Gene deletion in a patient with chronic granulomatous disease and McLeod syndrome: fine mapping of the Xk gene locus

In a patient suffering from X-linked chronic granulomatous disease (X-CGD)--a disorder of phagocytesuperoxide generation--and McLeod syndrome, characterized by the absence of the red cell Kell antigen, we identified a deletion of the entire X-CGD gene by means of DNA hybridization with a cDNA probe. Our findings suggest that the X-CGD and McLeod loci are physically close in the p21 region of the X chromosome proximal to the Duchenne muscular dystrophy locus.

Comparison of a commercial hexadimethrine bromide method and low-ionic-strength solution for antibody detection with special reference to anti-K

The sensitivities of manual low-ionic hexadimethrine bromide (Polybrene, LIP) and low-ionic Polybrene indirect antiglobulin tests (LIPAT) were compared with those of a manual low-ionic-strength indirect antiglobulin test (LISS) by using a commercial Polybrene kit. One hundred antibodies were coded, titrated, and tested in parallel. LIP did not detect 36 antibodies: 31 anti-K, two anti-E, two anti-Fya, and one anti-Jka. LIPAT did not detect seven anti-K, two anti-E, and two anti-Jka. The combination of LIP and LIPAT did not detect two anti-E that were reactive only in a two-stage enzyme test and seven anti-K that had titers of 2 or lower by LISS. LISS detected all antibodies except for the two enzyme-reactive anti-E. There were no significant differences in the titers of 63 percent of the antibodies studied. For 54 percent of the antibodies in the Kell system, LISS produced significantly higher titers; for 25 percent of antibodies in the Rh system, LIP did so. The poor sensitivity of the Polybrene kit for anti-K makes it unsuitable as a primary method for antibody screening.

Fetal blood group determination in first-trimester pregnancy for the management of severe immunization

The presence or absence of Rho (D) and Kell antigens on fetal red blood cells was determined in the first trimester of pregnancy on erythrocytes obtained by chorionic villi sampling with the use of mixed agglutination and solid phase microimmunofluorescence techniques. Pregnancies in one Kell-sensitized woman and seven severely RH-sensitized women with a poor obstetric history and a partner heterozygous for the offending antigen were examined. A conclusive diagnosis could be made in seven of the eight cases studied.

Positive antiglobulin tests due to intravenous immunoglobulin in patients who received bone marrow transplant

To investigate an increased frequency of positive direct (DAT) and indirect (IAT) antiglobulin tests in bone marrow transplant (BMT) patients who received intravenous immunoglobulin (IVIG), serologic testing was performed weekly on blood samples from 94 consecutive BMT patients. Group 1 (47 patients) did not receive IVIG. Group II (47 patients) received high-dose IVIG as prophylaxis for cytomegalovirus infections. Before transplantation no alloantibodies were found in the serums of 92 patients and anti-E was found in the serums of two patients. DATs were negative in all patients before BMT. Four percent of Group I had a positive IAT and 13 percent had a positive DAT. In contrast, 25.5 percent of Group II patients had a positive IAT and 49 percent had a positive DAT, usually within 1 week after initiation of IVIG therapy (p less than 0.001). Antibodies identified in serums and eluates of patients in Group I were anti-A and anti-B. Antibodies identified in serums and eluates of patients in Group II were anti-A, -B, -D, and -K. Twenty-one lots of IVIG were tested and antibodies identified were anti-A, -B, -D, and -K. The data suggest that the higher frequency of positive serologic tests in Group II was due to passively acquired antibodies from high-dose IVIG.

Isolation of a Kell-reactive protein from red cell membranes

A red cell membrane protein which exhibits Kell blood group antigen activity has been identified with a purified anti-Kell bound to a Protein-A agarose column and eluting with lithium diiodosalicylate (LIS). Although anti-Kell as well as the Kell-reactive membrane protein were eluted from the column, the eluate was capable of reducing the titer of added anti-Kell from 64 to 4. In addition, the eluate was shown to possess Kell reactivity by binding I125 Protein A after incubation with anti-Kell. Electrophoresis (SDS gel polyacrylamide 5-20% gradient) showed a band at approximately 90,000 daltons when solubilized membranes from Kell-positive red cells were used but not when membranes from dithiothreitol- and papain-treated Kell-positive red cells or Kell-negative red cells were used. A band isolated with unreduced conditions was capable of neutralizing anti-Kell.

