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Immunohematology JOURNAL of BLOOD GROUP SEROLOGY and EDUCATION Immunohematology JOURNAL OF BLOOD GROUP SEROLOGY AND EDUCATION VOLUME 17, NUMBER 1, 2001 From the publishers of Immunohematology A Comprehensive Laboratory Manual Immunohematology Methods and Procedures Featuring— • Over 100 methods— just about every method used in a reference lab. • Eleven chapters discussing problems faced by blood group serologists and the procedures and methods that can be used to solve them. • An extra set of the methods to use at the bench, printed on durable waterproof paper. • See business reply order card enclosed in this issue or order on the Web at redcross.org/immunohematology Now available from Montgomery Scientific Publications APPLIED BLOOD GROUP SEROLOGY, 4th EDITION by Peter D. Issitt and David J. Anstee A totally revised, mostly rewritten, fully up-to-date edition of one of the most popular books about the blood groups and blood transfusion ever published. I 46 chapters, an increase of 16 over the third edition 1 ″× ″ • 1,208 plus xxiv 8 /2 11 pages, hardbound, fully indexed, over 1,500 entries I 260 tables and 112 figures, an increase of more than 60% over the third edition • Over 13,500 references, more than 5,000 are papers written since 1985 Prices; each includes shipping: USA $125.00; Canada/International $130.00 (surface mail); International $170.00 (air mail). ALL ORDERS MUST BE PREPAID (Check or Credit Card) in U.S. DOLLARS International orders by check drawn on a bank in the USA or by credit card please. Order from: Montgomery Scientific Publications, P.O. Box 2704, Durham, NC 27715, U.S.A. Credit card orders accepted by fax at (919) 489-1235 (No phone orders, please.) We accept VISA,MasterCard, and Discover Card. Immunohematology JOURNAL OF BLOOD GROUP SEROLOGY AND EDUCATION VOLUME 17, NUMBER 1, 2001 CONTENTS 1 Red blood cell antigen changes in malignancy: case report and review J.L. WINTERS AND D.S. HOWARD 10 Discrepancies in Rh(D) typing of sensitized red blood cells using monoclonal/polyclonal anti-D reagents: case report and review B.J. PADGET AND J.L. HANNON 14 Confirmation of positive antibody screens by solid-phase red cell adherence assay using a tube technique method with polyethylene glycol enhancement R.R. GAMMON, M. LAKE, N. VELASQUEZ, AND A. PRICHARD 17 Evaluation of a new solid-phase immunoassay for alloantibody detection using bromelin-treated and untreated red blood cells T. T AMAI AND T. M AZDA 22 Likelihood of D heterozygosity in Mestizo Mexicans and Mexican Americans N.D. MEANS, N. B ANDARENKO, K.J. MOISE, JR, AND M.E. BRECHER 24 BOOK REVIEW S. GERALD SANDLER, MD 25 COMMUNICATIONS Letter from the Editors ERRATA It’s our 17th year! Vol. 16, No. 4, 2000, p. 161 26 27 27 ANNOUNCEMENTS CLASSIFIED AD ADVERTISEMENTS 29 35 LITERATURE REVIEW INSTRUCTIONS FOR General (1999–2000) A U T H O R S EDITOR-IN-CHIEF MANAGING EDITOR Delores Mallory, MT(ASCP)SBB Mary H. McGinniss, AB, (ASCP)SBB Rockville, Maryland Bethesda, Maryland TECHNICAL EDITOR MEDICAL EDITOR Christine Lomas-Francis, MSc S. Gerald Sandler, MD Austin, Texas Washington, District of Columbia EDITORIAL BOARD Patricia Arndt, MT(ASCP)SBB Brenda J. Grossman, MD Scott Murphy, MD Los Angeles, California St. Louis, Missouri Philadelphia, Pennsylvania James P. AuBuchon, MD Christine Lomas-Francis, MSc Paul M. Ness, MD Lebanon, New Hampshire Austin, Texas Baltimore, Maryland Malcolm L. Beck, FIBMS, MIBiol Gary Moroff, PhD Mark Popovsky, MD Kansas City, Missouri Rockville, Maryland Braintree, Massachusetts Richard Davey, MD Ruth Mougey, MT(ASCP)SBB Marion E. Reid, PhD, FIBMS Rosslyn, Virginia Carrollton, Kentucky New York, New York Geoffrey Daniels, PhD John J. Moulds, MT(ASCP)SBB Susan Rolih, MS, MT(ASCP)SBB Bristol, United Kingdom Raritan, New Jersey Norcross, Georgia Sandra Ellisor, MS, MT(ASCP)SBB Marilyn K. Moulds, MT(ASCP)SBB David F. Stroncek, M.D. Raritan, New Jersey Houston, Texas Bethesda, Maryland George Garratty, PhD, FRCPath Marilyn J. Telen, MD Los Angeles, California Durham, North Carolina PRODUCTION ASSISTANT Linda Berenato COPY EDITOR Sonia E. Connor ELECTRONIC PUBLISHER Jane Moore Immunohematology is published quarterly (March, June, September, and December) by the American Red Cross, National Headquarters, Washington, DC 20006. The contents are cited in the EBASE/Excerpta Medica and Elsevier BIOBASE/Current Awareness in Biological Sciences (CABS) databases. The subscription price is $30.00 (U.S.) and $35.00 (foreign) per year. Subscriptions, Change of Address, and Extra Copies: Immunohematology, P.O. Box 40325 Philadelphia, PA 19106 Or call (215) 451–4902 Web site: redcross.org/immunohematology Copyright 2001 by The American National Red Cross ISSN 0894-203X Red blood cell antigen changes in malignancy: case report and review J.L.WINTERS AND D.S. HOWARD Red blood cell (RBC) antigens represent inherited neutrophils (normal 40 to 70%), 3 percent traits and as such, their expression should be constant metamyelocytes (normal 0%), 15 percent myelocytes throughout the life of an individual. We describe a (normal 0%), 7 percent lymphocytes (normal 24 to patient in whom the expression of the Rh D and C 44%), 1 percent monocytes (normal 3 to 7%), 4 percent antigens was lost due to the development of chronic basophils (normal 0 to 1%), 4% eosinophils (normal 0 to myelogenous leukemia (CML). For this patient, this 3%), and 1 percent blasts (normal 0%). A bone marrow represented more than a blood bank curiosity but was biopsy and aspirate were obtained and demonstrated of critical importance in determining further treatment a hypercellular (100%) bone marrow with histologic of the leukemia. and flow cytometric features consistent with CML. The mechanisms behind changes in RBC antigens Cytogenetic analysis revealed the presence of the due to malignancy are reviewed for a number of Philadelphia chromosome (t [9;22]), consistent with antigens, antigen systems, and antigen collections. CML. No further abnormalities, including abnormalities Previous case reports of RBC antigen changes due to of chromosome 1, were noted on karyotype analysis. malignancy are summarized. Subsequent molecular studies from peripheral blood confirmed the presence of BCR/ABL fusion product. Key Words: leukemia, erythrocytes, antigens, mutation, The patient was treated with hydroxyurea for ABO blood group system, Rh blood group system, MNS normalization of peripheral blood counts. blood group system, Lewis blood group system, I blood Following initial presentation and management, the group collection, chromosome abnormalities patient was referred to our center to be evaluated for syngeneic hematopoietic stem cell transplantation as Case Report definitive therapy for her diagnosis. The patient’s A 48-year-old Caucasian woman presented to a physical examination and pretransplant organ function referring clinic with a 3-month history of increasing studies were normal. Results from physical examination malaise and poor energy. She had experienced recent and donor evaluation studies of the patient’s sibling bruising and abdominal pain. Her past medical history were also normal. The twins physically appeared to be revealed a well adult with prior surgeries including total identical. Molecular typing of the sisters for HLA abdominal hysterectomy and tonsillectomy/ revealed them to be identical (6 out of 6 match at the adenoidectomy and no prior hospitalizations for HLA-A, HLA-B, and HLA-DR loci). Additional molecular medical illnesses. She was on no routine medications. studies were undertaken to prove that the sisters were She denied exposure to known marrow toxins. Her identical twins. These consisted of comparing four family history revealed her to be one of a set of variable number of tandem repeats (VNTRs) and nine identical twins. Significant physical exam findings short tandem repeats (STR) loci. The two were identical included multiple bruises on the extremities and a at all 13 loci tested. However, ABO and Rh typing by palpable spleen. Hemogram showed a white blood cell serologic methods revealed that the patient typed as A, count of 225,200/mL (normal 4,800 to 10,800/mL), D– whereas her sister typed as A, D+. In order to resolve hematocrit of 36.8 percent (normal 37 to 47%), this apparent discrepancy, additional testing was hemoglobin of 12.8 g/dL (normal 12 to 16 g/dL), and a performed. A new specimen was obtained from each platelet count of 468,000/mL (normal 130,000 to sister that confirmed the previous ABO and Rh typing. 400,000/mL). White cell differential showed 65 percent Weak D testing with appropriate controls was IMMUNOHEMATOLOGY, VOLUME 17, NUMBER 1, 2001 1 J.L. WINTERS AND D.S. HOWARD performed on the patient and was negative. An aspirate for the presence of the BCR/ABL fusion extended RBC phenotype was performed and is given product remain positive. below: Patient: D–, C– E–, c+, e+, M+, N+, S+, s–, K–, k+, Changes in Red Blood Cell Antigens With Fy(a+b+), Jk(a+b+) Malignancy Either loss or diminished expression of RBC antigens Sister: D+, C+, E–, c+, e+, M+, N+, S+, s–, K–, k+, have been reported to occur in a number of Fy(a+b+), Jk(a+b+) malignancies (both hematologic and solid; see Table 1). Additional history was obtained from the patient and The first report,2 and those which make up the majority from review of outside medical records. As opposed to of reports,3–6 have involved alterations in the expression her current D– typing, the patient had typed as D+ at of ABO blood group antigens. In addition to the ABO the birth of her second child in 1982 and also at four blood group system, multiple other antigens and whole blood donations between 1984 and 1989. antigen systems/collections have been reported to be Therefore, further testing was initiated. Additional affected by malignancy (see Table 1). studies included molecular genotyping for the RHD These changes in blood group antigens can result gene via polymerase chain reaction.
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