A red blood cell autoantibody with mimicking anti-E specificity.
BACKGROUND
Uncommonly, antibodies that appear to exhibit antigenic specificity on red blood cell (RBC) panels fail to maintain specificity following alloadsorption (i.e., they mimic antigenic specificity). Understanding both the pitfalls and the proper pathways to establish the diagnosis and to interpret the clinical significance of these mimicking antibodies is important for patient management.


METHODS
A 68-year-old woman was admitted with dyspnea, anemia, bilateral pulmonary emboli, and metastatic ovarian cancer. Blood bank evaluation identified anti-E reactivity in the patient's plasma sample and a positive direct antiglobulin test (DAT).


RESULTS
The DAT was positive for immunoglobulin G and negative for C3b. An eluate of the RBCs showed E-antigen specificity on a RBC antibody panel. Repeat serologic testing with RBC antibody panels with adsorbed patient plasma showed removal of apparent anti-E reactivity with either E-antigen-positive or E-antigen-negative RBC stroma.


CONCLUSIONS
A mimicking autoantibody with apparent E-antigen specificity was identified in the plasma sample of a woman with newly diagnosed ovarian cancer. Despite their relative low frequency, mimicking antibodies, whether auto- or alloantibodies, may interfere with the timely issuance of compatible blood products and may confuse laboratory and clinical staff. Determining the clinical significance of the antibody, by taking into account the RBC phenotype of the patient and the antigen prevalence in the general population, guides the extent of workup required to best utilize resources while assuring patient safety.
Dwyre
Denis M
DM
DeGowin Blood Center, University of Iowa, Iowa City, Iowa, USA. dwyred@uihc.uiowa.edu
Clapper
Adam
A
Heintz
Mary
M
Elbert
Char
C
Strauss
Ronald G
RG
D000327:Adsorption; D000368:Aged; D000918:Antibody Specificity; D001323:Autoantibodies / Q000276:immunology*; D001788:Blood Grouping and Crossmatching / Q000379:methods*; D004912:Erythrocytes / Q000276:immunology*; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000276:immunology*; D007163:Immunosorbent Techniques; D018716:Molecular Mimicry; D009994:Osmolar Concentration; D010051:Ovarian Neoplasms / Q000097:blood / Q000150:complications / Q000276:immunology; D010298:Parity; D011655:Pulmonary Embolism / Q000097:blood / Q000209:etiology / Q000276:immunology; D012204:Rh-Hr Blood-Group System / Q000276:immunology*; D012996:Solutions / Q000494:pharmacology
D001323:Autoantibodies; D007074:Immunoglobulin G; D012204:Rh-Hr Blood-Group System; D012996:Solutions