Journal of Blood Group Serology and Molecular Genetics VOLUME 33, N UMBER 3, 2017 This issue of Immunohematology is supported by a contribution from Grifols Diagnostics Solutions, Inc. Dedicated to advancement and education in molecular and serologic immunohematology Immunohematology Journal of Blood Group Serology and Molecular Genetics Volume 33, Number 3, 2017 CONTENTS C ASE R EPO R T 99 ABO serology in a case of persistent weak A in a recipient following a group O–matched unrelated bone marrow transplant D.E. Grey, E.A. Fong, C. Cole, J. Jensen, and J. Finlayson O R IGINAL R EPO R T 105 Stability guidelines for dithiothreitol-treated red blood cell reagents used for antibody detection methods in patients treated with daratumumab W.L. Disbro C ASE R EPO R T 110 A LU:−16 individual with antibodies C. Éthier, C. Parent, A.-S. Lemay, N. Baillargeon, G. Laflamme, J. Lavoie, J. Perreault, and M. St-Louis C ASE R EPO R T 114 Postpartum acute hemolytic transfusion reactions associated with anti-Lea in two pregnancies complicated by preeclampsia M. Marchese O R IGINAL R EPO R T 119 Red blood cell phenotype prevalence in blood donors who self- identify as Hispanic C.A. Sheppard, N.L. Bolen, B. Eades, G. Ochoa-Garay, and M.H. Yazer R EVIEW 125 DEL Phenotype D.H. Kwon, S.G. Sandler, and W.A. Flegel 133 138 142 144 A NNOUN C EMENTS A DVE R TISEMENTS I NST R U C TIONS S UBS cr IPTION FO R A UTHO R S I NFO R M AT I O N E DITO R - IN -C HIEF E DITO R IAL B OA R D Sandra Nance, MS, MT(ASCP)SBB Philadelphia, Pennsylvania Patricia Arndt, MT(ASCP)SBB Geralyn M. Meny, MD Pomona, California San Antonio, Texas M ANAGING E DITO R Barbara J. Bryant, MD Paul M. Ness, MD Cynthia Flickinger, MT(ASCP)SBB Galveston, Texas Baltimore, Maryland Wilmington, Delaware Lilian M. Castilho, PhD Thierry Peyrard, PharmD, PhD Campinas, Brazil Paris, France TEC HNI C AL E DITO R S Christine Lomas-Francis, MSc Martha R. Combs, MT(ASCP)SBB S. Gerald Sandler, MD New York City, New York Durham, North Carolina Washington, District of Columbia Joyce Poole, FIBMS Geoffrey Daniels, PhD Ira A. Shulman, MD Bristol, United Kingdom Bristol, United Kingdom Los Angeles, California Dawn M. Rumsey, ART(CSMLT) Anne F. Eder, MD Jill R. Storry, PhD Washington, District of Columbia Lund, Sweden Norcross, Georgia Melissa R. George, DO, FCAP Nicole Thornton S ENIO R M EDI C AL E DITO R Hershey, Pennsylvania Bristol, United Kingdom David Moolten, MD Julie K. Karp, MD Philadelphia, Pennsylvania Philadelphia, Pennsylvania E ME R ITUS E DITO R S Jose Lima, MD Delores Mallory, MT(ASCP)SBB A SSO C I AT E M EDI C AL E DITO R S Douglassville, Georgia Supply, North Carolina P. Dayand Borge, MD Philadelphia, Pennsylvania Christine Lomas-Francis, MSc Marion E. Reid, PhD, FIBMS New York City, New York Bristol, United Kingdom Corinne L. Goldberg, MD Durham, North Carolina M OLEC ULA R E DITO R Margaret A. Keller, PhD Philadelphia, Pennsylvania Immunohematology is published quarterly (March, June, September, and December) by the E DITO R IAL A S S I S TA N T American Red Cross, National Headquarters, Washington, DC 20006. Linda Frazier Immunohematology is indexed and included in Index Medicus and MEDLINE on the MEDLARS system. The contents are also cited in the EBASE/Excerpta Medica and Elsevier P R ODU C TION A S S I S TA N T BIOBASE/Current Awareness in Biological Sciences (CABS) databases. Marge Manigly The subscription price is $50 for individual, $100 for institution (U.S.), and $60 for individual, $100 for institution (foreign), per year. C OPY E DITO R Subscriptions, Change of Address, and Extra Copies: Frederique Courard-Houri Immunohematology, P.O. Box 40325 Philadelphia, PA 19106 P R OOF R EADE R Wendy Martin-Shuma Or call (215) 451-4902 Web site: www.redcrossblood.org/hospitals/immunohematology E LEC T R ONI C P UBLISHE R Copyright 2017 by The American National Red Cross Paul Duquette ISSN 0894-203X O N O U R C OVE R The late 19th century and early 20th century Italian Jewish painter, Amedeo Modigliani, fits as well as anyone the romantic archetype of the tragic Bohemian artist. A master of expressionist portraits and figure studies, he enjoyed little success during his brief career. Elegantly lengthened mask-like faces and bodies with simplified idealized features were hallmarks of his style, although he also provoked controversy by his stark inclusion of pubic hair in his nudes. Impoverished and suffering from terminal tuberculosis in his early thirties, he sank deeper into alcoholism although he continued to paint. He had one serious romantic interest, Jeanne Hébuterne, a young model who became his fiancé at the end of his life, despite the objections of her parents. Here he depicts her during her pregnancy in a white chemise (1919). The article by Marchese addressing Lewis antibodies in pregnancy is included in this issue. David Moolten, MD CASE R EPO R T ABO serology in a case of persistent weak A in a recipient following a group O–matched unrelated bone marrow transplant D.E. Grey, E.A. Fong, C. Cole, J. Jensen, and J. Finlayson