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Indirect Coombs Test

Blood
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Report in 4Hrs

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At Home

nofastingrequire

No Fasting Required

Details

The Indirect Coombs Test detects free-floating antibodies in the patient's serum that may target red blood cells (RBCs) — especially non-self (foreign) RBCs

₹299₹825

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Indirect Coombs Test - Comprehensive Medical Information Guide

  • Why is it done?
    • Detects presence of alloantibodies (IgG antibodies) in the serum that react against red blood cell antigens not present on the patient's own cells
    • Pre-transfusion screening to identify incompatible blood types and prevent hemolytic transfusion reactions
    • Evaluation of hemolytic disease of the newborn (HDN) to assess antibody levels in maternal serum
    • Investigation of transfusion reactions, particularly delayed hemolytic transfusion reactions
    • Assessment of alloimmunization in frequently transfused patients (chronic transfusion recipients, patients with sickle cell disease)
    • Detection of red cell antibodies in prenatal screening, particularly for ABO, Rh(D), and other clinically significant blood group antigens
    • Typically performed as part of routine blood banking procedures before planned transfusions or during prenatal care
  • Normal Range
    • Negative Result (Normal): No agglutination or hemolysis observed; indicates absence of clinically significant red cell antibodies in the serum
    • Positive Result (Abnormal): Agglutination or hemolysis observed; indicates presence of red cell alloantibodies requiring identification and cross-matching
    • Titer Values (for positive results): Expressed as reciprocal dilutions (1:1, 1:2, 1:4, 1:8, 1:16, 1:32, etc.); higher titers may indicate greater risk of hemolytic disease
    • Units of Measurement: Qualitative (positive/negative) or quantitative (titer dilution); some laboratories report as IU/mL or other standardized units
    • Clinical Interpretation: Negative results indicate blood is compatible for transfusion (when donor cells are also negative); positive results require additional antibody identification and further testing
  • Interpretation
    • Negative Result Interpretation: Patient's serum contains no detectable alloantibodies; blood is available for transfusion without risk of antibody-related complications; compatible donor blood can be identified through routine cross-matching
    • Positive Result Interpretation: Alloantibodies present; specific antibody identification (ID panel) is mandatory; extended cross-matching required to find compatible blood; transfusion carries risk of hemolytic reaction
    • Low Titer Results (1:1 to 1:4): Antibodies present but at lower concentrations; lower risk of hemolytic transfusion reaction; compatible blood may be found but careful selection necessary
    • High Titer Results (≥1:16 or higher): Significant antibody concentration; high risk of hemolytic transfusion reaction and hemolytic disease of the newborn; careful transfusion planning required; may indicate recent sensitization or multiple transfusions
    • Factors Affecting Results: Previous transfusions, pregnancy history, previous transfusion reactions, blood type mismatch, medications (methyldopa, quinidine), warm or cold agglutinins, IgG subclass and epitope specificity of antibodies, time elapsed since sensitization
    • Clinical Significance: Critical for ensuring transfusion safety; identifies patients at risk for immediate and delayed hemolytic transfusion reactions; helps diagnose hemolytic disease of newborn; determines need for extended antigen-negative blood for transfusion-dependent patients
  • Associated Organs and Conditions
    • Primary Organ Systems Involved: Blood (hematologic system); immune system; bone marrow
    • Hemolytic Transfusion Reactions: Antibodies bind to transfused red blood cells causing hemolysis; affects kidneys (acute kidney injury), liver, and cardiovascular system; may present with fever, back pain, hemoglobinuria, hypotension, shock
    • Hemolytic Disease of the Newborn (HDN): Maternal antibodies cross placenta and attack fetal red blood cells; results in hemolysis in utero and in newborn; affects brain (kernicterus), liver (hepatosplenomegaly), and cardiovascular system
    • Alloimmunization Conditions: Sickle cell disease, thalassemia, aplastic anemia, multiple transfusion recipients, transfusion-dependent patients
    • Hemolytic Anemias: Immune hemolytic anemia, autoimmune hemolytic anemia (AIHA), blood group incompatibility
    • Associated Complications: Acute kidney injury, disseminated intravascular coagulation (DIC), hypotension and shock, severe anemia, jaundice (neonatal), neurological damage (kernicterus), fetal hydrops, intrauterine fetal death
  • Follow-up Tests
    • Antibody Identification (ID Panel): Mandatory when indirect Coombs is positive; determines specific antibody type (anti-D, anti-K, anti-Kidd, anti-E, etc.); guides blood selection for transfusion
    • Extended Cross-Match: Performed using donor blood lacking the identified antigen; essential for finding compatible blood in sensitized patients
    • Quantitative Titer Testing: Performed in pregnant patients to assess risk of hemolytic disease of newborn; usually repeated every 2-4 weeks if elevated
    • Direct Coombs Test (DAT): Detects antibodies already bound to red blood cells; useful in evaluating hemolytic transfusion reactions and hemolytic disease of newborn
    • Complete Blood Count (CBC): Evaluates hemoglobin, hematocrit, and red blood cell indices; detects anemia severity in suspected hemolytic reactions
    • Reticulocyte Count: Assesses bone marrow response to hemolysis; elevated in hemolytic disease
    • Bilirubin (Total and Direct): Elevated in hemolytic disease; critical monitoring in neonates to prevent kernicterus
    • Blood Urea Nitrogen (BUN) and Creatinine: Assess renal function in suspected transfusion reactions; elevated in acute kidney injury secondary to hemolysis
    • Lactate Dehydrogenase (LDH): Elevated in hemolysis; marker of RBC destruction
    • Haptoglobin: Decreased in hemolysis; useful marker of ongoing hemolysis
    • Prenatal Monitoring Schedule: First indirect Coombs at initial prenatal visit; repeat 28 weeks; repeat 34 weeks; monthly if antibodies detected; more frequent if high titers present (critical titer ≥1:16 or ≥1:32 depending on laboratory)
  • Fasting Required?
    • Fasting Requirement: NO - Fasting is not required for this test
    • Sample Collection: Blood sample collected via venipuncture; serum or plasma used for testing; timing of collection not affected by meals
    • Medications to Avoid: Generally no medications require discontinuation; however, inform healthcare provider of recent immunosuppressive therapy, vaccinations, or recent transfusions; certain medications (methyldopa, quinidine, NSAIDs, anticonvulsants) may cause false positive results by coating RBCs
    • Pre-test Preparation: No special preparation required; routine blood draw precautions apply; properly identify patient to ensure correct blood sample; inform phlebotomist of recent transfusions or pregnancy
    • Sample Handling: Keep sample at room temperature; do not refrigerate before testing (can cause cold agglutinin reactions); submit to laboratory promptly; improper storage may affect accuracy
    • Important Clinical Considerations: Patient should disclose history of previous transfusions, pregnancy, medications, and recent vaccinations; inform provider immediately if transfusion reaction symptoms develop after recent transfusion; emergency test availability important for pre-transfusion screening

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