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Policy for use of blood Kell Positive


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18 hours ago, Malcolm Needs said:

Sorry John, but you are incorrect - and correct!  The first antigen within the Kell Blood Group System is, under the ISBT numerical system 006 001 (006 being the number of the Blood Group System, and 001 being the first antigen within that system) and, indeed, the 006 is never used in terms of Blood Group Systems (except on computers), and the "00" bit of the "001" is redundant, so you would think that K is equivalent to K1, but it isn't!  To quote from Reid ME, Lomas-Francis C, Olsson ML.  The Blood Group Antigen FactsBook."  3rd edition, 2012, Academic Press, page 3-7, "It is incorrect to refer to the K and k antigens as, respectively, K1 and K2; in the numerical terminology they should be referred to as KEL1 and KEL2."

Annan, please see this quote from above.

K1 is incorrect (as quoted from The Blood Group Antigen FactsBook) and there is no such antigen as Kell.

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The K1 and K2 antigens were named after two pregnant women -- a Mrs. Kellacher and a Mrs. Cellano -- who were first identified as having developed the corresponding antibodies.  (Apparently Mrs. Kellacher was first in 1946, or we would be calling it the Cellano system.)  Then there's a Mr. Hugh McLeod, who was identified as a K null  in 1961.  Hence the terms McLeod phenotype and McLeod Syndrome, which Henry VIII may have suffered from, along with anyone around him in his later years.

Scott

Edited by SMILLER
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43 minutes ago, SMILLER said:

The K1 and K2 antigens were named after two pregnant women -- a Mrs. Kellacher and a Mrs. Cellano -- who were first identified as having developed the corresponding antibodies.  (Apparently Mrs. Kellacher was first in 1946, or we would be calling it the Cellano system.)  Then there's a Mr. Hugh McLeod, who was identified as a K null  in 1961.  Hence the terms McLeod phenotype and McLeod Syndrome, which Henry VII may have suffered from, along with anyone around him in his later years.

Scott

Sorry Scott, but an awful lot of this is wrong!  Certainly K and k (NOT K1 and K2, as explained above) were named after two pregnant women, and anti-K had primacy over anti-k, but anti-k (as mentioned in both The Blood Group Antigen FactsBook AND Bloody Brilliant!  A History of Blood Groups and Blood Groupers.) the woman involved in the discovery of anti-k was actually named Nocella, rather than Cellano.  Anti-K was described in 1946 in  the paper by Coombs, Mourant and Race that described the Direct Antiglobulin Technique, whereas anti-k was not described until 1949 in a paper by Levine, Backer, Wigod and Ponder.  All of that having been said, the actual first antibody/antigen that was described that is now in the Kell Blood Group System was Levay (now Kpc or KEL21), which was described by Callender, Race and Paykoc in 1945, but, of course, it was not recognised as part of any System at the time, as, for years and years, there was only one known example of anti-Levay, otherwise the Kell Blood Group System would have been called the Levay Blood Group System, and not the Cellano Blood Group System.

Mr Hugh McLeod, a dental student, was not a true Ko (or Kellnull), but had weak expression of Kell Blood Group System antigens.  True, his phenotype was described in 1961 (by Allen, Krabbe and Corcoran), but the true Ko (or Kellnull) phenotype, which, unlike the McLeod phenotype, has no expression of the Kell antigens whatsoever, and which was first described in 1957, just after Allen and Lewis had described anti-Kpa.  Such individuals usually produce an anti-Ku (the "u" standing for universal).

The McLeod phenotype and the McLeod Syndrome are by no mean synonymous.  Indeed, there are three interwoven conditions (for want of a better way of putting it).  There is the McLeod phenotype, as described above, which results in weaken expression of the antigens of the Kell Blood Group System, but such individuals are physically and mentally well.  Then there are individuals who have X-linked Chronic Granulomatous Disease (or CGD), but do not have the McLeod phenotype.  Thirdly, there are individuals who have both the McLeod phenotype and CGD, a condition that is known as the McLeod Syndrome (which is a bit strange, because the first person to be described who had the McLeod phenotype and CGD was actually named Claas).  Both the XK and the X-linked form of CGD are mapped to Xp21.1.

In 2010, a paper was published that suggested that King Henry VIII (not his father King Henry Vii) had McLeod Syndrome (Banks-Whitley C, Kramer K.  A new explanation for the reproductive woes and midlife decline of Henry VIII.  The Histoical Journal 2010; 53 (4): 827-848).  Three years later, A similar paper was published (Stride P, Lopes-Floro K.  Henry VIII, McLeod syndrome and Jacquetta's curse.  J R Coll Physicians Edin 2013; 43: 353-360).  These two papers are perfect examples of a little knowledge being a dangerous thing!!!!!!!!!!!!!

I will be talking about the Kell and Kx Blood Group Systems, and about Henry VIII and CGD in Providence, Rhode Island in May.

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  • 5 years later...
On 4/10/2017 at 9:14 AM, Malcolm Needs said:

I think I've seen all yours then!!!!!!!!!

 

On 4/10/2017 at 10:27 AM, Malcolm Needs said:

I have been biting my tongue, trying not to say anything, but I have just got to!

Kell is the name of a Blood Group System, but the first antigen within the system is named K, and the antibody against it is named anti-K.

