Production of direct agglutinins by the combination of incomplete antibodies to protein A-bearing Staphylococcus aureus cells

A novel method is described for the production of saline-reacting antibodies from "incomplete' blood grouping sera. IgG anti-D is combined to protein A-bearing Staphylococcus aureus (SA), forming a polyvalent anti-D assembly. The SA-anti-D has a high titre in saline and is stable on 4 degrees C storage and lyophilisation. The material was successful in Rh(D) typing cells sensitised in vitro with various antibodies. Saline-reacting SA-anti-Kell and SA-anti-C were also produced.

Multiple antibody formation in a primigravida: anti-D, anti-C, anti-Kpb

A case of primigravida in whom anti-C, anti-D, and anti-Kpb developed during the third trimester is described. Her first-born infant, delivered at 40 weeks' gestation, was mildly affected with hemolytic disease of the newborn and responded well to phototherapy. Her second-born infant, delivered at 36 weeks' gestation, had a positive direct antiglobulin test, but required no treatment. Clinical and laboratory aspects of both pregnancies are discussed.

Structural and biochemical analysis of the Mcleod erythrocyte membrane. I. Freeze fracture and discontinuous polyacrylamide gel electrophoresis analysis

The abnormal erythrocyte of the McLeod phenotype displays a reduced Kell blood group expression, an abnormal morphology in about 30% of the total red blood cell population and a decrease in water permeability. These parameters have previously been shown to be independent of membrane lipid composition, microviscosity and electrolyte transport. Findings such as these seem to implicate the involvement of a defective membrane protein. The present study investigated membrane composition by utilizing two techniques: freeze-fracture electron microscopy and discontinuous polyacrylamide gel electrophoresis. Electrophoretic scans revealed no apparent band additions or deletions showing McLeod membrane protein composition to be normal. Freeze-fracture electron microscopy did show a significant increase in intramembrane particle density. These findings may be resolved by proposing a dissociation of the band 3 glycoprotein. Unlinkage of this polypeptide, thought to be involved in water transport and intramembranous particle composition, could account for the decreased water transport and increased particle density seen in the McLeod erythrocyte membrane.

Management of Hodgkin's disease in a patient with sickle cell anemia

A right periauricular swelling developed in a 21-year-old woman with sickle cell anemia. The mass was removed and revealed Hodgkin's disease of the lymphocyte predominance type. While preparing the patient for a staging laparotomy, an allo-anti-Kell and an allo-antic-C were identified in the patient's sera. The patient's direct antiglobulin test was positive and an auto-anti-e was eluted from the patient's erythrocytes. The patient was treated with nine courses of MOPP therapy given over a nine-month period. The clinical and therapeutic implications for the management of patients with sickle cell anemia and lymphoproliferative disorders are discussed.

Acanthocytosis and haemolytic anaemia due to the McLeod blood group

A fourteen-year-old boy presenting with marked acanthocytosis of the red blood cells and a compensated haemolytic anaemia was shown to have the McLeod blood type. Only three other individuals have been reported as having this abnormality of the Kell blood group system without evidence of chronic granulomatous disease. Serological typing for the McLeod phenotype should be undertaken in males with unexplained acanthocytosis, and CPK estimation may provide a screening test for this condition.

Hemolytic transfusion reaction due to anti-Kell undetectable in low-ionic-strength solutions

Low-ionic-strength solution (LISS) reagents and methodologies have become popular in recent years in hospital transfusion service laboratories for alloantibody detection and compatibility testing of blood recipients. It has been the experience with all other hemagglutination technics that some examples of alloantibodies unpredictably fail to react. Such is the case with this patient's alloantibody with respect to LISS. The patient had a significant hemolytic transfusion reaction due to Kell incompatibility of one unit of packed human erythrocytes. Using various LISS reagents and methodologies, the anti-Kell was undetectable in pretransfusion and posttransfusion samples through the fifth day. The anti-Kell was of immunoglobulin class IgG, and it was detected in saline solution or albumin at room temperature, at 37 C and by the antiglobulin technic.

