Identification of Complex and Combined Antibody Consisted of Anti-c, Anti-E, Anti-Jka and Anti-Fya / 中国实验血液学杂志

OBJECTIVE@#To investigate the role of multiple serological methods in the identification of complex antibodies.@*METHODS@#The blood group antigens were detected by saline and microcolumn agglutination methods. The saline method was used to screen and identify IgM-type antibodies in the patient's serum, while the polybrene, anti-globulin, microcolumn agglutination, enzymic and absorption-elution methods were used to screen and identify IgG-type antibodies.@*RESULTS@#The patient was B/CCDee/Jk(a-b+)/Fy(a-b+) blood type. The serum reacted with panel cells, and the reaction presented anti-E pattern in the saline medium. It was fully positive in the microcolumn agglutination card, except 2 negative ones after using papain to treat the panel cells. Referring to the pattern table, it was concluded that there existed anti-c, anti-E, and anti-Jka antibodies, and one antibody corresponding to an antigen that was easily destroyed by papain. The red blood cells with specific phenotype were selected for absorption-elution to identify IgG-type anti-c, anti-E, anti-Jka and anti-Fya antibodies.@*CONCLUSION@#It is confirmed that IgM-type anti-E, and IgG-type anti-c, anti-E, anti-Jka and anti-Fya antibodies exist in the patient's serum by multiple serological methods.

Identification of immune hemolytic transfusion reaction and exploration of transfusion compatibility testing / 中国输血杂志

【Objective】 To analyze the causes of immune hemolytic transfusion reaction in one case, identify related antibodies, and explore transfusion compatibility testing. 【Methods】 ABO/Rh blood group identification, unexpected antibody identification of serum and diffusion fluid, direct antiglobulin test(DAT) and cross matching were conducted by saline method and/or microcolumn gel method. 【Results】 The patient′s blood group was O, and Rh phenotype was identified as DCCee. The DAT was negative, with strong anti-E antibody and weak anti-c antibody detected. Acute hemolytic transfusion reaction occurred in the patient after the last transfusion. 【Conclusion】 Currently, immune hemolytic transfusion reaction in China are mainly caused by Rh blood group system antibodies. The absence of unexpected antibody screening before blood transfusion and the weak anti-c antibody which resulted in missed detection of non compatibility in cross matching led to acute hemolytic transfusion reaction. It is recommended to conduct unexpected antibody screening before blood transfusion, and to collect blood sample for testing as soon as possible to improve the accuracy of DAT when acute hemolytic transfusion reaction is suspected.

Identification of anti-C alloantibodies accompanying anti-e autoantibodies / 中国输血杂志

Objective To confirm the specificity of antibodies recently found in a hospitalized patient.Methods Methods including antibody screening,antibodies identification,alloantibody titers,isolation of red blood cells by high speed capillary centrifugation and determination of Rh phenotype were employed to investigate the characteristics of antibodies.Results Anti-C alloantibody and anti-e autoantibodies were detected in the patient.Autoantibodies were non-specific in the early stages,and gradually changed into specific auti-e antibodies.The titers of anti-C alloantibody were always lower than 4.Conclusion The identification of antibodies should be integrated as far as possible in various aspects of methodology.

Analysis of anti-E IgG combined with IgG + IgM anti-Mur for leading to the cross-match incompatibly / 国际检验医学杂志

Objective To perform the serological identification of anti‐E and anti‐Mur found in the detection before blood trans‐fusion and to analyze its clinical significance in blood transfusion .Methods The reaction pattern of serum with the antibody screen‐ing spectrum was detected by using the micro‐column gel method for identifying the antibody type and specificity .Results The 3 kinds of antibody anti‐E IgG combined with anti‐Mur IgG + IgM existed in the serum of 2 patients .Conclusion Anti‐E and anti‐Mur all are easier to lead to the hemolytic blood transfusion reaction .Selecting the suitable donor on the basis of the accurate anti‐body identification can provide guarantee for blood transfusion safety .