Sonographic detection of fetal hydrops. A report of two cases

Ultrasound can be useful for fetal assessment in Kell-isoimmunized pregnancies. Because severe hydrops may develop within six days, ultrasound should be repeated more frequently than once per week even if the delta OD450 values are low.

A proposal for compatibility testing incorporating the manual hexadimethrine bromide (Polybrene) test

In November 1984, the Standards Committee of the American Association of Blood Banks changed the requirements for pretransfusion testing by making the performance of an antiglobulin crossmatch optional when the antibody screening test is negative. The crossmatch would be necessary only to confirm ABO compatibility. Many will welcome this change; others will persist in their current methods. This article presents data supporting the use of the manual hexadimethrine bromide (Polybrene) test, a 1-minute room temperature procedure, as a crossmatch technique when the antibody screening test is negative. The manual Polybrene test (MPT) is an effective method for detecting ABO incompatibility. Forty-seven randomly selected serums gave expected results with A1, A2, and B red cells. Only 66 percent of 84 group B sera were serologically incompatible with A2B red cells by MPT, but the same results (69% positive) were observed using a 5-minute low-ionic-strength solution (LISS) room temperature technique. As only 37 percent of these crossmatches were incompatible using a LISS immediate spin (IS) method, the reliability of an IS method is questioned. An MPT crossmatch provides added security in that most unexpected blood group antibodies are demonstrable by this method. Of 106 serums tested which contained antibodies, 83 reacted. We believe that the MPT provides a rapid and sensitive test that, accompanied by a carefully performed antibody screening test, meets the requirements of Standards and will provide for safe red cell transfusion without the need for an antiglobulin crossmatch.

Frequency of alloantibodies accompanying autoantibodies

Blood samples of 109 patients with warm autoantibodies were evaluated for the presence of accompanying alloantibody. Clinically significant alloantibodies were present in 41, or 38 percent, of the cases.

The phospholipid organisation in the membranes of McLeod and Leach phenotype erythrocytes

The phospholipid composition, the distribution of phospholipids over the two membrane layers as well as the phosphatidylcholine-specific transfer protein-mediated exchangeability of phosphatidylcholine from the membrane, has been investigated in two types of abnormal erythrocytes--the McLeod phenotype and the Leach phenotype. The acanthocytic McLeod cells appeared to have a normal phospholipid composition and distribution, but the exchangeability of phosphatidylcholine was found to be markedly enhanced. Unlike control erythrocytes, in which 75% of all of the phosphatidylcholine can be exchanged during an 8 h incubation, the McLeod cell showed a complete exchange of this phospholipid within the same time period. This obviously indicates an enhanced transbilayer mobility of phosphatidylcholine in the membrane of McLeod cells. Erythrocytes of the Leach phenotype showed an elliptocytic shape and increased osmotic fragility, but no abnormalities were observed as to the composition and organisation of the phospholipid complement of their membranes.

Expression of red cell antigens by K562 human leukemia cells before and after induction of hemoglobin synthesis by hemin

We studied the red cell antigens present on K562 human leukemia cells before and after induction of hemoglobin synthesis by hemin. The fetal antigens i, IF, and IT were detected on uninduced cells. While expression of both i and IT antigens increased after hemin induction, expression of IT was closely related to fetal hemoglobin synthesis as determined in experiments in which the induction was reversed. The EnaFR, NVg, and T antigens of glycophorin A were also present on uninduced cells. In contrast, the M and Pra antigens of glycophorin A, the Kell system antigens, and the P1 antigen became detectable only after hemin induction. Antigens of other major red cell systems were not detected.

Glucose-6-phosphate dehydrogenase deficiency and blood groups in northern Sardinia

Glucose-6-phosphate dehydrogenase deficiency, A1A2BO, Rhesus and Kell systems were investigated in a sample of 28,439 blood donors native of northern Sardinia. The frequency of deficient male individuals was 6.56%. Higher values of r, D, and CDe compared to the averages for continental Italy were observed. Variations within the island were found in the A1A2BO and Rhesus blood group systems.

