A simple alternative for Rh phenotyping red cells that have a persistently positive Rh control

Investigation of a patient's red cell sample with a persistently positive Rh control revealed that if the patient's red cells were treated with ZZAP, then incubated at 37 degrees C with commercial Rhtyping reagents, then washed four times with saline, the positive Rh control could be circumvented and the Rh phenotype readily determined. One hundred red cell samples of known Rh phenotype were treated with ZZAP and coated with autoantibody to resemble the cells of the index case. Accurate results were obtained when these modified cell samples were tested against Rh typing reagents from three manufacturers using a 37 degrees C incubation followed by four saline washes. The procedure, termed Z37W, appears to be a simple alternative that can assist in determination of Rh phenotypes when the Rh control is positive.

Investigation of transfusion reactions through microcomputer education software

The purpose of this study was to develop educational software to simulate laboratory investigation of transfusion reactions. An interactive, branching-style program was developed using a 256K Personal Computer (International Business Machines, Boca Raton, FL). Over 75 institutions in the United States and Canada are currently using the software in preprofessional and continuing professional education programs.

Successful transplantation of blood group A2 kidneys into non-A recipients

The ABO subgroup A2 has been reported to be less reactive with the anti-A1 antibody naturally occurring in the serum of group O and B recipients and to occur in approximately 20% of group A individuals. Between March 1986 and February 1987, the Midwest Organ Bank (MOB) in Kansas City, screened all group A renal donors for the A2 subgroup. A total of 190 cadaverdonor kidneys were retrieved during this time, of which 68 were subgroup A1 and 16 were subgroup A2 (incidence of A2 = 19% of As and 8.5% of all donors). Of the subgroup A2 kidneys, 13 were transplanted into 9 group O and 4 group B recipients. One group O recipient received an HLA-identical A2 living-related graft. Recipients were not preselected or modified by splenectomy, plasmapheresis, or other means, and were treated with cyclosporine, steroids--and, in most cases, azathioprine, after transplantation. There was one hyperacute rejection and there were 5 acute cellular rejection episodes, 3 of which were reversed. One additional patient died at 2.5 months with a functioning graft. Including the successful living-related graft, 10 of 14 patients (71%) have functioning grafts, with a follow-up of 5 to 14 months, and a mean creatinine of 1.7 mg/dl. We find that the A2 subgroup represents a small but important minority of A donors, and that transplantation into non-A recipients can generally, but not universally, be safely accomplished. We recommend the screening of A donors for the A2 subgroup in both the cadaver-donor and living-related groups, and suggest that the utilization of A2 donors in non-A patients may contribute to the transplantation of group O and highly sensitized patients--and, in some cases, improve the degree of HLA matching.

Example of a thimerosal-dependent antibody without apparent blood group specificity

A third example of a thimerosal-dependent hemagglutinin is reported. The IgG antibody reacted by antiglobulin or ficin techniques with all cells incubated in the presence of thimerosal, including iadult cells and two examples of the Rhnull phenotype. Agglutination was inhibited by excess thimerosal (5 g/dl).

Solid-phase ABO grouping and Rh typing

A solid-phase adherence method (SPAM) for ABO grouping and Rh typing of red cells (RBCs) has been developed. Adherence reactions were read spectrophotometrically and interpreted by a computer. The SPAM had a 99.6 percent correlation with conventional microplate agglutination methods for ABO grouping and Rh typing. The increased sensitivity of the SPAM was demonstrated because it directly detected Du-positive RBCs and weak subgroups of A and B.

Solid-phase techniques in blood transfusion serology

For nearly a century, erythrocyte agglutination has persisted as the most widely used method for the demonstration of antigen-antibody reaction in immunohematology. So far, no other system has been developed which can match its simplicity, versatility, and general reliability. The major disadvantage of agglutination reactions is the lack of an objective endpoint, which has severely hindered attempts to automate routine pretransfusion tests. To overcome this problem, we have designed a series of solid-phase assays for ABO and Rh grouping, antibody screening, compatibility, and hepatitis tests. Each of these solid-phase assays shares a common endpoint of red cell adherence, which is easily interpreted visually or spectrophotometrically. Computer interface permits the automatic interpretation and recording of results. We believe this solid-phase system should finally bring the blood bank laboratory into the age of automation.

A solid-phase antiglobulin test

A solid-phase antiglobulin test was developed as an alternative to hemagglutination for compatibility testing. The solid-phase endpoint of red cell adherence allowed results to be read visually or spectrophotometrically. This method was easier to perform than a hemagglutination antiglobulin test and had increased sensitivity without loss of specificity.

A solid phase antibody screen

An automated solid phase antibody screen (SPAS) in microplates has been developed. Red blood cell (RBC) adherence was used as the end point instead of agglutination. Consequently, positive and negative reactions were readily distinguished by a microplate spectrophotometer. The SPAS performed as well as conventional antiglobulin methods for detecting IgG antibodies in donor sera and had increased sensitivity as determined by serial dilutions of antibodies.

