title: Anti-Jka, -C, and -E in a single patient, initially demonstrable only by the manual hexadimethrine bromide (Polybrene) test, with incompatibilities confirmed by 51Cr-labeled red cell studies.
abstract: Published reports have confirmed the superior sensitivity of the manual hexadimethrine bromide (Polybrene) test (MPT) for demonstrating many alloantibodies in vitro; however, the clinical significance of alloantibodies demonstrable exclusively by MPT has not been shown conclusively. A patient with macroglobulinemia experienced chills, fever, hemoglobinemia, and hemoglobinuria following the transfusion of 1 unit of red cells (RBCs) shown to be compatible by the low-ionic-strength antiglobulin (LIS-AG) method. Serologic investigation was negative. Intravascular hemolysis occurred with a second "compatible" unit. Serologic studies were again negative by LIS-AG and ficin-AG methods, but revealed anti-Jka by MPT. Both donors were Jk(a+b-), and 51Cr studies of the second donor's RBCs revealed a t1/2 of less than 30 minutes, with marked intravascular hemolysis. A LIS-AG-compatible Jk(a-) unit was transfused uneventfully, but with no rise in hematocrit. MPT next revealed anti-C; subsequent 51Cr studies with the Jk(a-), Cc donor's RBCs showed a 51Cr t1/2 of 100 minutes with slight intravascular lysis. Four transfusions of Jk(a-), C- blood were uneventful, but 5 days later the patient's hemoglobin declined. The following day, anti-E was demonstrable exclusively by MPT. 51Cr-labeled Jk(a-), C-, E- RBCs had normal 24-hour survival. The patient's hemoglobin rose to 11 g per dl following transfusions of Jk(a-), C-, E- RBCs, and he was discharged. In vitro studies employing the patient's purified IgM paraprotein revealed no interference with alloantibody binding or detection.
mesh_terms: D000368:Aged; D001789:Blood Group Antigens / Q000276:immunology*; D001787:Blood Group Incompatibility / Q000175:diagnosis*; D001803:Blood Transfusion; D002860:Chromium Radioisotopes; D004905:Erythrocyte Aging; D004912:Erythrocytes; D006583:Hexadimethrine Bromide; D006801:Humans; D007518:Isoantibodies / Q000032:analysis; D007667:Kidd Blood-Group System / Q000276:immunology*; D008297:Male; D008722:Methods; D010266:Paraproteins / Q000032:analysis; D011073:Polyamines; D012204:Rh-Hr Blood-Group System / Q000276:immunology*
chemical_list: D001789:Blood Group Antigens; D002860:Chromium Radioisotopes; D007518:Isoantibodies; D007667:Kidd Blood-Group System; D010266:Paraproteins; D011073:Polyamines; D012204:Rh-Hr Blood-Group System; D006583:Hexadimethrine Bromide