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Anti-kell reacting at immediate spin?


bloodbankninja

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Today I had an anti Kell that reacted 4+ on the echo, and 2+ at immediate spin. This is the second time ive seen an anti kell reacting at I.s. This wasn't a new antibody; it was identified 7 months ago at a different hospital. Anyway.. what im wondering is.. what causes some people's anti kell to be igM when most are igG?

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I don't think anyone really knows why some antibodies directed against proteinous antigens go almost entirely to IgG and others stay as mostly IgM (antibodies directed against carbohydrate antigens are more often IgM, with ABO antibodies being a bit of an exception).

It may be something to do with the HLA-DRB type of the person making the antibody (people who produce anti-K tend to be HLA-BRB1*11 or HLA-DRB1*13, but it could be that people who do not have these HLA alleles can still make anti-K, but less efficiently? This last bit is pure and utter speculation on my part, I may add.

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Some anti-Kells are just different . . .  I had a pt who had a long hx of anti-K and was transfused with K=rbcs about every 2 weeks.  He also always had a positive DAT and we always eluted only anti-K . . .  could never figure that one out as he was K negative and always rec'd K neg rbcs.

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We also had a patient like that David.

I asked for advice from Joyce Poole and she said that she thought (in our case) that it was an auto-antibody mimicking anti-K, rather like most auto-antibodies mimic something in the Rh Blood Group System, but which can be adsorbed to extinction with antigen negative blood. I was going to test this theory, but, sadly, the patient reached extinction before I got the chance.

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My darling wife (the nurse) has 3 antibodies,  Her anti-K shows up at IS, goes away at 37o and returns at AHG.  It always has and I found it 30+ years ago.  Her anti-D shows up at 37 and at AHG.  Her anti-s showed up once, maybe twice, and then vanished never to be seen again.  She was a good one to give to students when trying to explain that antibodies have a nasty habit of not reading and following the book.

 

I've also seen a couple of anit-K "like antibodies" on regular blood donors who happened to work in the same area on the local Air Force base.  Neither had any history of transfusion or pregnancy (one male and one female).  The antibody was detectable for about 8 to 10 months then it went away and to the last of my knowledge never came back.  Chemical exposure?????

 

Gotta love the mysteries of biological systems.  I think that is what has kept me in the profession for so long.  :crazy:

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Malcolm, is not the auto anti-K go by some Japanese like name?

 

We also had a patient like that David.

I asked for advice from Joyce Poole and she said that she thought (in our case) that it was an auto-antibody mimicking anti-K, rather like most auto-antibodies mimic something in the Rh Blood Group System, but which can be adsorbed to extinction with antigen negative blood. I was going to test this theory, but, sadly, the patient reached extinction before I got the chance. 

Edited by ChrisH
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Thank you I could not think of the name.

 

Are you thinking of the Matuhasi-Ogata phenomenon?

 

I saw this a couple months ago when a patient was having a transfusion reaction caused by anti-hrS/hrB antibody. We could elute their other antibodies from their cells even though they had been transfused antigen negative blood.

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