indirect Coombs test. Coombs reagent is antihuman
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Reid ME, Lomas-Francis C (23 December 2015). "Chapter 136: Erythrocytes
Antigens and Antibodies".
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686:. IgG antibodies are smaller and require assistance to bridge well enough to form a visual
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611:(also known Coombs reagent) in this stage, and the indirect Coombs test will be positive.
388:(IgM mediated activation of classical complement pathway and Membrane attack complex, MAC)
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to antigens on the RBC surface, the antibodies will bind to the surface of the RBCs.
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Other blood group incompatibility (RhC, Rhe, Kidd, Duffy, Lewis, MN, P and others)
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The indirect Coombs test is used to screen for antibodies in the preparation of
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who requested the Coombs test, perhaps with assistance from a laboratory-based
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797:"The direct antiglobulin test: A critical step in the evaluation of hemolysis"
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1964:
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733:. Today, it is commonly done using automated solid phase or gel technology.
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antibodies are most reactive at 37°C. IgM antibodies are easily detected in
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Common clinical uses of the Coombs test include the preparation of blood for
108:
95:, leading to anemia. The direct Coombs test is used to detect antibodies or
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A blood sample from the recipient and a blood sample from every unit of
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643:. It is made by injecting human globulin into animals, which produce
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927:"A new test for the detection of weak and incomplete Rh agglutinins"
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484:, antibody identification, RBC phenotyping, and titration studies.
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159:(RBCs). In the appropriate test tube conditions, this can lead to
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The direct Coombs test is used clinically when immune-mediated
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The indirect Coombs test is used to screen pregnant women for
1635:
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1474:
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or complement factors have been fixed on to the RBC surface
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1354:
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Examples of autoimmune hemolysis/immunohemolytic hemolysis
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664:
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367:
907:
Image by Mikael Häggström, MD. Source for conditions:
127:
Schematic showing the direct and indirect Coombs tests
829:
795:
Zantek, Nicole D.; Koepsell, Scott A. (2012-04-12).
790:
788:
281:(the direct Coombs test may only be weakly positive)
925:Coombs, R. R.; Mourant, A. E.; Race, R. R. (1945).
260:
333:(antiplatelet antibodies and hemolytic antibodies)
237:Algorithm for the main diagnoses in a positive DAT
91:, a condition where the immune system breaks down
924:
860:
785:
670:bind strongly with their complementary antigens.
2179:
1257:Transfusion-associated graft versus host disease
492:
269:(also known as HDN or erythroblastosis fetalis)
147:of non-human animals after immunizing them with
756:"Coombs test: MedlinePlus Medical Encyclopedia"
711:The Coombs test was first described in 1945 by
554:
887:
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750:
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143:. These anti-human antibodies are produced by
1794:
1545:
1007:
515:. The donor's and recipient's blood must be
257:or a drug-induced immune-mediated mechanism.
131:The two Coombs tests are based on anti-human
1252:Transfusion associated circulatory overload
908:
743:
87:The direct Coombs test is used to test for
1801:
1787:
1552:
1538:
1262:Febrile non-hemolytic transfusion reaction
1135:International Society of Blood Transfusion
1014:
1000:
285:Anti-Kell hemolytic disease of the newborn
984:at the U.S. National Library of Medicine
942:
931:British Journal of Experimental Pathology
812:
318:Warm antibody autoimmune hemolytic anemia
232:
122:
1808:
1646:Enzyme multiplied immunoassay technique
865:(9th ed.). New York: McGraw-Hill.
466:
443:are washed (removing the patient's own
376:(IgG mediated type II hypersensitivity)
2180:
835:
368:Drug-induced immune-mediated hemolysis
344:Idiopathic cold hemagglutinin syndrome
135:binding to human antibodies, commonly
1782:
1533:
1247:Transfusion related acute lung injury
995:
295:Rh E hemolytic disease of the newborn
290:Rh c hemolytic disease of the newborn
273:Rh D hemolytic disease of the newborn
208:
654:
577:
566:that are likely to pass through the
451:(also known as Coombs reagent). If
339:Cold antibody immunohemolytic anemia
279:ABO hemolytic disease of the newborn
915:Citing: C Feldman & J O'Connor.
780:Case Studies in Immunology, 4th ed.