A case of Severe Hydrops Fetalis due to Anti-E Alloimmunization

Hydrops fetalis is a condition characterized by an accumulation of fluid, or edema, in at least two fetal compartments. Only a small percentage (less than 10%) of hydrops fetalis cases are related to immune hydrops caused by variant antigens present the surface of the red blood cells (RBCs), depending on blood groups, such as ABO, Rh (C, D, E, c, e), I, P, Kell, etc. The Rh (E) antigen generally does not cause fetal anemia; however, in rare cases, it can be lethal, leading to stillbirth. We report a case of a preterm infant born at 28 weeks gestational age with severe hydrops fetalis caused by anti-E alloimmunization.

Case analysis of incompatibility in blood crossmatching induced by anti-Dia and anti-E antibodies / 国际检验医学杂志

Objective To investigate the reason of anti-Dia combined with anti-E antibodies inducing incompatibility in blood crossmatching.Methods Retrospectively analyse a case of patient treated in the hospital,whose blood crossmatching failed for sev-eral times.Through blood typing,direct Coombs test,irregular antibody screening,adsorption and elution experiments to determine the patient′s blood type,possible irregular antibodies,cell spectral response pattern.Results Forward blood typing:anti-A antibody (-),anti-B antibodies(-);Reverse blood typing:Ac (++++),Bc(++++),RBC(-),Oc(-);Rh blood grouping:anti-c an-tibody(-),anti-C antibody (+ + + +),anti-D antibody (+ + + +),anti-e antibody (+ + + +),anti-E antibody (-),direct Coombs test(-).Patient′s serum contained anti-E and anti-c antibodies.Conclusion Irregular antibodies in the serum of patients is an important cause of crossmatch discord.

Codelivery of IL-7 Augments Multigenic HCV DNA Vaccine-induced Antibody as well as Broad T Cell Responses in Cynomolgus Monkeys

BACKGROUND: A crucial limitation of DNA vaccines is its weak immunogenicity, especially in terms of eliciting antibody responses in non-human primates or humans; therefore, it is essential to enhance immune responses to vaccination for the development of successful DNA vaccines for humans. METHODS: Here, we approached this issue by evaluating interleukin-7 (IL-7) as a genetic adjuvant in cynomolgus monkeys immunized with multigenic HCV DNA vaccine. RESULTS: Codelivery of human IL-7 (hIL-7)-encoding DNA appeared to increase DNA vaccine-induced antibody responses specific for HCV E2 protein, which plays a critical role in protecting from HCV infection. HCV-specific T cell responses were also significantly enhanced by codelivery of hIL-7 DNA. Interestingly, the augmentation of T cell responses by codelivery of hIL-7 DNA was shown to be due to the enhancement of both the breadth and magnitude of immune responses against dominant and subdominant epitopes. CONCLUSION: Taken together, these findings suggest that the hIL-7-expressing plasmid serves as a promising vaccine adjuvant capable of eliciting enhanced vaccine-induced antibody and broad T cell responses.

A Case of Autoimmune Hemolytic Anemia Caused by Anti-e Antibody / 대한수혈학회지

The incidence of autoimmune hemolytic anemia in children is rarer than that in adults. It is estimated that the rate of autoimmune hemolytic anemia is around 2 persons per 10,000,000. We describe here a boy with warm autoimmune hemolytic anemia that was due to immunoglobulin G with an anti-e specificity. A 13-month-old boy with severe hemolytic anemia (hemoglobin: 6.0 g/dL) showed strong anti-IgG reactivity (4+) on the direct antiglobulin test. Antibody targeted against the e antigen was identified from both of his serum and the RBC eluate. In addition, he had e antigen on his RBCs. He was treated with prednisolone for 4 days and RBCs transfusions. After the second transfusion of RhD positive/e negative RBCs, his hemoglobin-level was increased to 10.3 g/dL. On his fifth hospital day, he was discharged with showing clinical improvement and improved values on his laboratory tests.

A Case of Simultaneously Detecting Anti-D as an Autoimmune Antibody and Anti-E as an Alloimmune Antibody / 대한수혈학회지

We report here on a case of simultaneously detecting anti-D as an autoimmune antibody and anti-E as an alloimmune antibody without any evidence of autoimmune hemolytic anemia. A 66-year-old female with tuberculous spondylitis was admitted for removing a previously-placed surgical screw in her spine. She had received antituberculosis drugs and six units of AB, RhD positive packed red blood cells during the previous 6 months. The laboratory findings were as followings: the direct antiglobulin test was positive for IgG, the Rh phenotype of the erythrocytes was typed as group CcDe and RhD antigen was confirmed by the molecular method and the serological method to rule out partial-D.