Use of a modified procedure for treating small amounts of red blood cells with 2-aminoethylisothiouronium bromide

Kell null red blood cell samples can be prepared using 2-aminoethylisothiouronium bromide (AET). This article describes a modification whereby only three drops of a 5% red blood cell suspension may be AET treated. This procedure has been used routinely in the authors' laboratory for more than a year. One patient's serum contained anti-Kpb plus anti-C and anti-D. Tests with panel cells pretreated with AET made it possible to identify underlying Rh antibodies without using a panel of genetic Kpb negative red blood cells. Of 24 red blood cell eluates from patient sample with warm autoantibodies, one had specificity within the Kell blood group system. This small volume AET-treatment method is a quick screen for the differentiation of a Kell-related specificity from a non-Kell specificity of both warm autoantibodies and alloantibodies to high-incidence antigens.

Distribution of eight blood-group systems and ABH secretion in Mongolian, Korean, and Zhuang nationalities in China

Among different blood-group systems investigated here, the distribution of the ABO system varies most of all, followed by MNSs and P. Although there are differences in ABH secretion in the different populations, no striking regularity has been found. No significant difference has been found in the distribution of the blood-group systems Rhesus, Diego, Duffy, Kell and Kidd in these Chinese populations: the Rh (-) rate is less than 1%, the frequency of Dia is about 0.04, the frequency of Fya is rather high, the frequency of K extremely low and Jka is about 0.4. In the three nationalities under study, Mongolians are characterized by a high frequency of IB, M higher than 0.5 and a relatively high frequency of P1. Koreans are characterized by a high frequency of IA, slightly more M than N and rather high CDE in the Rh system. The peculiarities of the Zhuangs are a rather high frequency of IO and M and the lowest frequency of P1.

Automated reading of red cell antibody identification tests by a solid phase antiglobulin technique

A new solid phase antiglobulin ( SPAG ) test is described which makes possible the automated reading of erythrocyte antibody identification tests. This new test uses microplates coated with anti-human globulin as a solid phase onto which previously sensitized erythrocytes adhere. A wash stage removes unsensitized erythrocytes and a chromogenic substrate is reacted with the hemoglobin peroxidase of the adhering, sensitized red cells. The color produced is read automatically on a spectrophotometer interfaced with a computer programmed to produce printouts of results. Comparative tests between conventional anti-human globulin tests and the SPAG test using titrated antibodies showed equivalent sensitivity. Comparisons of the present test system in use in our laboratory, consisting of saline, 0.5 percent bromelin, and indirect anti-human globulin techniques for identifying antibodies, with a SPAG test used in conjunction with a bromelin-enzyme test system, showed agreement in 224 (90%) of the 249 sera tested. This methodology is compared with current enzyme-linked immunosorbent assay (ELISA) techniques.

Erythrocyte antigens on human platelets. Absence of Rh, Duffy, Kell, Kidd, and Lutheran antigens

There is considerable controversy as to whether antigens of the Rh, Duffy, Kidd, Kell, or Lutheran red cell systems are present on human platelets. The majority of previous investigators of this topic have reported them to be present. We have used a sensitive two-stage radioimmunoassay to examine human platelets for the presence of antigens of these five red cell systems. Platelets from donors of appropriate red cell phenotype were incubated with monospecific anti-erythrocyte IgG, followed by a second-stage incubation with 125I-labeled mouse IgG monoclonal anti-human IgG (Fc). Analysis of ligand bound per cell demonstrated no significant difference in binding of erythrocyte antibodies to platelets from donors homozygous, heterozygous, or negative for D, C, c, E, e, Fya, Fyb, Jka, Jkb , K, k, and Lub antigens. These findings indicate that major antigens of the Rh, Duffy, Kidd, Kell, and Lutheran systems are not expressed on the surface of human platelets.