HLA-matched hematopoietic stem cell transplantation (HSCT) group to donor blood group in the recipient. In contrast, most from red blood cell (RBC)-incompatible donors is not uncommon. non-hematopoietic tissues retain expression of the patient’s The engraftment process following ABO-incompatible allogeneic original blood group for life, and these antigens may adsorb HSCT results in the transition from patient blood group to donor 5 blood group in the recipient. In contrast, most non-hematopoietic from the plasma onto the donor-derived RBCs. tissues retain expression of the patient’s original blood group for The correct serologic interpretation of the recipient’s life, and these antigens may adsorb from the plasma onto the ABO blood group during this engraftment process can be donor-derived RBCs. Correct serologic interpretation of the ABO blood group during this engraftment process can be difficult. difficult because of serologic discrepancies caused by ABO We present the serologic findings of a 15-year-old girl of Maori incompatibility between the recipient and donor during descent, who was diagnosed with acute myeloid leukemia and engraftment, transfusion of blood components with differing transplanted with an HLA-matched unrelated group O, D+ bone ABO group to the recipient, administration of high-dose marrow. Despite engraftment, her RBCs showed persistence of weak A. This case report showcases the importance of awareness intravenous immunoglobulin producing elevated levels of ABO and correct serologic interpretation of weak persistence of isoagglutinins, engraftment failure, and relapse. In addition, recipient ABH substance on the patient’s RBCs for clinical adsorption of recipient antigens onto donor RBCs adds another decision-making, blood component support, and patient well- level of complexity to the interpretation of the ABO group, and being. Immunohematology 2017;33:99–104. this may have implications for blood component support and Key Words: ABO, transplant, serology, monoclonal, clinical decision-making. antibody, recipient ABH substance We present the serologic findings of a case of persistent weak A in a recipient following a group O HLA-matched HLA-matched hematopoietic stem cell transplantation unrelated bone marrow transplant. (HSCT) from red blood cell (RBC)-incompatible donors is not uncommon.1 ABO-incompatible HSCT is of particular Case Report importance because of the consequences of acute hemolysis and the complexity of blood component selection. A 15-year-old girl of Maori descent was diagnosed with ABO antigens and the closely related H, secretor, and acute myeloid leukemia in 2014. Her RBCs typed as group A, Lewis histo-blood group carbohydrates are synthesized D+, Le(a–b–). A total of 46 units of group A, D+ RBCs and by specific glycosyltransferases encoded byABO, FUT1, 64 units of group A and 2 units of group O apheresis platelets FUT2, and FUT3, respectively. These enzymes incorporate were transfused during the first 5 months following diagnosis. monosaccharide units into precursor oligosaccharide chains, The patient was then transplanted with an HLA-matched modifying them and creating new antigenic specificities.2 unrelated group O, D+ bone marrow. A further 7 units of FUT1 and ABO encode enzymes that synthesize H, A, and B RBCs, all group O, D+, and 18 group A and 4 group O units in mesodermal and hematopoietic tissues that are therefore of apheresis platelets were transfused post-transplant, within intrinsic to the RBC. FUT2 and FUT3, together with ABO, are a 1-month period. There were no units of RBCs or platelets responsible for H, A, B, Lea, Leb, ALeb, and BLeb carbohydrates transfused during the following 27 months. on ectodermal tissues such as the gut, respiratory and urinary Engraftment was confirmed by day 24 post-transplant mucosae, and exocrine secretions, which are transported to with short tandem repeat chimerism studies (lymphocytes) the plasma and adsorbed onto the RBC membrane.2–4 showing 99 percent chimerism (Table 1). The engraftment process following ABO-incompatible Five months post-transplant, routine blood grouping allogeneic HSCT results in the transition from patient blood (BioVue column agglutination technology [CAT]; Ortho IMMUNOHEMATOLOGY, Volume 33, Number 3, 2017 99 D.E. Grey et al. Table 1. Results of patient ABO and D blood typing by CAT (BioVue, Ortho Clinical Diagnostics, Bridgend, UK; agglutination grade 0–4+) and short tandem repeat lymphocytes chimerism studies at diagnosis and at different time points post-transplant Anti-A Anti-B Anti-A,B Anti-D Anti-H A1 Cells B Cells STC (%) Time Point (MH04, 3D3) (NB10.5A5, NB1.19) (MH04, 3D3, NB10.5A5, NB1.19) At diagnosis 4+ 0 nt 4+ nt 0 4+ nt Day 9 mf 0 nt 4+ nt 0 3+ nt Day 24 nt nt nt nt nt nt nt 99 3 months nt nt nt nt nt nt nt 99 5 months 1+ 0 nt 4+ nt 0 3+ 99 8 months nt nt nt nt nt nt nt 98 Post-Transplant 9 months 2+ 0 nt 4+ nt 0 3+ nt 28 months 1+ 0 2+ 4+ 4+ 0 2+ nt mf = mixed field; nt = not tested; STC = short tandem repeat lymphocytes chimerism.