A Case of Delayed Hemolytic Transfusion Reaction in a Patient with Anti-c, Anti-E, and Anti-Jk(b) / 대한수혈학회지

Delayed hemolytic transfusion reaction (DHTR) due to multiple red blood cell (RBC) alloantibodies has rarely been reported in Korea. We report a case of DHTR in a patient with anti-c, anti-E, and anti-Jk(b). A 45-year-old man visited the emergency room with flame burn injury over 61% of his entire body. He received six units of packed RBCs and three units of fresh frozen plasma during the operation for excision and glycerol-preserved allografting. His hemoglobin (Hb) level gradually decreased from 13.5 g/dL on the operation day to 7.8 g/dL on the 11th postoperative day in spite of receiving three and two additional units of packed RBCs on the 8th and 9th postoperative days, respectively. His laboratory data was total bilirubin/direct bilirubin 15.9/11.4 mg/dL, lactate dehydrogenase 983 IU/L, haptoglobin 5.93 mg/dL and plasma hemoglobin 8.0 mg/dL. The urinalysis revealed hemoglobinuria, and the peripheral blood film showed moderate spherocytosis. Both the direct and indirect antiglobulin tests were positive, and the follow-up antibody identification test showed anti-c, anti-E, and Jk(b). His Hb levels increased after he was transfused with two units of packed RBCs without c, E, and Jk(b) antigens. This is a case of DHTR due to alloimmunization, which developed within a short interval after the patient had received multiple transfusions.

A Case of Gallbladder Stones Associated with Anti-E Antibody Hemolytic Disease in a Neonate

Cholelithiasis is rarely recognized in children, especially in infants. Hemolytic disorders, long-term total parenteral nutrition (TPN), congenital anomalies of the biliary tree leading to stasis of bile flow, congenital IgA-deficiency, furosemide treatment, and prolonged fasting have been reported as predisposing factors for cholelithiasis in childhood. Hemolytic disease of the newborn due to anti-E has rarely been reported as a risk factor for cholelithiasis. We report a case of gallbladder stones in a neonate associated with anti-E antibody hemolytic disease.

A Case of Anti-Wr(a) with Anti-E / 대한수혈학회지

Authors found a case of anti-Wr(a) with anti-E antibody in 67 years old female patient. Anti-Wr(a) in Korea was reported for the first time in 2005. Anti-Wr(a) has been associated with hemolytic transfusion reaction (HTR) and hemolytic disease of the newborn (HDN). It is necessary to study the incidence of Wr(a) antigen and anti-Wr(a) in Korea.

A Case of Idiopathic Thrombocytopenic Purpura with Anti-E Antibody Developed after Transfusion of Platelet Concentrates / 대한수혈학회지

Alloantibodies against RBCs after transfusion of only platelet products are rarely reported except for RhD mismatched platelet transfusion. We report a case of anti-E antibody developed after transfusion of platelet concentrates. The patient was a 27- month male infant with idiopathic thrombocytopenic purpura and was treated with IV immunoglobulin and IV Rh immunoglobulin. Anti-E antibody was detected after transfusion of 18 units of platelet concentrates for about 40 days. RBC alloimmunization was developed after transfusion of platelet products, which suggests platelet transfusion may be cause of RBC alloimmunization in childhood.

Fatal Acute Hemolytic Transfusion Reaction Due to Anti-E+Fy(a) / 대한진단검사의학회지

A 72-year-old man with a regrowing tongue mass and refractory anemia received two units of compatible red blood cells by saline and albumin phase crossmatching tests. One hour after the last unit, he had a hemolytic transfusion reaction manifested by chest discomfort, fever, redcolored urine, fall in hemoglobin, hemoglobinuria and bilirubinemia. He developed acute renal failure and pulmonary edema and died three days later. Anti-E+Fy(a) antibodies were identified in the patient's serum. This case suggests that indirect antiglobulin crossmatching tests or antibody screening tests are needed for routine pretransfusion tests in Korea.