Fatal intravascular immune hemolysis induced by hydrochlorothiazide

A patient receiving antihypertensive therapy developed acute intravascular hemolysis and died. Hemolysis was due to an immune process associated with antibody to thiazide. Only two other cases have been reported. Thiazide-induced hemolysis appears to be confined to those patients treated concommitantly with methyldopa.

Range forb lectins

In this study we tested the seeds of uncultivated plants for lectin activity. Extracts prepared from the seeds of 167 forb species were tested against human red cell samples. Extracts of 54 species agglutinated unmodified or enzyme-modified red cells. In nine species, the hemagglutinating lectin activity could be neutralized by N-acetyl-D-galactosamine, mannose, or glucose.

Incompatibility associated with the bite of a brown recluse spider (Loxosceles reclusa)

Red cell samples from a patient who was suffering from massive hemolysis due to a brown recluse spider (Loxosceles reclusa) bite were found to be reactive by indirect antiglobulin test with most ABO-compatible serum samples. Spider venom, enzymes related to those in spider venom, and antisera to plasma proteins and Rh antigens were used to investigate the unusual reactivity of the patient's cells. IgG was detected on the patient's cells by indirect antiglobulin tests. Cells treated with brown recluse spider venom or phosphatidylcholine phosphatidohydrolase reacted similarly. These findings suggest that sphingomyelinase D, which has been identified in brown recluse spider venom, may be related to the unusual reactivity of the patient's cells. Unexpected reactions were observed when venom-treated cells were tested with Rh antibodies: O negative cells absorbed and eluted anti-D from Rh immune globulin; E negative cells were reactive with a commercial anti-E reagent.

Anti-Wj: an autoantibody that defines a high-incidence antigen modified by the In(Lu) gene

An IgG autoantibody, named anti-Wj, reacts with all random and most selected red cell samples. It does not agglutinate cells of Lu(a-b-) type caused by the In(Lu) dominant inhibitor gene, but cells of recessive Lu(a-b-) type are reactive. These data establish that synthesis of the Wj antigen is suppressed by the In(Lu) gene, but it is not a part of the Lutheran blood group system. The Wj antigen is not well developed on fetal red cells. This example of auto anti-Wj is a non-complement-binding IgGl protein that did not appear to cause accelerated in vivo destruction of the patient's red cells.

Hematologic and enzymatic analysis of Ctenopharyngodon idella x Hypophthalmichthys nobilis F1 hybrids

1. Erythrocyte counts, hemoglobin concentrations and hematocrit values were determined for diploid and triploid Ctenopharyngodon idella X Hypophthalmichthys nobilis hybrids and the parental species. 2. Comparisons of diploid and triploid hybrids with the parental species revealed low erythrocyte counts for triploids, high mean corpuscular hemoglobin values for triploids, elevated hematocrits for diploids and triploids and similar hemoglobin concentrations for all fish. 3. Alkaline phosphatase, aldolase, and lactate dehydrogenase specific activities were determined spectrophotometrically. Levels of specific activity of these enzymes in the hybrids were consistently elevated above that of the parental species. These higher levels of enzyme activities in hybrids were probably the result of a breakdown in gene regulation.

Factors influencing monocyte recognition of human erythrocyte autoantibodies in vitro

Erythrocytes, serum, and blood monocytes from patients with erythrocyte autoantibodies were examined by in vitro serologic and cell culture procedures in order to evaluate factors modulating patient mononuclear phagocyte activity. Monocyte recognition of autoantibody-coated erythrocytes was influenced both by antibody titer score and by the monocyte source. The results suggest that patients with low serum autoantibody titer scores and normal monocyte behavior are less likely to destroy autologous or normal donor erythrocytes than are patients with high-serum antibody titer scores or enhanced monocyte activity. We conclude that patient, rather than normal donor monocytes, must be used in cellular assays designed to predict the fate of erythrocytes transfused into patients with erythrocyte autoantibodies.

SEM analysis of body hairs and whiskers of heterozygous tortoiseshell (Moto/+) female mice (Mus musculus)

Back hairs of +/+ and Moto/+ female Mus musculus generally exhibited identical form when examined by SEM. However, the hair shafts of Moto/+ female mice were beaded in appearance (monilethrix), twisted (pili torti) or exhibited a rough nodular appearance. Also, some hairs of Moto/+ female mice which were devoid of pigment appeared enlarged and bitubular. The whiskers of +/+ and Moto/+ female mice were identical in form. The hair abnormalities of Moto/+ female mice resulted from a copper deficiency and were similar to those hair anomalies observed in other mottled mice and in copper-deficient crinkled mice.