The immune destruction of red cells.
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Biomedical subjects
Publications and source records attributed to C P Engelfriet.
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We describe 2 patients with thrombocytopenia and autoantibodies in the blood against platelet membrane glycoprotein (GP) IIb/IIIa, in whom reactivity of the antibodies with their antigen was greatly diminished in the presence of sodium EDTA. One patient also showed a marked thrombocytopathy, suggesting a functional blocking of GP IIb/IIIa by these autoantibodies. These observations show that some immunologically important autoantibodies can easily be missed in routine serological investigations in which EDTA blood is used, obscuring the autoimmune nature of a thrombocytopenia and possibly of a thrombopathy as well.
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In 1987 the Central Medical Blood-transfusion Committee of the Netherlands Red Cross decided to modify their definition of 'Rh-negative' as it applied to blood donors. Until then the term Rh-negative had been reserved for donations that grouped as C- and E-negative and failed to react with IgG anti-D by the indirect antiglobulin test (IAT). From June 1987, however, donations were considered to be Rh-negative if they failed to react with two strong anti-D sera. An evaluation is presented over the first one and a half years of working with the new definition, the problems that were encountered and the measures that are taken to guarantee the quality of Rh testing.
The extremely rare phenotypes p, P1k and P2k (0.0005-0.0006%) of the blood group P system are usually found in consanguinous families. In the serum of these persons haemolytic antibodies with the specificity anti-PP1Pk and anti-P are found, causing severe haemolytic reactions after transfusion of incompatible blood. Because of their rarity it is difficult to find compatible blood donors. The antibodies are also associated with abortion early in pregnancy. Since 1948 at the "Institut für Blutgruppenserologie der Universität Wien" 4 persons of the phenotype p and 3 of the type P2k were observed in altogether 5 families. Two of them needed blood transfusions, the one p patient received p blood from her sister, who likewise gave blood to the other p patient. This latter patient additionally received three blood units which had been stored in liquid nitrogen and came from Austria and from the European bank of frozen blood in Amsterdam (Council of Europe). The pedigrees of three families with 5 probands out of the 7 observed cases could be reconstructed and showed consanguinity, partly some generations back. A genetic model valid at the moment for the biosynthetic pathway of the P antigens is demonstrated and the appropriate serological characteristics of the haemolytic antibodies are shown. The seven antibodies are partly IgG and partly IgM antibodies, optimally reacting using the indirect antiglobulin test or enzyme-treated red cells. The range of the antibody titres was between 1:8 and 1:1024. Absorption of Anti-PP1Pk sera with red cells of type P1 to get Anti-Pk and inhibition with hydatidcyst fluid and globoside to receive Anti-P and Anti-P1 + Pk, respectively were partly successful.
FcRIII is not present on peripheral blood monocytes, but becomes expressed upon culturing and can be demonstrated on tissue macrophages. We studied the expression of FcRIII of cultured monocytes in detail and compared its structure with FcRIII of neutrophils and NK cells. The cell density of FcRIII reached a plateau within 3 days of culturing. During that time, the expression of FcRI and FcRIIa, also present on monocytes, did not change significantly. FcRIII on cultured monocytes lacked, as did NK cell FcRIII, the NA1-allotypic variant of the NA system present on the neutrophil FcRIII. Studies with glycosyl-phosphatidyl-inositol-specific phospholipase C and analysis of cells of patients with paroxysmal nocturnal hemoglobinuria revealed that FcRIII on cultured monocytes is not anchored by phosphatidyl-inositol-glycan in the cell membrane. Similarly, FcRIII on NK cells was resistant to glycosyl-phosphatidyl-inositol-specific phospholipase C treatment, suggesting that NK cell FcRIII is also not anchored by a phosphatidyl-inositol-glycan moiety, in contrast to neutrophil FcRIII. Analysis by SDS-PAGE showed that the FcRIII of cultured monocytes had a similar mobility as the FcRIII on NK cells, but was clearly distinct from neutrophil FcRIII. Treatment with N-glycanase showed that the protein backbone of deglycosylated FcRIII of cultured monocytes was similar to that of FcRIII of NK cells, but deglycosylated neutrophil FcRIII was different. Specific blocking of FcRIII of cultured monocytes with an anti-FcRIII mAb did not reduced the lytic action of the cultured monocytes towards sensitized erythrocytes. However, FcRIII was modulated from the cell surface by incubation with sensitized E, whereas non-FcR Ag were not. These findings indicate that FcRIII is involved in binding of immune complexes, but does not act as a trigger molecule for extracellular lysis of sensitized E.
