Serological characteristics of Lewis antibodies and their clinical significance - A case series

Abstract Introduction Lewis antibodies have been thought to play a small role in clinical transfusion practice, but recent reports suggest that they have gained more importance in the context of transfusion and transplantation. Data regarding the prevalence of Lewis antibodies and their clinical significance in the Indian context is very limited. Hence, this study was aimed at analyzing the serological characteristics and clinical significance of Lewis antibodies encountered in our patient and donor populations. Methods The retrospective data analyzed the records of red cell antibody screening results and the additional serological evaluation performed on the donor and patient samples included in the study. Results A total of 26 study subjects were noted to have Lewis antibodies (including 6 healthy donors and 20 patients). Of them, 13 individuals had anti-Leb, 10 had anti-Lea and the remaining three had an anti-Lea/Leb mixture. IgG Lewis antibodies were detected in 7 individuals. All cases of IgM Lewis antibodies detected were reacting at 37°C. Two patients were suspected of having hemolytic transfusion reactions due to Lewis antibodies. Antigen-negative cross-match compatible units were provided for transfusion in the recipients. Conclusion Lewis antibodies of the IgM class reacting at 37°C should be regarded as clinically important. The present study findings urge that the lab personnel look for the thermal amplitude of Lewis antibodies, irrespective of the fact that the antibody class and antigen-negative crossmatch compatible units should be provided to avoid hemolytic transfusion reactions.

Lewis Blood Group Percentage Distribution among Indigenes of Ogoni Ethnicity in Rivers State, Nigeria

Aim: We attempted to determine the frequencyand percentage distributionof Lewis blood group antigens among indigenes of Ogoni ethnicity in Rivers State, Nigeria.Study Design:The study consisted of 101 Ogoni people, who were apparently healthy and free from transfusion transmissible infections confirmed by serological screening. Ogoniland is located along the Niger Delta Eastern edge, and to the north-east of the Imo River and Port Harcourt city. All subjects were recruited and their blood samples were collected. The presence of Lewis-a and -b (Lea/Leb) blood group was examined using Anti-Leaand Lebmonoclonal antibody, respectively (Lorne Laboratories).Results:Leaand Lebblood group was observed in 17.8%and 11.9%, respectively.Conclusion:Leaand Lebin this population was observed less frequently than those in other population previously reported. The Lewis antigen was reported to be associated with thrombotic disorders and Helicobacter pylori infection. Further studies may be directed to examine the association between Lewis blood group antigens and the risk of these conditions in Ogoni subjects

A Case of Anti-Le(bH) Antibody Identified in a Patient with Ulcerative Colitis

A 67-year-old man previously diagnosed with ulcerative colitis complained of difficulty in defecation and underwent balloon dilatation of rectum, but the procedure failed. The patient was transferred to a surgical department for further treatment. Before surgery, his red cells were typed A, Rh(D) positive. The antibody screening test was positive and the results of the identification tests were atypical. The reactivity was similar to anti-Le(b) antibody; however, the antibody showed panreactivity against papainized red cells. It showed stronger reactivity against O red cells than A Le(a−b+) red cells, and we concluded that the antibody was anti-Le(bH). After reexamination, his Lewis phenotype was found to be Le(a−b−). His FUT2 and FUT3 were analyzed to confirm his Lewis blood type, and c.59T>G and c.1067T>A variants were found on the FUT3. Therefore, the patient's Lewis blood type was concluded as Le(a−b−).

Role of the Lewis and ABO Blood Group Antigens in Helicobacter pylori Infection

Background: Helicobacter pylori infection is a major risk factor for chronic gastritis and gastric cancer. Some findings show increased frequencies of these diseases in individuals with type O blood and in secretors (expressing Leb antigen), but other studies have not found any relationship between blood groups and this infection. Given that H. pylori infection and gastric cancer are common in Iran, the assessment of the pathogenesis of this infection in relation to these blood groups could be valuable. Methods: In a cross-sectional study, we determined the ABO and Lewis blood groups of participants using the tube method and evaluated the level of anti-H. pylori immunoglobulin G using an enzyme-linked immunosorbent assay. This study included 171 Iranian blood donors from Mashhad, Iran, during 2010. The significance of the differences in the frequencies of the Lewis and ABO phenotypes between individuals infected with and without H. Pylori infection were tested using the chi-square test. A P-value < 0.05 was considered significant. Results: H. pylori infection was found in 76.6% of the study subjects (n = 131). The most common ABO blood group was O (33.9%), and the most common Lewis blood group was Le(a-b+) (54.7%). The frequencies of the ABO, Lewis, and secretion phenotypes were not significantly different between the infected and uninfected subjects. Conclusion: We did not find any significant relationship between the Lewis, ABO, and secretion phenotypes and H. pylori infection.

