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1/16. Characterisation of the anti-A antibody response following an ABO incompatible (A2 to O) kidney transplantation.

    Anti-A,B antibodies produced in a blood group OLe(a-b-) recipient receiving a kidney graft from a blood group A2Le(a-b ) donor have been analysed for their ability to bind to different glycosphingolipid antigens. Solid-phase RIA using pure glycosphingolipid antigens and a chromatogram binding assay using total nonacid glycosphingolipid fractions from erythrocytes of different human blood group phenotypes together with pure glycolipid antigens were used as assay systems. serum antibodies were shown to bind equally well to A (types 1, 2, 3 and 4) and B (types 1 and 2) antigenic structures but no binding to H antigens (types 1, 2 and 4) was detected. After adsorption of serum antibodies on A1 Le(a-b ) erythrocytes there was a residual anti-A antibody activity which could not be adsorbed by synthetic A-trisaccharides coupled to crystalline silica (Synsorb-A). These residual antibodies, which are not present in a pretransplant serum sample, had a specificity for the A antigen with type 1 core saccharide chain and the binding epitope obviously included both the N-acetylgalactosamine and the N-acetylglucosamine. The fucose residue was apparently not obligate for binding. The conformation of the sugar units involved in the binding epitope was determined.
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2/16. Iso-immune neonatal neutropenia due to an anti-Fc receptor III (CD16) antibody.

    We report a case of transient neonatal neutropenia due to a maternal iso-immunization against a non polymorphic region of the glycosylphosphatidylinositol-linked Fc receptor type III (CD16) on granulocytes. The mother's granulocytes were typed NA1-negative, NA2-negative and CD16-negative with human and monoclonal antibodies whereas her lymphocytes express the CD16 molecule. Expression of other markers were comparable to the controls. Flow cytometric analysis showed that maternal antibody recognized the granulocytes but not the lymphocytes from blood bank donors and that its binding was decreased on normal, phospholipase C-treated, granulocytes. The binding of commercial CD16 monoclonal antibodies was also dramatically decreased on normal granulocytes pre-incubated with maternal serum. The CD16 specificity of the antibody was confirmed by negative reactions with another CD16-deficient granulocytes. This observation leads us to conclude that cell-lineage specific differences of CD16 molecules are recognized by the patient's antibody. Moreover, we confirm that the absence of the FcRIII (CD16) on granulocytes is not associated with any pathology or susceptibility to infections and that, in the children, the blockade of this receptor by the maternal antibody only led to moderate neutropenia.
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3/16. Transfusion-related acute lung injury resulting from designated blood transfusion between mother and child: a report of two cases.

    Transfusion-related acute lung injury (TRALI) is an underdiagnosed serious complication of blood transfusion characterized by the rapid onset of respiratory distress, hypoxia, and noncardiogenic pulmonary edema during or soon after blood transfusion. The presence of anti-HLA and/or antigranulocyte antibodies in the plasma of donors is implicated in the pathogenesis of TRALI. We report 2 cases of TRALI that were caused by designated blood transfusion between mothers and their daughters; one in a 4-month-old girl who received designated packed RBCs donated by her mother and the second in a 78-year-old mother who received blood from her daughter. In both cases, examination of mother's serum revealed panel-reactive cytotoxic HLA antibodies. It is most likely that the mothers were sensitized from earlier pregnancy and produced HLA antibodies against the daughters' paternally derived hla antigens. Designated blood transfusion between multiparous mothers and children might add an additional transfusion-related risk owing to the higher likelihood of the HLA antibody-antigen specificity between mother and child.
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4/16. Antibody response in an ABO-incompatible blood transfusion. Antigen specificity and immunoglobulin class.

    The anti-A response in a group B patient accidentally given 1 unit transfusion of A1 blood is described. The antibody response is characterized both with conventional agglutination techniques and with radioimmunoassay using pure group A antigens with different core saccharide structures (type 1, 2, and 4 chains) and class-specific second antibodies. The anti-A titer rose to a maximum Days 11 to 14 after the incompatible transfusion. The antibodies involved were mainly of the IgG and IgA types, while the IgM response was moderate. The IgA antibodies seemed to be nonselective with respect to group A antigen type, while the IgG antibodies showed a specificity against type 2 chain group A antigens.
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5/16. Acquired loss of red-cell Wj antigen in a patient with Hodgkin's disease.

