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Anti‐Jk a , ‐C, and ‐E in a single patient, initially demonstrable only by the manual hexadimethrine bromide (Polybrene) test, with incompatibilities confirmed by 51 Cr‐labeled red cell studies
Author(s) -
Maynard B.A.,
Smith D.S.,
Farrar R.P.,
Kraetsch R.E.,
Chaplin H.
Publication year - 1988
Publication title -
transfusion
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.045
H-Index - 132
eISSN - 1537-2995
pISSN - 0041-1132
DOI - 10.1046/j.1537-2995.1988.28488265253.x
Subject(s) - hemolysis , medicine , chills , hematocrit , serology , waldenstrom macroglobulinemia , gastroenterology , immunology , pathology , antibody , lymphoma
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‐Jk a by MPT. Both donors were Jk(a+b−), and 51 Cr studies of the second donor's RBCs revealed a t½ of < 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 51 Cr studies with the Jk(a−), Cc donor's RBCs showed a 51 Cr t½ 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. 51 Cr‐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.