Discrepant results by High Protein Anti-D and Low Protein Anti-D in a D Negative Newborn / 대한임상병리학회지

High-protein anti-D reagents prepared from pools of human serum have been used for routine RhD typing but, low-protein, saline reactive anti-D reagents formulated predominantly with monoclonal antibodies are in current use. Because some of the high-protein reagents contain macromolecular additives that may cause red cells coated with immunoglobulin to aggregate spontaneously, antisera with these additives may produce a false-positive reaction. A four-day old male was admitted due to severe jaundice. Initially, the RhD type of the newborn using a high-protein reagent was D-positive and then, using two low-protein reagents, it was D-negative. The blood type of the mother was B, CDe, and that of the newborn was B, CcdEe. The direct antiglobulin test on the newborn's RBC was positive. Anti-E and anti-c were identified in the mother's serum and anti-E only was identified in the newborn's serum. The newborn was treated with phototherapy for 10 days and discharged as recovered. We present a case of hemolytic disease of the D negative newborn, which showed a discrepancy between high protein anti-D and low protein anti-D. With a review of literature, the newborn was possibly misinterpreted as D positive.

A Case of Delayed Hemolytic Transfusion Reaction with Acute Renal Failure Caused by Anti-E Antibody / 대한수혈학회지

A delayed hemolytic transfusion reaction (DHTR) is the result of delayed anamnestic alloantibody response four to fourteen days after transfusion of apparently compatible blood. Most DHTRs are very mild and may not be recognized clinically. Some are manifested only by anemia. Only a few cases are severe enough to induce a massive hemolytic reaction followed by frank renal failure. Recently, we experienced a case of DHTR with acute renal failure (ARF) due to anti-E. A 21-year-old woman received compatible four units of packed red cells after right artificial total hip replacement arthroplasty due to juvenile rheumatoid arthritis. She had a history of transfusion 4 years ago. Fourteen days after the transfusion, she showed a fall in hematocrit, hemoglobinuria and a positive indirect antiglobulin test, and accompanied by ARF. Anti-E was identified in the patient's serum by antibody screening and identification test at that time. She recovered from ARF after hemodialysis with conservative management. However, eventually, she died due to disseminated intravascular coagulopathy.

A Case of Autoimmune Hemolytic Anemia Induced by Anti-e

Autoimmune hemolytic anemia(AIHA) is characterized by the production of Coombs antibodies, which are responsible for the destruction of RBCs. The antibody specificity of warm A1HA(WAIHA) is very complex while all cells tested are usually reactive in routine test. Although some autoantibodies have broad specificity to the Rh system, apparent specificity for simple Rh antigen(D, C, E, c, e) is rare. A 63 year-old farmer was admitted at Inha University Hospital for evaluation of anemia. He had no history of blood transfusion. He presented overt anemia with decreased Hb (6.6g/dL) and increased reticulocyte count(18.5%, corrected reticulocyte count 8.4%). The direct antiglobulin test(DAT) was strongly positive for IgG and negative for C3d while indirect antiglobulin test(IAT) was weakly positive. Both two different antibody identification test kits identified this antibody as anti-e. His Rh phenotype was CDe. Although the eluted antibody from his own RBCs failed to show specificity against e but agglutinated all the reagent RBCs, we diagnosed this case as WAIHA induced by IgG anti-Rh(e) because his serum agglutinated all e-positive RBCs while it was non-reactive with e-negative RBC in the cross- matching test. Drugs(loxoprofen, cimetidine) couldn' t be ruled out as causative agent. (Korean J Blood Transfusion 10(1): 61-67, 1999)

