Samwel Mikaye/LinkedIn
Mar 2, 2026, 16:01
Samwel Mikaye: Understanding Direct and Indirect Coombs Testing in Diagnosing Immune-Mediated Hemolysis
Samwel Mikaye, Medical Doctor at MSK, shared a post on LinkedIn:
“Coombs Test (Antiglobulin Test)
The Coombs test detects antibodies or complement proteins bound to red blood cells (RBCs), helping diagnose immune-mediated hemolysis.
There are two main types: Direct and Indirect.
1. Direct Coombs Test (DAT)
Purpose: Detects antibodies already attached to the patient’s RBCs.
Principle
- Patient RBCs are washed and incubated with Coombs reagent (anti-human globulin).
- If RBCs are coated with IgG or complement, the reagent causes agglutination.
Clinical Uses
- Autoimmune hemolytic anemia (AIHA)
- Warm antibody type (IgG)
- Cold antibody type (IgM/complement)
- Hemolytic disease of the newborn (HDN)
- Mother’s antibodies attack fetal RBCsDrug-induced hemolysis
2. Indirect Coombs Test (IAT)
Purpose: Detects antibodies in the patient’s serum that can bind to RBCs.
Principle
- Patient serum is incubated with RBCs of known antigen type.
- Coombs reagent is added – agglutination indicates presence of antibodies.
Clinical Uses
- Pre-transfusion testing (detecting incompatible antibodies)
- Prenatal testing for Rh incompatibility (maternal anti-D antibodies)”
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