A mimicking red blood cell autoantibody accompanying transfusion and alloimmunization

Abstract

A patient with sickle cell disease who concomitantly developed red cell autoimmunity and alloimmunization is reported. The implied but 'wrong' specificity of the autoantibody mimicked one of the alloantibodies in the patient's serum. Although the patient's red blood cells phenotyped at Ro4, anti-rh" was eluted from them on several occasions. Absorption and secondary elution from selected cells proved the cell bound antibody had a unique and independent specificity from the anti-rh" in his serum. Standard antibody identification procedures did not distinguish these differences.

Red-Cell Auto-Antibodies Mimicking Anti-Fy^b Specificity

“…This phenomenon has been described for antibodies directed against antigens of the Rhesus system [1,2,5,7], but also against antigens in the S system…”

Erythrocyte autoantibodies in paediatric patients with sickle cell disease receiving transfusion therapy: frequency, characteristics and significance

“…In each of the previously reported cases the erythrocyte autoantibody developed in association with erythrocyte alloantibodies. Frequently, multiple alloantibodies had already been identified (Orlina et al , 1991; Sosler et al , 1989; Petz & Garratty, 1980; Chaplin & Zarkowksy, 1981; Ambruso et al , 1987), and in some cases the autoantibody occurred simultaneously with the development of new alloantibodies (Lalezari et al , 1975; Wenz et al , 1982). Our data support this observation, since seven of our patients were previously alloimmunized and eight developed one or more new alloantibodies simultaneous with the erythrocyte autoantibody (Table II).…”

“…In patients with sickle cell disease there are only a few reports of erythrocyte autoantibody formation. Wenz et al (1982) described a child who, after receiving a single preoperative erythrocyte transfusion, developed an IgG autoantibody with anti-E specificity. The authors did not comment about surface complement or clinical haemolysis.…”

“…The development of erythrocyte autoantibodies in association with transfusions is much less commonly recognized. Erythrocyte autoantibodies in transfused patients have been described only in case reports (Orlina et al , 1991; Sosler et al , 1989; Lalezari et al , 1975; Petz & Garratty, 1980; Wenz et al , 1982) or small series (Chaplin & Zarkowksy, 1981; Ambruso et al , 1987). In some of these patients the autoantibodies were associated with clinically significant haemolysis.…”

Transfusion of the Hemoglobinopathy Patient

“…96 In 1999, Castellino and associates 97 reported on the frequency, characteristics, and significance of erythrocyte autoantibodies in a large group of multiply transfused children with SCD. 96 In 1999, Castellino and associates 97 reported on the frequency, characteristics, and significance of erythrocyte autoantibodies in a large group of multiply transfused children with SCD.…”