Evaluation of the Genotypes of the Lewis Blood Group in a Korean Population Using Direct Sequencing

BACKGROUND: The FUT2 and FUT3 genes determine the Lewis phenotype of red blood cells (RBCs). Recently, the Lewis genes, the secretor genes, and several mutations that cause Lewis negative and nonsecretor phenotypes have been identified. The purpose of this study was to analyze the gene frequency of FUT2 and FUT3 in a Korean population by comparing the use of the direct sequencing method to the use of the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method for mutation detection in the FUT2 and FUT3 genes. METHODS: RBCs and peripheral blood leukocytes were obtained from 225 apparently healthy volunteers to determine the phenotype and genotype of the FUT2 and FUT3 genes. Lewis phenotypes were determined on K3EDTA-stablized fresh blood samples using the column agglutination method. Lewis blood group genotyping was performed by use of the direct sequencing method. For the detection of T59G, C357T, and A385T mutations, the PCR-RFLP method was performed. RESULTS: The frequencies of the Lewis blood group phenotype were 12.4% for Le(a+b-), 70.7% for Le(a-b+), 11.1% for Le(a-b-) and 5.8% for Le(a+b+), respectively. Direct Sequencing of the FUT2 gene identified 92.2% C357T, 56.9% A385T, 0.4% G244A mutations and 1.8% del396. Direct Sequencing of the FUT3 gene identified 46.9% T59G, 30.4% G508A, 1.1% T202C, 1.1% C314T, 0.7% A1029G, 3.0% T1067A and 13.3% G1242A mutations. The PCR-RFLP method results were discordant in nine cases (1 case for C357T, 4 cases for A385T and 2 cases for T59G) as compared to the direct sequencing method results. CONCLUSION: We have determined the frequencies of FUT2 and FUT3 gene mutations in a Korean population. The use of the direct sequencing method was more accurate than the use of the PCR-RFLP method for the determination of the genotype of the FUT2 and FUT3 genes.

Correlation of the Lewis Blood Group and the CEA Serum Level in Stomach Cancer Patients

PURPOSE: The purpose of our study was to compare the serum levels of CEA, CA19-9 and H.pylori antibody in patients with the Lewis (a+) blood group with that of the patients with the Lewis (a-) blood group. We also compared the outcome of the stomach cancer patients with the Lewis (b+) blood group with that of the stomach cancer patients with the Lewis (b-) blood group. METHODS: All of the 94 patients who underwent gastrectomy for stomach cancer at our hospital were retrospectively reviewed. The outcomes of the CEA, CA19-9 and H.pylori. antibody serum levels, the TNM stage, the ABO blood group and the Rh blood group were compared between the patients with the Lewis blood groups (a+) and (a-) and the patients with the Lewis blood groups (b+) and (b-), respectively. RESULTS: The mean serum level of CEA between the patients with the Lewis blood group (a+) and (a-) showed a statistical correlation (mean value: 5.51 ng/ml vs 3.25 ng/ml, respectively, P=0.016). But the mean serum level of CA19-9 and H.pylori. antibodies between the patients with the Lewis blood group (a+) and (a-) did not show a significant difference. The mean serum levels of CEA, CA19-9 and H.pylori antibodies between the patients with the Lewis blood group (b+) and (b-) did not show a significant difference. CONCLUSION: It was revealed that an elevated CEA level was related with the Lewis blood group (a), but this was not related with the Lewis blood group (b) in stomach cancer patients.

Evaluation of the RBC Lewis Blood Group Phenotypes and Genotypes of the FUT3 and FUT2 Gene / 대한진단검사의학회지

BACKGROUND: The Lewis and secretor gene determine the Lewis phenoytpe. Conventional Lewis blood grouping is difficult because of the presence of nongenuine Lewis negative individuals. Recently, the Lewis gene (FUT3), the secretor gene (FUT2), and several mutations that cause the Lewis negative and the nonsecretor phenotypes were identified. The purpose of this study was to compare Lewis phenotypes determined by commercially available three pairs of monoclonal antibodies with the Lewis and secretor genotypes. METHODS: RBCs for phenotyping and peripheral blood leukocytes for genotyping of FUT3 and FUT2 gene were obtained from 184 apparently healthy volunteers. Lewis phenotypes were determined on K3EDTA-stablized fresh blood samples using three pairs of commercially available monoclonal antibodies, one of which was the column agglutination method and the others were the tube agglutination methods. Lewis blood group genotyping was performed by the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method to detect T59G, G428A, C357T, and A385T mutations. RESULTS: The frequencies of the Lewis blood group phenotype were Le(a+b-) 15.0%, Le(a-b+) 65.8%, Le(a-b-) 14.8%, and Le(a+b+) 4.3%, respectively. The Lewis blood group phenotypes determined by three pairs of monoclonal antibodies were 93.5%, 93.5% and 89.1% in accordance with the genotypes. The frequencies of Le, le, Se and se alleles were 64.4%, 35.6%, 48.6%, and 51.4% and we have newly detected 4 cases with only one A385T mutation. All of the Le(a+b+) phenotype cases have both C357T, and A385T homozygotic mutations. CONCLUSIONS: The PCR method may be effectively used for the genotyping of the FUT3 and FUT2 genes and offers an attractive alternative to Lewis phenotyping using hemagglutination method.