Three examples of anti-Fy3 produced in Negroes.

We present three examples of anti-Fy3 produced by Negroes. Results of serologic studies were similar to those of previously reported examples of Negro produced anti-Fy3, including negative to weak reactivity with cord red blood cells, separable anti-Fya, and the presence of multiple unexpected alloantibodies. These findings reinforce the difference between anti-Fy3 produced by Negroes and that produced by non-Negroes. The rare formation of Duffy antibodies by Negroes may signify the presence of an amorphic gene at the Duffy locus.

Amish study, IV: Genetic linkage study of pedigrees of bipolar probands.

Genetic linkage studies were conducted on five Old Order Amish bipolar pedigrees in 1979 and 1982, with 94 members tested for color blindness and typed for 42 red blood cell and related markers in 17 antigen systems. Also, 59 individuals in two pedigrees were typed for HLA, Bf, and GLO. Linkage analyses assuming X-linkage and autosomal inheritance of bipolar illness were done with diagnostic schemes ranging from strict bipolar to milder forms of affective disorder. Linkage to affective disorders was not strongly supported for any marker locus. Close linkage to HLA was excluded, with weaker evidence against linkage to GLO.

An immediate hemolytic transfusion reaction due to anti-C and a delayed hemolytic transfusion reaction due to anti-Ce+e: hemoglobinemia, hemoglobinuria and transient impaired renal function.

A patient with phenotype R2r and anti-C has a hemolytic transfusion reaction (HTR) with hemoglobinemia and hemoglobinuria which occurred within 2 h of receiving an R1r transfusion. Transient impaired renal function ensued. A patient with phenotype R2R2 and anti-Ce+e had the same experience on day 4 after receiving three R1r and one rr units. 2 other patients, 1 R2r with anti-C who received one R1r unit and the other R2R2 with anti-Ce+e who received two R1r units, showed no clinical evidence of HTR. Both anti-C antibodies were entirely IgG while both anti-Ce+e antibodies initially were predominantly IgM. IgG subclassing was unsuccessful and red blood cell-mononuclear phagocyte assays were normal. These cases occurred from 1979 to 1981.

Successful transfusion results using Rg(a+) blood in four patients with anti-Rga.

4 patients with anti-Rga successfully transfused in 1979 and 1980 with Rg(a+) donor units are herein reported since the literature lacks information on transfusion results in patients with this alloantibody. The transfusions of both Rg(a+) whole blood and packed red blood cell units caused no discernible immediate or delayed transfusion reactions. Clinically, predicted hematocrit increases were attained and sustained and the laboratory findings showed no evidences of shortened survivals of donors' red blood cells.

The serology of the York-Cost-McCoy-Knops red blood cell system.

Since 1965, sera from 305 patients who produced alloantibodies against the red blood cell antigens Yka, Csa, McCa, McCc, McCd and Kna have been evaluated by the author. These antibodies were acquired as a result of either transfusion or pregnancy. They reacted only by indirect antiglobulin technique, and were generally unaffected by ficin pretreatment of test cells. The majority reacted poorly in EM-V LISS when 10 minute incubations were used. Cord red blood cells showed normal expression of the antigens. Serologic difficulties were due to relative antigen fragility in vitro of patients' samples, varying expression of antigen strength, relative low antibody avidity, and in 48% of the sera coexistence of additional unrelated alloantibodies. Antigen frequencies for Yka, Csa, McCa and Kna ranged between 90 and 99%, also displaying racial differences.

Anti-Rga: identifying serologic characteristics.

Anti-Rga is a rare alloantibody that is difficult to recognize and identify. Although posing no apparent transfusion risk itself, it can mask the presence of underlying alloantibodies which could be transfusion risks. The five patients reported here demonstrate the serologic findings characteristic of anti-Rga. Known Rg(a-) test cells and multiple "target cells" in neutralization studies are needed to demonstrate partial neutralization findings and to detect underlying alloantibody. Other observations were that clotted samples of red cells retained Rga reactivity for 49 days, whereas EDTA-anticoagulated red cell samples lost such reactivity after 13 days. Frozen red cells tested within hours of deglycerolization showed excellent Rga reactivity.

Biological significance of the York, Cost, McCoy and Knops alloantibodies.