    A patient with Hodgkin's disease became temporarily Wj-negative with alloanti-Wj in his serum. Four human autoantibodies, and 1 of 2 murine monoclonal antibodies, with serological characteristics of anti-Wj were nonreactive with his red cells, confirming that they have anti-Wj specificity. Six siblings of the patient are all Wj-positive. The patient was also temporarily Anton-negative, and cross-testing between Wj and Anton red cells and antisera showed mutual compatibility, indicating that the antigens are the same. The patient and 3 of his 6 siblings are also of the rare Lu: - 13 phenotype, providing the first evidence that this is an inherited characteristic.
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6/16. Successful transplantation of marrow from an HLA-A, -B, -D mismatched heterozygous sibling donor into an HLA-D-homozygous patient with aplastic anemia.

    A patient with aplastic anemia who was found to be homozygous for an HLA-D determinant shared by her unrelated parents achieved sustained engraftment and full restoration of hematopoietic and lymphoid function following a transplant from an HLA-A and -B nonidentical, ABO incompatible sibling who was heterozygous for the shared HLA-D specificity. Transplantation was complicated by transient graft-versus-host disease of moderate severity, which resolved completely following treatment with antithymocyte globulin and prednisone. The case indicates that patients found to be HLA-D-homozygous may be successfully transplanted from HLA-D-heterozygous sibling donors despite HLA-A and HLA-B incompatibilities, and thus further demonstrates the importance of the HLA-D region as a marker of donor-host histocompatibility.
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7/16. Neonatal alloimmune thrombocytopenia due to fetomaternal Zwb incompatibility.

    A case of neonatal alloimmune thrombocytopenia due to fetomaternal incompatibility against the platelet-specific antigen Zwb (PlA2) is described. The antibody was of the IgG class and did not fix complement in vitro. Its specificity was established by panel identification and by comparison to a Zwb antiserum. gene dosage determinations of Zwa antigens on platelets of parents and child revealed that the mother was homozygous Zwa Zwa, while father and child were heterozygous for this antigen.
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8/16. Hemolytic anti-hr" (e) detectable solely by an automated polybrene technique.

    An example of a hemolytic anti-hr" (e) detectable solely by an AutoAnalyzer-Polybrene (AAP) system is reported. The antibody was undetectable by routine indirect antiglobulin and enzyme tests, and produced a delayed intravascular hemolytic transfusion reaction. The anti-hr" (e) was no longer AAP detectable five months after the transfusion reaction. This paper points out the potential usefulness of the AAP technique in detecting alloantibodies in cases of transfusion reactions where no antibody specificity can be demonstrated by standard manual techniques.
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9/16. Eluate analysis of anti-Bg a associated renal allograft rejection.

    Renal allograft rejection, following development of a positive indirect antiglobulin reaction, occurred in a multiply transfused recipient. Panel techniques confirmed both anti-Bga and anti-Kell antibodies. Recognition of the concordant antigenic specificity of the Bga and HL-A7 antigens led to an investigation of the potential role of this antibody in the rejection phenomenon. In the absence of serological cytotoxicity, a modified elution technique was used to directly obtain immunoglobulin from the rejected allograft. The eluate obtained displayed specificity for the Bga red blood cell antigen. The described technique affords an additional approach to the documentation of immunologically mediated graft rejection and obviates the limitations imposed by the absence of serological cytotoxicity. Emphasis is placed on the need for recognition of the relationship between red blood cell and HL-A antigens.
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10/16. Detection of fetal-maternal hemorrhage in a mother with sickle trait and hereditary persistence of fetal hemoglobin.

    An Rh-negative term primigravida with sickle trait and hereditary persistence of fetal hemoglobin and an Rh-positive infant were evaluated postpartum for fetal-maternal hemorrhage (FMH) by the acid-elution test for fetal hemoglobin (HbF) cells. Using the acid-elution test, 100 percent of the cells contained HbF. The patient received one vial of Rh immune globulin and was discharged. This report illustrates that lack of specificity is a major problem of the acid-elution test for detection of fetal-maternal hemorrhage, due to its failure to differentiate true fetal Rh-positive cells from maternal Rh-negative HbF cells. Moreover, productivity studies suggest performance of agglutination tests such as the immune rosetting test is more convenient than performance of the acid-elution test to screen for FMH. The recently developed enzyme-linked antiglobulin test, however, may replace both of these procedures for detection of FMH.
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