608:
448:
16:Blood test used in immunohematology
13:
1596:Ouchterlony double immunodiffusion
976:Drugs that cause haemolytic anemia
14:
2209:
1290:Transfusion transmitted infection
963:
626:
572:haemolytic disease of the newborn
406:haemolytic disease of the newborn
911:"028: Who DAT? with Sue Johnson"
729:. Historically, it was done in
547:RBCs. This is sometimes called
480:. The IAT can also be used for
478:hemolytic disease of the newborn
404:and is used to test infants for
267:Hemolytic disease of the newborn
261:Examples of alloimmune hemolysis
895:"13.3: Pre-transfusion testing"
601:
570:into the fetal blood and cause
349:Waldenström's macroglobulinemia
918:
901:
854:
801:American Journal of Hematology
772:
631:Coombs reagent (also known as
585:
459:, the antihuman globulin will
359:Paroxysmal cold hemoglobinuria
1:
1586:Chromatin immunoprecipitation
842:. StatPearls Publishing LLC.
736:
614:
493:Blood transfusion preparation
434:
174:, atypical antibodies in the
1631:Chemiluminescent immunoassay
1611:Counterimmunoelectrophoresis
1179:Intraoperative blood salvage
555:Antenatal antibody screening
447:) and then centrifuged with
326:Systemic lupus erythematosus
118:
7:
1741:Direct fluorescent antibody
1195:Blood compatibility testing
225:Coombs test is often done.
89:autoimmune hemolytic anemia
10:
2214:
909:Joe Chaffin (2017-02-27).
836:Theiss, Samuel R. (2023).
721:(after whom it is named),
706:
691:strength solution (LISS),
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275:(also known as Rh disease)
249:. This mechanism could be
2155:
2100:Hypersegmented neutrophil
2090:
2060:
2051:
2021:
2007:Hemoglobin precipitation
1973:
1947:
1937:Hereditary stomatocytosis
1883:Hereditary elliptocytosis
1852:
1826:
1817:
1763:Total complement activity
1708:
1674:
1621:
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1298:
1242:Transfusion hemosiderosis
1230:
1187:
1148:
1112:
1033:
782:, Garland Science, p.173.
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40:
26:
21:
2132:Critical green inclusion
1923:Sickle cell/drepanocyte
1895:Hereditary spherocytosis
1726:Complement fixation test
1222:Monocyte monolayer assay
986:Medical Subject Headings
354:Infectious mononucleosis
56:The direct and indirect
1864:Membrane abnormalities
1097:Granulocyte transfusion
699:(PEG), and proteolytic
228:
2034:Red cell agglutination
1601:Radial immunodiffusion
778:F. Rosen and R. Geha,
238:
217:factors have bound to
128:
1716:Diagnostic immunology
1606:Immunoelectrophoresis
1232:Transfusion reactions
649:monoclonal antibodies
645:polyclonal antibodies
482:compatibility testing
396:to remember that the
306:transfusion reactions
304:Alloimmune hemolytic
236:
126:
2188:Transfusion medicine
2137:Alder–Reilly anomaly
1991:Basophilic stippling
1736:Immunohistochemistry
1212:Kleihauer–Betke test
1174:Exchange transfusion
1053:Platelet transfusion
1027:transfusion medicine
467:Indirect Coombs test
2112:Pelger–Huët anomaly
2070:Reactive lymphocyte
1996:Pappenheimer bodies
1927:Sickle cell disease
1731:Immunocytochemistry
1700:Latex fixation test
1578:Immunoprecipitation
1300:Blood group systems
1235:and adverse effects
1070:Fresh frozen plasma
863:Williams hematology
697:polyethylene glycol
633:Coombs antiglobulin
590:Nonpatient, washed
97:complement proteins
1960:Hypochromic anemia
1666:Immunofluorescence
1661:Radiobinding assay
972:- Medlineplus.org.
637:antihuman globulin
609:antihuman globulin
523:Antibody screening
449:antihuman globulin
239:
209:Direct Coombs test
155:on the surface of
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2193:Immunologic tests
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2127:Toxic vacuolation
2122:Toxic granulation
2053:White blood cells
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1986:Howell–Jolly body
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1753:Skin allergy test
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1104:Blood substitutes
1092:White blood cells
1023:Blood transfusion
814:10.1002/ajh.23218
655:Enhancement media
578:Laboratory method
513:blood transfusion
499:blood transfusion
215:complement system
188:hemolytic anemias
182:women as part of
82:blood transfusion
62:antiglobulin test
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2142:Jordans' anomaly
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1975:Inclusion bodies
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1684:Hemagglutination
1656:Radioimmunoassay
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1217:Antibody elution
1164:plateletpheresis
1130:Blood management
1113:General concepts
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243:hemolytic anemia
74:immunohematology
60:, also known as
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1318:Secretor status
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1085:Cryosupernatant
1080:Cryoprecipitate
1060:Red blood cells
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978:- Merck Manual.