The biological significance of alloantibodies directed against the red blood cell antigens York, Cost, McCoy, and Knops has been investigated by means of a literature search and an analysis of 304 patient referrals received since 1965. Neither method detected documented cases of erythroblastosis fetalis due to these antibodies. The analysis of the patient referrals identified 11 women immunized by pregnancy. The literature search provided one documented case of hemolytic transfusion reaction and one probable case of successful transfusion of incompatible blood. The analysis of the patient referrals revealed two cases of probable successful transfusions of incompatible blood, nine patients with documented evidences of extravascular hemolytic transfusion reactions, and one patient with documented evidence of intravascular hemolytic transfusion reaction. The conclusion reached is that alloantibodies directed against the York, Cost, McCoy, and Knops antigens are biologically significant with respect to red blood cell transfusions in some patients. Transfusion practices show that most patients have received compatible transfusions, an indication that the physicians in the hospitals adhere to the philosophy of compatible transfusions, whenever possible.

Extravascular hemolytic transfusion reactions due to anti-Yk(a)+Cs(a).

The literature lacks cases which document significant hemolytic transfusion reactions or which document successful transfusions of incompatible donor blood in patients who have anti-Yk(a), anti-Cs(a), or anti-Yk(a)+Cs(a). A patient who had multiple extravascular hemolytic transfusion reactions due to anti-Yk(a)+Cs(a) is herein reported. The initial reaction was on the basis of a secondary episodes involving incompatible donor units resulted in more rapid red cell destruction and finally oliguria.

Hemolytic transfusion reaction due to anti-Kell undetectable in low-ionic-strength solutions.

Low-ionic-strength solution (LISS) reagents and methodologies have become popular in recent years in hospital transfusion service laboratories for alloantibody detection and compatibility testing of blood recipients. It has been the experience with all other hemagglutination technics that some examples of alloantibodies unpredictably fail to react. Such is the case with this patient's alloantibody with respect to LISS. The patient had a significant hemolytic transfusion reaction due to Kell incompatibility of one unit of packed human erythrocytes. Using various LISS reagents and methodologies, the anti-Kell was undetectable in pretransfusion and posttransfusion samples through the fifth day. The anti-Kell was of immunoglobulin class IgG, and it was detected in saline solution or albumin at room temperature, at 37 C and by the antiglobulin technic.

Intravascular hemolytic transfusion reaction due to anti-Vw+Mia with fatal outcome.

Because of the increasing use of type, screen and hold protocols and minimal surgical blood order protocols in transfusion services, a number of patients are receiving un-cross-matched blood in elective situations. There are many low-frequency red blood cell antigens which are lacking on reagent cells used for antibody screening procedures, and alloantibodies directed against these antigens are relatively common and occur in either natural or immune forms. A case of an intravascular hemolytic transfusion reaction resulting in death is reported. The patients had a naturally occurring anti-Vw+Mia and received 1 U of Vw+Mia-positive donor red cells. It is the 1st documented case of a hemolytic transfusion reaction due to this incompatibility. The potential threat of transfusion reactions due to low-frequency antigens must be recognized by the physicians who design type, screen and hold protocols and it has particular reference to the selection of possible recipients for whom the protocols are applied.

Lewis phenotypes of American Caucasians, American Negroes and their children.

Lewis antisera produced in goats was used to test the red blood cells of 1,818 unrelated American adults and 758 unrelated children. All lived in northeastern states of the USA. Among 950 Caucasian adults, the frequency of Le(a-b-), Le(a+b-), and Le(a-b+), red cell phenotypes was 9.7, 20.1 and 70.2%, respectively. Among 883 Negro adults, the frequency of these phenotypes was 28.5, 19.6 and 51.9%, respectively. Among 469 infants aged 1-24 months, the red cell phenotypes Le(a+b+) was found in 37.4% of 265 Caucasians and 13.2% of 204 Negroes.

The second example of anti-M1 antibodies produced by a group MN person.

A second example of anti-M1 antibodies produced by a group MN person has been identified, and the reactions observed confirm the results obtained with the first example. The antibodies react with 17.2% of American black M positive samples. At 25-27 degrees C, the serum reacts strongly with untreated cells; the reactions are weaker with ficin-treated cells, but are enhanced with neuraminidase-treated cells. The antibodies are IgM; they were detected in ABO reverse grouping tests.

A new antigen, McCa (McCoy), and its relationship to Kna(Knops).

The antigen McCa is detected in 98.5 and 96.7 per cent of the American Caucasian and Negro populations respectively. In population studies with anti-McCa and anti-Kna, a strong association was demonstrated between the two antigens, with 53 per cent of McC(a-) sample being Kn(a-) compared with a reported frequency for Kn(a-) of only 0.19 per cent.

A new antigen Yk-a (York), and its relationship to Cs-a (Cost).

The antigen Yk-a is detected in 92 and 98% of the American Caucasian and Negro populations, respectively. In population studies with anti-Yk-a and anti-Cs-a, association was demonstrated between the two antigens; however, in two of three informative families Yk-a and Cs-a segregated independently. The possibility that these antigens have a relationship with leucocyte antigens is discussed.