[Effect of the genetic markers Kell(K1), P1, Km(1), Tf(C<B<D), AK and 6-PGD on the outcome of paternity cases]

This statistical analysis of the results of 288 paternity cases is a contribution to the discussion of those blood group systems to be selected for the basis of paternity expertise in the Federal Republic of Germany. When typing 22 blood-group systems in 288 one-man cases, we found exclusions in 101 (35.07%) of them. In only 83 (44.39%) of the 187 cases with nonexclusions did the resulting EM value correspond to the verbal predicate: "paternity practically proved." The results of the systems of factors Kell(K1), Tf(C,B,D), AK and 6-PGD had the smallest rate of exclusion constellations and only inferior influence on the resulting EM values. Replacing them by isoelectric focusing of the systems PGM1, Tf, Gc, Pi and PLG (plasminogen) seems to be reasonable. The factors P1 and Km(1) proved more favorable for the results of paternity cases.

Disulfide bonds are a requirement for Kell and Cartwright (Yta) blood group antigen integrity

We have investigated the effect of dithiothreitol (DTT) upon the Kell blood group system and other red cell antigens. All Kell blood group antigens studied (K, k, Kpa, Kpb, Jsa, Jsb and Ku) as well as the Cartwright (Yta) antigen were completely denatured after treatment with DTT. The Gerbich antigen was substantially weakened but not completely denatured. The Jsa and Jsb antigens appear to have an exquisite sensitivity to treatment with DTT and can be completely denatured using very low concentrations (less than or equal to 2 mM) whereas other Kell system antigens require much higher concentrations of DTT for their denaturation (100-200 mM). Of 38 other blood group antigens investigated, only the Yta antigen was completely denatured using 200 mM DTT. Furthermore, the Yta antigen was denatured within the same concentration range as Kell and one can speculate that this indicates some biochemical relationship between these two blood group systems. From our results, we conclude that: (1) at least two distinct disulfide (S-S) bonds are required for maintenance of the Kell blood group antigen system; (2) Jsa and Jsb antigens are distinctly different from other Kell system antigens based upon sensitivity to treatment with DTT; these antigens may be located on a different antigenic domain; and (3) the Yta antigen requires at least one disulfide bond for its maintenance of antigen integrity. Although the Gerbich antigen was not completely denatured, results indicate that disulfide bonds may also be important structural determinants for these antigens.

Comparison of antibody elution techniques by enzyme-linked antiglobulin test

The enzyme-linked antiglobulin test was used to determine the percentage of antibody removed from sensitized red cells by five elution methods: Rubin ether, xylene, digitonin-acid, glycine, and heat. Antibodies examined in the study included anti-D, -c, -E, and -K. With two examples of anti-D, more antibody was eluted by the Rubin ether method (45.5% average) than the xylene (38%) or the digitonin acid method (35%) (p less than 0.05); the glycine (8%) and heat method (15%) were less efficient. With one example of anti-E and one example of anti-c, more antibody was eluted by the ether method. The percentage of anti-K recovery, however, was greater with the digitonin acid method (45%) than with the ether (30%). We found the enzyme-linked antiglobulin test method useful in the quantitative evaluation of elution procedures.

Paternity testing: analysis of six blood groups and HLA markers, with particular reference to comparison of races

Blood groups (ABO, Rh, MNSs, Kell, Duffy, and Kidd) and HLA markers were tested in cases involving 563 children of disputed parentage. In 149 (26.5%) cases, the accused men were excluded as the biologic fathers of the children in question. One hundred forty of the 149 exclusions were direct exclusions. Five exclusions were based on red blood cell data alone, i.e., HLA was non-exclusionary. Of the remaining 414 cases in which the alleged father could not be excluded as the biologic father, in 361 (87.2%) instances, the plausibility of paternity ws 95% or greater, and in 385 (93.0%) instances the comparison of men value was 20 or greater. Caucasians, blacks, and men of other races were involved in 367 (65.1%), 185 (33%), and 11 (1.9%) cases, respectively. No significant difference among races was observed in the rate of exclusion of accused men. However, of the non-excluded men, in a significantly greater proportion of black men than white men, the plausibility of paternity was below 95%. The difference was probably due to lower polymorphism of the markers tested in blacks than in whites. It is suggested that tests for additional polymorphic genes be directed towards the 12-15% of the nonexclusionary cases with plausibility of paternity values below 95%.