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Inhibition of an anti‐Pr 1d cold agglutinin by citrate present in commercial red cell preservative solutions
Author(s) -
Green E.D.,
Curtis B.R.,
Issitt P.D.,
Gutgsell N.S.,
Roelcke D.,
Farrar R.P.,
Chaplin H.
Publication year - 1990
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.1537-2995.1990.30390194352.x
Subject(s) - cold agglutinin , cold agglutinin disease , agglutinin , chemistry , titer , sodium citrate , chloramphenicol , preservative , biochemistry , antibody , chromatography , medicine , food science , immunology , autoimmune hemolytic anemia , antibiotics , lectin , pathology
A patient with known cold autoimmune hemolyticanemia was admitted for surgery. Routine cold agglutinin evaluations, using commercial red cells (RBCs) in modified Alsever's preservative solution, revealed a cold agglutinin titer of 4 to 16. However, using RBCs washed four times with saline, a high‐titer (>2000 at 4° C) cold autoagglutinin was demonstrated. The cold agglutinin was shown to be an IgM kappa paraprotein with anti‐Pr 1d specificity. The addition of Alsever's solution to washed RBCs inhibited the cold agglutinin. Each major component of Alsever's solution (neomycin, chloramphenicol, inosine, dextrose, and citrate) was tested individually; only citrate inhibited the patient's cold agglutinin. Various compounds structurally related to citrate were tested and found to cause various degrees of inhibition. The strongest inhibition correlated with the presence of either three carboxyl groups on molecules devoid of double‐bonded carbon atoms or two carboxyl groups in cis configuration. A panel of 54 cold agglutinins, including 7 with anti‐Pr specificity, was analyzed. None was significantly inhibited by Alsever's solution, although one with anti‐Pr 2 specificity was weakly inhibited. In summary, these studies describe an anti‐Pr 1d cold autoagglutinin that was inhibited by citrate in RBC preservative solutions. The failure to detect such a cold agglutinin can result from not washing RBCs free of citrate before testing.