Those of you who screen for "Kell" and find negative donations are finding an awful lot of Ko donors (whereas the rest of the world is trying desperately to find some to freeze down), and those of you who are finding all these examples of "anti-Kell" are finding an awful lot of examples of anti-Ku, and in 43 years working in Reference Laboratories, I have only seen one example!

Malcom Needs, please tell me your thoughts on this puzzle that I am trying to unravel. I have been researching this for a few days and you seem to be the most accurate source on the net! Note that I do not work in Pathology.  My parents had 3 children F (had 3 child 2F, 1M),M (4F), F (0), in that order (I am the youngest F). I received a pathology card stating that my elderly father was Blood Type: 0+, Unexpected Antibody(s):  Anti-Kell. My purpose in writing you is in part because it is my nature to learn (obsessed) and to know if my nieces and nephews and their children will carry it. Also my brother currently has dementia and I am interested in the possibility of McLeod.  Thank you for your time. 

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Phew, I am certain I do not deserve those kind words, and nor am I sure that I can live up to them, but I will do my best to explain Kea.

The first thing to say is that not everyone who is K Negative, as your father must be, otherwise he would be unable to make anti-K (which is what they mean by saying he has made anti-Kell - VERY bad nomenclature on their behalf!).  Except in certain, rare, pathological conditions, one does not produce an antibody against an antigen expressed on one's own red cells.

I suppose really, I should start by explaining some terms.  An antigen (in this case, I am talking about something expressed on the red cells - they can also be expressed on white cells, platelets and other tissues within the body - but that will complicate things more than is required, so I will stick to red cells) is a structure on the surface of the red cell (usually either a protein or sugar) that, if these red cells are transfused to another individual who does not express the same antigen on his or her red cells, can stimulate the recipient's immune system to produce a specific antibody directed against this antigen.  This antibody can lead to the destruction of the transfused red cells, should such antigen positive red cells be transfused to the same individual a second or subsequent time; so, in this case, if K Positive red cells are transfused to a K Negative individual, the recipient may produce an anti-K as a result, and if K Positive blood is transfused to this individual a second time (after a few weeks or months), those K Positive red cells may be destroyed in what is called a haemolytic transfusion reaction (please excuse my English spelling!).  Another way in which such an antibody may be produced is if a woman is, for example, K Negative, and her baby is K Positive (the K gene would have to be inherited from the biological father for the baby/foetus to express the antigen on its red cells).  Some antibodies are produced "naturally", without stimulation with red cells.

Two things are important to say here.

Firstly, an antibody is NOT produced by everyone when they are transfused with red cells that do express an antigen that the recipient does not express (or the pregnant woman does not possess -despite the fact that in almost all pregnancies there is a small bleed from the foetus into the maternal blood system).; the production of an antibody is by no means automatic.

Secondly, the transfusion of antigen positive blood to someone who has made such an antibody does NOT necessarily mean that they will have a haemolytic transfusion reaction (certainly not one that is clinically significant). 

So, getting back to your family, your father MUST be (or have been) K Negative, and MUST have been transfused with K Positive blood at some point during his life (he, fairly obviously, could not have been pregnant with a K Positive foetus - and, if he was, I want to be his manager!!!!!!!!!!!).

Now, for an antigen to be expressed on an individual's red cells, they have to have inherited a gene, either from their mother or their father (or both) that encodes for that particular antigen (genes are inherited, but antigens cannot be inherited - they are the result of inherited genes).

Antibodies, on the other hand, which are found (normally) in the plasma (the "watery" part of the blood) once they have been stimulated CANNOT be as a result of inheritance (except very loosely, in that some, very rare individuals, never seem to produce antibodies, however many times their immune system is "challenged" by a "foreign antigen").

This means that, unless your elder sister is, as is likely, K Negative and then received either a K Positive transfusion, or was pregnant with a K Positive foetus, she is unlikely to have produced an anti-K.  Similarly, if, as is likely, your brother is K Negative, he is most unlikely to have anti-K in his plasma, unless, at some point during his life, he was transfused with K Positive blood.  The fact that antibodies are NOT inherited, it is highly UNLIKELY that your nieces and nephews will have anti-K in their circulation.

The McLeod phenotype is very, very unlikely, as is the McLeod Syndrome.  They can both be inherited but would result in antibodies of different specificities than anti-K but may well also result in certain other pathological symptoms, so I really wouldn't worry about that.

Sorry, I have gone on a bit, and I hope this helps, but will attempt to attach a PowerPoint lecture that may explain things further, should you be so obsessed as to read it!

If this is not what you wanted, I would suggest you ask another member of this group, named "Danny", who knows more about the subject than I ever will.

In Depth Lecture on the Kell and Kx Blood Group Systems.pptx

Edited by Malcolm Needs
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Malcom Needs, thank you very much! Give yourself more credit, it did appear to me that often the antigens and antibodies are not explained (expressed) properly in writing and this made it even more confusing! It is a lot to take in, but since I was already researching it makes it easier for me to understand your reply, and yes, I believe I do. I needed someone that knows about the subject to assist by addressing my specific questions, and you have. I really appreciate your help, and I will watch the lecture in the next few days and let you know how that goes. Best wishes! :wave: Kea

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