A second case of hemolytic disease of the newborn due to anti-Jsa

A second case of hemolytic disease of the newborn caused by Jsa sensitization is reported. The child was mildly affected and transfusions were not required. The mother and father are Arabs. Jsa was present in the father, the baby in question, and a sibling. In addition, the Fy gene was present in both mother and father, and in two of their three children.

Sinusoidal fetal heart rate pattern with severe fetal anaemia. Case report

A sinusoidal fetal heart rate pattern, associated with Kell incompatibility, severe fetal anaemia, maternal hypertension and intrauterine fetal growth retardation, is described. The mechanism and management are discussed.

[Hydrops fetalis caused by isoimmunization against Kell factor (author's transl)]

The article reports on a case of hydrops fetalis caused by Kell antibodies, antibody formation having been triggered by pregnancy. Since the relative frequency of Kell (and rhesus sub-group) intolerance is increasing due to the successes achieved by anti-D-immunoglobulin prophylaxis, the question arises, on account of the possibly severe course of the disease, whether the Kell factor should be taken into consideration in all blood transfusions in girls during their childhood and in women of childbearing age.

[Cross matching]

Donor blood should be selected properly before transfusion. Cross-matching has to be done in the laboratory by at least two established techniques. The importance of the bedside test and the controlled blood transfusion is pointed out.

The manual polybrene test: a simple and rapid procedure for detection of red cell antibodies

A rapid manual Polybrene test for detection of red blood cell antibodies have been devised which uses standard laboratory equipment. Red blood cells are incubated with the test sera in a low ionic medium at room temperature for one minute. Polybrene, a quaternary ammonium polymer, is then introduced to cause nonspecific red blood cell aggregation. The test tubes are centrifuged, the cell free supernatant fluid decanted, and the Polybrene effect on the cells is neutralized by adding a dilute sodium citrate-glucose solution. The hemagglutination results are evaluated macroscopically and microscopically. The entire procedure is completed in less than three minutes. In the Rh system, the test is 10--160-fold more sensitive than the antiglobulin reaction. In other systems tested, except for the Kell, a high sensitivity is achieved. The sensitivity for the Kell system is markedly increased, however, by performing a supplementary antiglobulin reaction on the sensitized, Polybrene-treated, red blood cells. The antiglobulin reagent used for this purpose should lack anti-C4 and anti-C3 activities. Sensitivity for cold reactive antibodies is augmented by cooling the cells for 30 seconds before citrate-glucose reagent is added.

Congenital dyserythropoietic anaemia (CDA) with severe gout, rare Kell phenotype and erythrocyte, granulocyte and platelet membrane reduplication: a new variant of CDA type II

A 43-year-old man with lifelong anaemia showed features which indicate him to have a previously undescribed variant of congenital dyserythropoietic anaemia (CDA), type II. The main clinical features--of which the first two are unique or very unusual in CDA--have been severe tophaceous gout, massive splenomegaly, gall stones mecessitating cholecystectomy and haemosiderosis affecting the liver and probably the heart. At age 41 he sustained a spontaneous retinal detachment. In the peripheral blood there were large numbers of nucleated red blood cells and marked macrocytosis; otherwise the picture was typical of CDA type II. The bone marrow contained many bi- and multi-nucleated erythrocyte precursors. There were increased levels of a number of red cell enzymes and a slightly raised level of HbF. Uncharacteristically, the red cells failed to lyse with acidified normal serum. The cells were strongly agglutinated by anti-i and were of the rare Kpb-negative phenotype. Plasma lipid analysis showed very low levels of cholesterol and vitamin E. Lipid peroxidation was markedly increased. Ultrastructural studies showed reduplication of the erythrocyte, granulocyte, and platelet cell membranes.

Simplified formulas for detecting linkage with a quantitative character

A simplified form of Smith's test for linkage between a mendelian and a quantitative character is described. Numerical examples are given of its application to the Kell blood group and sole dermatoglyphics.

