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Persistent anti-K in eluate


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Hello Fellow BB'ers!  We have somewhat of a mystery!  We have a patient who developed an anti-K about 6+ months ago.  At the same time they were also demonstrating what appeared to be a warm auto in their eluate (eluate positive with all cells).  We allo-adsorbed and found the anti-K in their adsorbed eluate as well.  Ok - not unheard of........... 

Jump forward to present............  This patient has been receiving K neg RBC transfusions - maybe x2 every other week - since the anti-K was discovered.  Our protocol requires us to repeat DAT on each visit when suspected warm autos were detected....until he DAT is negativ.  The DAT has consistently been positive (2-3+ in gel) AND, although the "warm" is gone, the anti-K is still there - clear as a bell!......but we can't, figure out WHY!!!???  Patient types K neg.  (They are a renal patient undergoing dialysis)

Any thoughts?  Anyone ever run into an issue like this?

(FYI - we are a very large academic medical center....we handle our "problems" much like a reference lab would and serve as the reference facility for several smaller "sister" facilities.) :writersblock:

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Well, the simple answer is "YES", but whether you believe me or not is up to you.

When I was the Reference Service Manager of the Red Cell Immunohaematology (RCI) Laboratory at the Tooting Centre of the National Health Service Blood and Transplant (NHSBT), we had a patient's sample referred to us from one of our samples from the East Coast of England (I have to be careful not to identify either the patient or the hospital) who had an anti-K, having never been transfused with K+ blood.  However, this patient consistently had a positive anti-K in their plasma, and also, believe it or not, could have anti-K eluted from their erythrocytes,

Knowing the situation (i.e. we had not supplied K Positive blood to the hospital for this patient for many years, AND knowing that they knew what they were doing - they would NOT have given K Positive blood), I was wondering if either I, and/or my staff (in their case, almost impossible, even if I was fallible) and so we sent the sample to the International Blood Group Reference Laboratory (IBGRL) for confirmation.  The report we got back (from Joyce Poole) was that they also detected an anti-K, from an apparently K Negative patient with a positive DAT, but the eluate was (again, apparently) anti-K!

Unfortunately, we lost track of this patient, BUT, if Joyce was a bit foxed by this case, I feel TOTALLY free to be foxed as well!  Her theory was that this was a case of a "mimic-anti-K", rather in the same way of almost all WAIHA specificities being a mimicking "specific Rh antibody".  Since then, of course, it has been shown that low prevalence antigens within the Kell Blood Group System can lead to "strange" antibody specificities within the Kell Blood Group System, together with weakly expressed antigens within the Kell Blood Group System.

I am NOT saying this is a total answer to your query (but it is the best I CAN DO!).

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The observation that antigen negative cells can yield an eluate with an antibody for an antigen not present has been known for more than half a century I believe.  It's often referred to as the Matuhasi-Ogata phenomenon, first reported in the 1950s and 1960s.  My mentor, Joe Bove and Patrick Mollison wrote about this a bit later in the 1970s based upon work Bove did during a sabbatical in London. Needless to say, I heard about this often as a resident physician under Bove's supervision :).  Brings back memories....

Immunology,1973,25,793.

Non-specificBindingofIgGtoAntibody-coated RedCells (The'Matuhasi-OgataPhenomenon')

J.R.BOVE,*A.M.HOLBURNANDP.L.MOLLISON

MRCExperimentalHaematologyUnit, StMary'sHospitalMedicalSchool,LondonW21PG  Summary.Severalobservershavereportedthatredcellscoatedwithaspecific blood-groupantibodymaytakeupasecondblood-groupantibodynon-specifically, aneffectknownasthe'Matuhasi-Ogataphenomenon'.Inthepresentwork, thiseffectwasinvestigatedusingeither'25I-labelledantibodiesofvarious specificitiesora1311-labelledpreparationofIgGlackingrelevantantibodies.In confirmationofmuchpreviouswork,itwasfoundthatredcellstookupappreciableamountsofIgGnon-specifically;however,thisuptakewasnotincreased bypreviouscoatingoftheredcellswithspecificantibody.WhentheIgGtakenup non-specificallyincludedablood-groupantibodyinrelativelyhighconcentration, aneluatesubsequentlypreparedfromtheredcellscontainedsufficientoftheantibodytobedetectable.Thus,thefindingofunexpectedantibodiesineluatesmay beduetonon-specificuptakeofIgGratherthantoadherenceofantibodiesto antigen-antibodycomplexes.

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I do not know if Malcolm's case was published (I did not find it?) but this kind of auto anti-K mimicking an allo antibody is well described in this paper issued back in 1982   

Autoanti-K antibody mimicking an alloantibody, Transfusion Jul-Aug 1982;22(4):329-32, E. Viggiano et al.

This anti-K was adsorbed onto and eluted from both K pos. and K neg. cells. 

Edited by Arno
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1 hour ago, Arno said:

I do not know if Malcolm's case was published (I did not find it?) but this kind of auto anti-K mimicking an allo antibody is well described in this paper issued back in 1982   

Autoanti-K antibody mimicking an alloantibody, Transfusion Jul-Aug 1982;22(4):329-32, E. Viggiano et al.

This anti-K was adsorbed onto and eluted from both K pos. and K neg. cells. 

No, we didn't publish as, although the case was new to me, Joyce Poole had seen this kind of thing a few times.

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  • 3 weeks later...
On 7/19/2022 at 6:43 AM, David Saikin said:

I had a patient who had anti-K.  He was transfused fairly regularly (2-4u/month) for years.  Always K neg rbcs.  Always had a +DAT.  Only anti-K in the eluate.   

I've also seen this in an elderly K- male patient - he had never even been hospitalized in his life, much less transfused, until we saw him with his positive DAT and anti-K.

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