Red cell antibodies can be detected with a direct Coombs test (antibody fix to red cells) and/or with an indirect Coombs test (free antibodies in serum or plasma). A positive direct Coombs test means the patient have an autoantibody directed to his own red cells, that is an immune hemolytic disease (sometimes without hemolysis or anemia). If the patient have a positive indirect Coombs test with a negative direct Coombs you can pressume he or she is alloimmunized by transfusions. You need to have a pool of identified red cells for the most common antigens (there are also commercially available panel detectors of 2 or 3 tubes). Once done you may assume, with the antigen chart, to which system is or are the antibodie/s directed. Usually a polytransfused patient first have alloantibodies against the Rh system (most commonly anti-E), and then for the Kell system (most commonly anti-K1). To identify correctly the antibody you must test the patient's serum or plasma against a panel of at least 11 tipified red blood cells and ending with the antiglobulun phase (Coombs antiglobulin-serum). Remember that red cell antibodies may be cold or warm (reacting preferably at 4ºC or 37ºC respectively). Therefore the test should be done at both temperatures. Details of the techniques may be found at the AABB Manual.