An example of 'naturally occurring' anti-Jsa (K6) in a Japanese female

Anti-Jsa was found in a Japanese female who had never received a transfusion and had borne 3 Jsa-negative children. The antibody agglutinated Jsa cells suspended in saline and treated with proteolytic enzymes as well as reacting with those cells by the indirect antiglobulin test. This example is the first reported 'naturally occurring' anti-Jsa.

Immune hemolytic anemia associated with anti-Kell and a carrier state for chronic granulomatous disease

A patient presented with immune hemolytic anemia associated with a strongly positive direct antiglobulin test (IgG and complement). Anti-K was eluted from the patient's red cells, which were shown to be K negative. A powerful complement-binding anti-K was present in the serum together with another antibody(ies) showing characteristics resembling anti-Bg. Leukocyte antibodies were also present in the patient's serum. The anti-K could be adsorbed and eluted from K negative red cells in vitro. It is suggested that either non-specific adsorption of the anti-K may have occurred due to the Matuhasi-Ogata phenomenon; or, the antibody was an auto "minicking anti-K" capable of reacting with a broader specificity within the Kell system. A serendipitous finding was that the patient was a carrier for chronic granulomatous disease. The associations of immune hemolytic anemia, chronic granulomatous disease, and the Kell system are discussed.

A comparison of six procedures for compatibility testing

Six procedures for compatibility testing were compared, using red blood cells sensitized in normal saline, albumin or low-ionic strength saline (LISS) combined with either broad spectrum or anti-IgG antiglobulin testing (AGT). Despite shortened incubation times, tests employing LISS were as sensitive as those with albumin and broad spectrum AGT and more sensitive than the other four combinations. No false positive results were found. LISS technique with broad spectrum AGT appears to be suitable and superior for routine antibody detection and compatibility tests.

Association of blood groups with essential and secondary hypertension. A possible association of the MNS system

Persons participating in a 5-day diagnostic protocol were routinely typed for ABO, Rh, MNS, Kell, Kidd, Duffy, P, Haptoglobin, phosphoglucomutase-1 (PGM-1), and acid phosphatase (AcP). The study population was composed of 164 normotensive whites, 34 normotensive blacks, 161 whites and 43 blacks with essential hypertension, and 52 whites with secondary forms of hypertension (18 atherosclerotic renovascular hypertensives, 17 patients with fibromuscular disease, and 17 patients with primary aldosteronism). There were no significant differences in phenotype frequencies in ABO, Rh, Kidd, Kell, Duffy, P, Haptoglobin, PGM-1 or AcP in any of the comparisons. However, there was a significantly different distribution of MNS phenotypes in comparisons of essential and atherosclerotic renovascular hypertensives with normotensive controls. Essential hypertensives had a lower frequency of the S gene and a higher frequency of s in whites (X2 = 12.21, p less than 0.005). Atherosclerotic renovascular hypertensives differed from the normotensive population in the frequencies of both MN (X 2 = 4.34, p less than 0.05) and Ss (X2 = 4.21, p less than 0.05). The finding of disease-blood group associations supports the hypothesis that there may be significant physiological differences between individuals of different blood types.

The Njinga of Angola: a serogenetic study

The Njinga, a matrilineal kiMbundu-speaking Negro people of northern Angola, inhabited the coast near Luanda during the sixteenth century, and were driven inland by Portuguese expansion subsequently. There is no evidence from the present sterogenetic study that they have received any appreciable contribution of Caucasoid genes. Nor is there any evidence of San ('Bushman') admixture apart from a moderate frequency of Gm; their genetic profile and their anthroposcopic traits disclose a greater similarity to West African than to Southern African Negroes. The present study confirms previous findings on the ABO, MNSs, Kell, Duffy, erythrocyte acid phosphatase, adenosine deaminase and adenylate kinase systems, and contributes the first account of the peptidase A, B, C and D, first and second locus phosphoglucomutase, glucose-6-phosphate dehydrogenase, esterase D, haptoglobin, transferrin, Gm and Inv systems in the Njinga.