Auto‐anti‐A₁ antibody in a patient with metastatic adenocarcinoma

Abstract

An autoantibody was found on the red cells of a patient who had never been transfused previously, but was ill with metastatic adenocarcinoma. The patient's blood group was A1. In addition, the patient's serum and the eluate from the patient's red cells agglutinated A1 but not A2, B, and O red cells. This auto-A1 antibody was reactive at a wide thermal range and was inactivated by dithiothreitol, suggesting the presence of an IgM immunoglobulin. Moreover, the antibody was not associated with a hemolytic anemia.

“Auto-anti-A1” in a healthy young blood donor

“…Most cases have been demonstrated in patient population with or without history of blood transfusion. [ 4 5 6 7 8 9 10 ] The current study may be considered as the first example of auto-anti-A1 in a healthy blood donor. The antibody belonged to IgM immunoglobulin class reactive at colder temperature with no clinical significance.…”

“…found auto-anti-A1 in a patient with metastatic carcinoma. [ 4 5 ] Immune auto-anti-A1 causing hemolytic graft versus host reaction in an A1 recipient following transplantation of “O” Group kidney was discussed by authors in 1987. [ 6 ] Most of these workers found cold reacting auto-anti-A1 of IgM type with no clinical significance.…”

A cold scare: Formation of cold reactive anti-A1 coinciding with gross hemolysis

“…As a number of tissues such as urothelium can express ABO-related antigens and corresponding carcinomas can express these antigens (perhaps with subtle modification), it had previously been speculated that this antigen expression could provoke an immune response in the host [9] , [11] , [12] . On the other hand, in a patient who is blood group A 2 , an immune response provoked by alloimmunization has been reported rarely, with one case series of two patients demonstrating an increase in titer and thermal amplitude of the normally weak naturally-occurring anti-A 1 [4] .…”

“…However, rare clinically significant cases have been noted when the antibody demonstrated reactivity at 37 °C; in some of these cases, acute or delayed hemolytic transfusion reactions have been documented as case reports in the literature [6] , [7] , [8] . Among these clinically significant cases in which the antibody had a wide thermal amplitude, rarer case reports have noted apparent development after alloimmunization with A 1 antigen exposure or development of an “auto-anti-A 1 ” in association with metastatic carcinoma [5] , [9] , [10] . Anti-A 1 antibodies with a significant autoimmune component have also been reported as arising after alloimmunization to A 1 antigen, in the setting of a malignancy, or idiopathically in an A 1 blood group patient shortly before death from severe intravascular hemolysis [5] , [9] , [10] .…”

Anti-A Autoantibody Associated with Immune Hemolytic Anemia

“…Anti-A autoantibodies are rarely associated with au toimmune hemolytic anaemia [1]; until today only a few cases have been reported in the literature and in most of them the autoantibody was associated with a malignant disease [2][3][4][5], A patient with a refractory anaemia required transfu sion for a severe and progressive loss of haemoglobin. Red cells from group Al units (the patient's red cell phenotype was Al, Rho (D) positive) were found to be incompatible in the crossmatch in the antiglobulin test at low ionic strength.…”