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807:(7): 707–709.
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723:Arthur Mourant
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627:Coombs reagent
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539:Cross matching
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2185:
2183:
2164:
2161:
2160:
2158:
2154:
2148:
2145:
2143:
2140:
2138:
2135:
2133:
2130:
2128:
2125:
2123:
2120:
2118:
2115:
2113:
2110:
2106:
2103:
2102:
2101:
2098:
2097:
2095:
2093:
2089:
2081:
2078:
2077:
2076:
2073:
2071:
2068:
2067:
2065:
2063:
2059:
2056:
2054:
2050:
2040:
2037:
2035:
2032:
2030:
2027:
2026:
2024:
2020:
2012:
2009:
2008:
2006:
2002:
1999:
1997:
1994:
1992:
1989:
1987:
1984:
1983:
1981:
1980:
1978:
1976:
1972:
1966:
1965:Polychromasia
1963:
1961:
1958:
1956:
1953:
1952:
1950:
1946:
1938:
1935:
1934:
1932:
1928:
1925:
1924:
1922:
1920:
1917:
1915:
1912:
1910:
1907:
1905:
1902:
1896:
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1871:
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1825:
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1816:
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1734:
1732:
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1727:
1724:
1722:
1719:
1717:
1714:
1713:
1711:
1707:
1701:
1698:
1694:
1691:
1690:
1689:
1688:Hemagglutinin
1685:
1682:
1681:
1679:
1677:
1676:Agglutination
1673:
1667:
1664:
1662:
1659:
1657:
1654:
1652:
1649:
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1642:
1639:
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1562:
1561:Medical tests
1555:
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1335:Chido-Rodgers
1333:
1331:
1328:
1326:
1323:
1319:
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1197:
1196:
1193:
1192:
1190:
1186:
1180:
1177:
1175:
1172:
1169:
1168:leukapheresis
1165:
1161:
1157:
1154:
1153:
1151:
1147:
1141:
1138:
1136:
1133:
1131:
1128:
1126:
1123:
1121:
1118:
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1111:
1105:
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1098:
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1038:
1036:
1032:
1028:
1024:
1017:
1012:
1010:
1005:
1003:
998:
997:
994:
987:
983:
980:
977:
974:
971:
968:
967:
954:
950:
945:
940:
937:(4): 255–66.
936:
932:
928:
921:
912:
904:
896:
890:
882:
878:
874:
872:9780071833004
868:
864:
857:
849:
845:
841:
840:
832:
824:
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815:
810:
806:
802:
798:
791:
789:
781:
775:
761:
757:
751:
749:
747:
742:
734:
732:
728:
724:
720:
717:
716:immunologists
714:
704:
702:
698:
694:
689:
688:agglutination
685:
684:agglutination
681:
677:
673:
669:
666:
662:
652:
651:can be used.
650:
646:
642:
638:
634:
624:
622:
612:
610:
599:
597:
593:
583:
575:
573:
569:
565:
562:
552:
550:
546:
545:blood donor's
538:
537:
536:
534:
530:
522:
521:
520:
518:
514:
510:
504:
500:
485:
483:
479:
474:
464:
462:
458:
454:
450:
446:
442:
432:
430:
429:
424:
423:
418:
416:
412:
407:
403:
399:
395:
394:memory device
387:
384:
381:
378:
375:
372:
371:
360:
357:
355:
352:
350:
347:
345:
342:
341:
340:
337:
332:
329:
327:
324:
321:
320:
319:
316:
315:
307:
303:
298:
296:
293:
291:
288:
286:
283:
280:
277:
274:
271:
270:
268:
265:
264:
258:
256:
252:
248:
244:
235:
226:
224:
220:
216:
206:
204:
200:
196:
191:
189:
185:
181:
177:
173:
169:
164:
162:
161:agglutination
158:
154:
150:
146:
142:
138:
134:
125:
116:
114:
110:
105:
103:
98:
94:
90:
85:
83:
79:
75:
71:
67:
63:
59:
49:
45:
43:
39:
35:
31:
29:
25:
20:
2117:Döhle bodies
2105:Arneth count
2092:Granulocytes
1955:Anisochromia
1933:Stomatocyte
1844:Microcytosis
1839:Macrocytosis
1834:Anisocytosis
1721:Nephelometry
1692:
1571:86000–86849)
1206:
970:Coombs' test
934:
930:
920:
903:
889:
862:
856:
838:
831:
804:
800:
779:
774:
763:. Retrieved
759:
719:Robin Coombs
710:
658:
636:
632:
630:
618:
605:
602:Second stage
589:
581:
558:
542:
526:
506:
470:
438:
427:
426:
421:
420:
414:
410:
409:
405:
397:
391:
255:alloimmunity
251:autoimmunity
240:
222:
212:
203:hematologist
195:venipuncture
192:
176:blood plasma
165:
149:human plasma
145:plasma cells
130:
113:antigenicity
106:
86:
65:
61:
58:Coombs tests
57:
55:
2198:Blood tests
2075:Smudge cell
2062:Lymphocytes
2001:Cabot rings
1914:Schistocyte
1878:Elliptocyte
1868:Acanthocyte
1693:Coombs test
1623:Immunoassay
1308:Blood types
1207:Coombs test
1043:Whole blood
839:Coombs Test
586:First stage
533:blood types
461:agglutinate
382:(high dose)
168:transfusion
102:agglutinate
70:blood tests
42:MedlinePlus
22:Coombs test
2182:Categories
2147:Left shift
2029:Haemoconia
2011:Heinz body
1909:Echinocyte
1890:Spherocyte
1810:Blood film
1758:Patch test
1565:immunology
1120:Blood bank
765:2019-05-06
737:References
731:test tubes
668:antibodies
615:Titrations
596:antibodies
564:antibodies
435:Laboratory
400:tests the
380:Penicillin
374:Methyldopa
322:Idiopathic
133:antibodies
1919:Degmacyte
1904:Dacrocyte
1651:RAST test
1325:Augustine
1269:reaction
1267:Hemolytic
1156:Apheresis
1048:Platelets
881:913870019
713:Cambridge
386:Quinidine
199:physician
119:Mechanism
2163:Auer rod
2039:Rouleaux
1873:Codocyte
1812:findings
1563:used in
1450:Lutheran
1355:Dombrock
1140:ISBT 128
953:21006651
848:31613487
823:22566278
727:Rob Race
641:globulin
568:placenta
473:in-vitro
457:in-vitro
431:= DAT.)
425:= RBCs,
223:indirect
180:pregnant
153:antigens
72:used in
1641:ELISpot
1489:Scianna
1375:Gerbich
1278:delayed
1149:Methods
944:2065689
707:History
701:enzymes
693:albumin
551:blood.
68:), are
34:D003298
1948:Colour
1768:MELISA
1400:Indian
1345:Cromer
1340:Colton
1065:Plasma
988:(MeSH)
951:
941:
879:
869:
846:
821:
676:saline
417:isease
361:(rare)
78:anemia
48:003344
2156:Other
2022:Other
1853:Shape
1709:Other
1636:ELISA
1519:Other
1445:Lewis
1435:Knops
1415:KANNO
1360:Duffy
1350:Diego
1273:acute
1188:Tests
659:Both
529:donor
509:blood
445:serum
109:serum
1827:Size
1499:T-Tn
1484:RHAG
1482:and
1475:Raph
1470:P1PK
1430:Kidd
1420:Kell
1385:GLOB
1370:FORS
1330:CD59
1075:PF24
1025:and
949:PMID
877:OCLC
867:ISBN
844:PMID
819:PMID
725:and
663:and
511:for
501:and
488:Uses
441:RBCs
408:is:
402:RBCs
247:RBCs
229:Uses
219:RBCs
28:MeSH
1569:CPT
1504:Vel
1494:Sid
1460:MNS
1440:Lan
1410:JMH
1380:GIL
1313:ABO
939:PMC
809:doi
678:at
672:IgG
665:IgG
661:IgM
635:or
561:IgG
535:).
517:ABO
398:DAT
392:(A
178:of
170:in
141:IgM
139:or
137:IgG
66:AGT
2184::
1514:Yt
1509:Xg
1480:Rh
1465:OK
1455:LW
1424:Xk
1405:JR
1395:Ii
1390:Hh
1365:Er
1166:,
1162:,
947:.
935:26
933:.
929:.
875:.
817:.
805:87
803:.
799:.
787:^
758:.
745:^
703:.
695:,
574:.
419:;
413:h
253:,
205:.
190:.
84:.
1802:e
1795:t
1788:v
1686:/
1567:(
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1539:v
1426:)
1422:(
1170:)
1158:(
1015:e
1008:t
1001:v
955:.
913:.
883:.
850:.
825:.
811::
768:.
428:D
422:R
415:D
411:R
64:(
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