A Case of Autoimmune Hemolytic Anemia Induced by Anti-e / 대한수혈학회지

Autoimmune hemolytic anemia (AIHA) is characterized by the production of Coombs' antibodies, which are responsible for the destruction of RBCs. The antibody specificity of warm AIHA (WAIHA) is very complex while all cells tested are usually reactive in routine test. Although some autoantibodies have broad specificity to the Rh system, apparent specificity for simple Rh antigen (D, C, E, c, e) is rare. A 63 year-old farmer was admitted at Inha University Hospital for evaluation of anemia. He had no history of blood transfusion. He presented overt anemia with decreased Hb (6.6g/dL) and increased reticulocyte count (18.5%, corrected reticulocyte count 8.4%). The direct antiglobulin test (DAT) was strongly positive for IgG and negative for C3d while indirect antiglobulin test (IAT) was weakly positive. Both two different antibody identification test kits identified this antibody as anti-e. His Rh phenotype was CDe. Although the eluted antibody from his own RBCs failed to show specificity against e but agglutinated all the reagent RBCs, we diagnosed this case as WAIHA induced by IgG anti-Rh(e) because his serum agglutinated all e-positive RBCs while it was non-reactive with e-negative RBC in the cross-matching test. Drugs (loxoprofen, cimetidine) couldn't be ruled out as causative agent.

Frequency and distribution of unexpected antibodies of Koreans / 대한수혈학회지

BACKGROUND: Several studies on the frequency and distribution of unexpected antibodies of Koreans have been done by some investgators. But more studies are necessory to grasp the real frequency and distribution. We hoped to investigate the frequency and distribution of unexpected antiboddis of Koreans. METHODS: We performed 188 unexpected antibody identification tests to evaluate the distribution of unexpected antibodies from May 1997 to June 1998. The sera we tested are antibody screening positive ones sent from 11 hospitals and 1 blood center. We also analized the frequecny of unexpected antibodues from the data of Dongsan Medical Center's antibody screening tests. RESULTS: The frequency of unexpected antibody of this study (using tube method) was 1.0%. Both anti-Lea and anti-E (with anti-c) antibodies were the most frequent antibodies up to 31 cases (33.0%) each. Among the identified antibodies from Dongsan Medical Center which used tube method, anti-Lea antibody was the most frequent antibody (41.3%). Otherwise among the identified antibodies from other two hospitals which used gel card method, anti-E (with anti-c) antibody was the most frequent antibody (45.5%). The cause of all four cases of hemolytic disease of newborn was anti-E antibody. About half of the specimens' antibodies were not identified due to the problemes of identification cells, tested sera, test methods. CONCLUSION: Anti-Lea and anti-E (with anti-c) antibodies were the most frequent ones in Korean people. But the prequency was varied according to antibody screenig test methods. Anti-E antibody is the most important unexpected antibidy for hemolytic disease of newborn in Korea. To decrease the missed cases of antibody identification tests both Korean and foreign identification cells, enzyme method should be used.

Analysis of antibodies causing hemolytic disease of the newborn / 대한수혈학회지

BACKGROUND: Since the introduction of anti-Rh immunoglobulin prophylaxis, the incidence of hemolytic disease of the newborn (HDN) due to anti-D has remarkably decreased while the number of HDN due to ABO antibodies or minor blood group antibodies remains same. In Caucasians, anti-c, anti-E and anti-K are antibodies most frequently implicated in HDN. But in Koreans, antigenic frequency of Rh or Kell blood group is very different from Caucasians, so it is expected that the frequency of antibodies causing HDN would also be very different. Because there has been no representative data on minor blood group antibodies causing HDN in Korea, we analyzed 79 antibodies associated with HDN. METHODS: From January 1989 to July 1998, we determined the antibody specificity causing HDN in 79 cases. The nature and in vitro characteristics of the antibodies were analyzed. RESULTS: Among 79 cases, ABO antibodies were responsible in 20 cases, and anti-D was responsible in 7 cases. In minor blood group incompatibility, anti-E+c (21 cases) and anti-E (18 cases) antibodies were the antibodies most commonly involved. In ABO incompatibility, Direct Coombs' test (DAT) on baby RBC was positive only in 65% (13/20 cases). In 13 cases, ABO antibodies were detected only in the eluate of baby RBC. In non-ABO incompatibility, 96.6% (57/59 cases) showed positive DAT. In cases associated with anti-E+c and anti-E, Rh subtypes of 20 mothers were all CCDee except one, and Rh subtypes of 12 babies were all CcDEe except one. CONCLUSION: In ABO-HDN, negative DAT was frequently found and the test on baby RBC eluate was an essential part for diagnosis. Among non-ABO incompatibility, Rh incompatibilities, including RhD, were responsible in 94.9% (56/59 cases). Among HDN due to minor blood group antibodies, in contrast to previous reports, we found that anti-E+c was the most common antibody involved in HDN.