A Comparative Evaluation of ABO Blood Group Antibody Titer Using Normal Saline, Low Ionic Strength Solution, and AB Plasma

Background Acute hemolytic transfusion reactions, hemolytic disorders in fetuses and neonates, and hemolysis in incompatible allogeneic hematopoietic stem cell transplantation are predominantly induced by antibodies in the ABO blood group system. Environmental factors appear to exert the most significant influence on the concentrations of isoagglutinin A and B antibody molecules, which may be classified as IgG, IgM, or IgA. The current study aimed to evaluate the ABO isoagglutinin A and B titers of whole blood donors. Methods This observational cross-sectional study was conducted at the All India Institute of Medical Sciences, Bhopal, India. We evaluated ABO isoagglutinin A and B titers in 199 healthy blood donors (Groups A, B, and O). Donor selection was based on national guidelines. Antibody titrations were performed using 0.9% normal saline (NS), low ionic strength solution (LISS), and AB plasma, followed by a comparative analysis. Results Antibody titration was done with all blood group donors with three different diluent media. Spearman's rank correlation coefficient (r) is used to assess the strength and significance of the relationship between titer measurements. A p-value under 0.05 was considered statistically significant for all analyses. A strong positive correlation was observed between NS and LISS (r = 0.828, <i>p</i> < .001), indicating high concordance between these two methods. Moderate correlations were found between AB plasma and both NS (r = 0.320) and LISS (r = 0.417), suggesting that AB plasma may yield slightly variable results compared to the other two techniques. All correlations were statistically significant (<i>p</i> < .05) in the anti-A titer of Blood Group B. Conclusion Among the three diluent media-normal saline, low ionic strength solution, and AB plasma-the low ionic strength solution yielded the most favorable titration results, followed by normal saline. Either diluent may be utilized for ABO antibody titration, contingent upon sensitivity. AB plasma produces inferior outcomes in comparison to other types. However, further multicenter studies are required to validate our results.