Antibody Tests (Coombs Test)

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Antibody tests are done to find certain antibodies that attack red blood cells.Antibodies are proteins made by
the immune system. Normally, antibodies bind to foreign substances, such as bacteria and viruses, and cause them
to be destroyed.
The following conditions cause antibodies to be made.
Transfusion reaction
Human blood is typed by certain markers (called antigens) on the surface of red blood cells . f you get a blood
transfusion, the transfused blood must match your type. That means the transfused blood must have the same
antigens as your red blood cells. f you get a transfusion of blood with antigens different from yours (incompatible
blood), your immune system destroys the transfused blood cells. This is called a transfusion reaction and can
cause serious illness or even death. This is why matching blood type is so important.
Rh sensitization
!h is an antigen. The full name for this antigen is !hesus factor.
f a pregnant woman with !h"negative blood is pregnant with a baby (fetus) with !h"positive blood, !h sensiti#ation
may occur. The baby may have !h"positive blood if the father has !h"positive blood. !h sensiti#ation happens when
the baby$s blood mi%es with the mother$s blood during pregnancy or delivery. This causes the mother$s immune
system to make antibodies against the baby$s red blood cells in future pregnancies. This antibody response is called
!h sensiti#ation and, depending on when it happens, can destroy the red blood cells of the baby before or after it is
born. f sensiti#ation happens, a fetus or newborn can develop mild to severe problems (called !h disease
or erythroblastosis fetalis). n rare cases, if !h disease is not treated, the fetus or newborn may die.
A woman with !h"negative blood can get a shot of !h immunoglobulin (such as !ho&A') that almost always stops
sensiti#ation from occurring. (roblems from !h sensiti#ation have become very rare since !h immunoglobulin was
developed.
Autoimmune hemolytic anemia
A type of hemolytic anemia called autoimmune hemolytic anemia is a rare disease that causes antibodies to be made
against a person$s own red blood cells.
Two blood tests can check for antibodies that attack red blood cells) the direct *oombs test and the indirect *oombs
test. The direct *oombs test is done on a sample of red blood cells from the body. t detects antibodies that are
already attached to red blood cells. The indirect *oombs test is done on a sample of the li+uid part of the blood
(serum). t detects antibodies that are present in the bloodstream and could bind to certain red blood cells, leading to
problems if blood mi%ing occurs.
Why It Is Done
Direct Coombs test
The direct *oombs test finds antibodies attached to your red blood cells. The antibodies may be those your body
made because of disease or those you get in a blood transfusion.
Why It Is Done continued...
The direct *oombs test also may be done on a newborn baby with !h"positive blood whose mother has !h"negative
blood. The test shows whether the mother has made antibodies and if the antibodies have moved through
the placenta to her baby.
Indirect Coombs test
The indirect *oombs test finds certain antibodies that are in the li+uid part of your blood (serum). These antibodies
can attack red blood cells but are not attached to your red blood cells. The indirect *oombs test is commonly done to
find antibodies in a recipient$s or donor$s blood before a transfusion.
A test to determine whether a woman has !h"positive or !h"negative blood (!h antibody titer) is done early in
pregnancy. f she is !h"negative, steps can be taken to protect the baby.
How To re!are
,ou do not need to do anything before you have this test.
How It Is Done
The health professional drawing blood will)
-rap an elastic band around your upper arm to stop the flow of blood. This makes the veins below the
band larger so it is easier to put a needle into the vein.
*lean the needle site with alcohol.
(ut the needle into the vein. f the needle is not placed correctly or if the vein collapses, more than one
needle stick may be needed.
Hook a tube to the needle to fill it with blood.
!emove the band from your arm when enough blood is collected.
(ut a gau#e pad or cotton ball over the needle site as the needle is removed.
(ut pressure to the site and then a bandage.
How It "eels
The blood sample is taken from a vein in your arm. An elastic band is wrapped around your upper arm. t may feel
tight. ,ou may feel nothing at all from the needle, or you may feel a +uick sting or pinch.
Ris#s
There is very little chance of a problem from having blood sample taken from a vein.
,ou may get a small bruise at the site. ,ou can lower the chance of bruising by keeping pressure on the
site for several minutes.
n rare cases, the vein may become swollen after the blood sample is taken. This problem is
called phlebitis. A warm compress can be used several times a day to treat this.
.ngoing bleeding can be a problem for people with bleeding disorders. Aspirin,warfarin (*oumadin), and
other blood"thinning medicines can make bleeding more likely. f you have bleeding or clotting problems, or if you
take blood"thinning medicine, tell your doctor before your blood sample is taken.
Results
Antibody tests (*oombs tests) are done to find antibodies that attack red blood cells.
$ormal
No antibodies are found. This is called a negative test result.
Direct Coombs test. A negative test result means that your blood does not have antibodies attached to
your red blood cells.
Indirect Coombs test. A negative test result means that your blood is compatible with the blood you are to
receive by transfusion. A negative indirect *oombs test for !h factor (!h antibody titer) in a pregnant woman means
that she has not developed antibodies against the !h"positive blood of her baby. This means that !h
sensiti#ation has not occurred.
Abnormal
Direct Coombs test. A positive result means your blood has antibodies that fight against red blood cells.
This can be caused by a transfusion of incompatible blood or may be related to conditions such as hemolytic
anemia or hemolytic disease of the newborn (H/N).
Indirect Coombs test. A positive test result means that your blood is incompatible with the donor$s blood
and you can$t receive blood from that person. f the !h antibody titer test is positive in a woman who is pregnant or is
planning to become pregnant, it means that she has antibodies against !h"positive blood (!h sensiti#ation). 0he will
be tested early in pregnancy to check the blood type of her baby. f the baby has !h"positive blood, the mother will be
watched closely throughout the pregnancy to prevent problems to the baby$s red blood cells. f sensiti#ation has not
occurred, it can be prevented by a shot of !h immunoglobulin.
What Affects the Test
!easons you may not be able to have the test or why the results may not be helpful include)
Having a blood transfusion in the past.
1eing pregnant within the past 2 months.
Taking some medicines, such as cephalosporins, sulfa medicines, tuberculosismedicines, insulin, and
tetracyclines.
What To Thin# About
A newborn baby (whose mother has !h"negative blood) may have a direct *oombs test to check for antibodies
against the baby$s red blood cells. f the test is positive, the baby may need a transfusion with compatible blood to
prevent anemia.