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Monoclonal antibodies (McAbs) were produced against the IgG allotypes G1m(z), G1m(a), G1m(f), G3m(b1/u) and G3m(g1). Four out of the six McAbs described in this paper showed in the haemagglutination assay cross-reactivity with some or all IgG-coated cell samples. In the haemagglutination inhibition assay, all six McAbs are useful as typing reagent for the above allotypes. In this assay, two of the McAbs show two different specificities, which depend on the Ig-coated cell sample used. Five McAbs are useful for allotyping in a capture ELISA. The results with four of these are promising for the development of a quantitative determination of Gm allotypes.
In 80 newborn infants ABO-incompatible with their mothers, the lysis-inducing effect of the maternal IgG anti-A or anti-B antibodies in an antibody-dependent cell-mediated cytotoxicity (ADCC) assay and the antigen density of A or B antigens on the red cells of the children were measured. On the basis of the results, the children were divided into two groups--24 children in whom increased haemolysis was to be expected, and 56 children in whom it was not. Signs of haemolysis and serological features of ABO haemolytic disease of the newborn (ABO-HDN) were compared in these two groups and a control group of 120 ABO-compatible infants. The effect of the maternal antibodies in the ADCC assay, the titres of maternal IgG anti-A or anti-B antibodies, the results of the direct antiglobulin test on the red cells in the cord blood, and the titre of IgG anti-A or anti-B antibodies in the serum of the infants were compared for their ability to predict the severity of ABO-HDN. This was also done for the combination of the ADCC assay results plus the A or B antigen density and the direct antiglobulin test plus the titre of maternal IgG anti-A or anti-B antibodies. The ADCC assay with maternal serum was the most sensitive assay to predict ABO-HDN, and the combination of the ADCC assay with A or B antigen density determination the most specific test.
IgG antibodies against blood group antigens A or B (anti-A/B) are able to sensitize erythrocytes for destruction in an antibody-dependent cell-mediated (ADCC) assay with monocytes as effector cells. The activity of maternal IgG anti-A/B in this test was compared with clinical signs of haemolytic disease of the newborn (HDN). When the ADCC was negative (less than 10% of the sensitized cells lysed), signs of increased red-cell destruction in the children were never observed. In three cases with a strongly positive ADCC (greater than 45% lysis), the children were severely affected and needed more than one exchange transfusion. In the cases with greater than 10% but less than 45% lysis in the ADCC, there was no clear correlation between the result of the ADCC and the degree of lysis in the newborn infants. In these cases, the degree of lysis of the red cells of the infant was shown to be strongly influenced by the number of A/B antigens per red cell. There was a direct correlation between the degree of lysis in the ADCC and the titre of IgG3 anti-A/B in the sera. There was comparable activity of maternal IgG anti-A/B in the ADCC test in the 32nd week of pregnancy and at the moment of delivery.
Sera of 22 patients with Felty's syndrome and 14 patients with rheumatoid arthritis were tested in assays routinely used for the detection of neutrophil antibodies (i.e. immunofluorescence, agglutination and cytotoxicity tests) as well as in the antibody-dependent lymphocyte-mediated granulocytotoxicity test. One or more of the routinely used assays were positive in a high percentage of the sera (77% and 64%, respectively). The antibody-dependent lymphocyte-mediated granulocytotoxicity test was only positive with sera of three patients with Felty's syndrome. Positive results in the immunofluorescence and agglutination tests could be attributed to the presence of immune complexes in the sera, whereas positive antibody-dependent lymphocyte-mediated granulocytotoxicity tests were probably due to the presence of HLA alloantibodies. It is concluded that serological tests routinely used for the detection of neutrophil autoantibodies should be interpreted with caution in patients with Felty's syndrome. Our results also indicate that the neutropenia in Felty's syndrome is rarely, if ever, due to neutrophil-specific autoantibodies.
We studied the lysis in vitro of group A red cells by IgG anti-A. IgG anti-A, which strongly lysed A red cells from adults, did not lyse A red cells from cord blood, if fresh cord serum from a child with blood group AB was used as a source of complement. In cases of haemolytic disease of the newborn due to A-O or B-O antagonism with a positive direct antiglobulin test with anti-IgG serum, the red cells did not react with anti-complement sera. Apparently, complement is also not activated in vivo in case of A-O haemolytic disease of the newborn.
Replicate blind AHG tests with weak IgG anti-D sensitised red cells revealed that 32% of workers caused 5 per cent or more false negative errors by using excessive agitation in reading techniques. The common quality control procedure of adding strongly sensitised cells to all negative AHG tests cannot reveal this type of error. Furthermore, strongly sensitised control cells may create an illusion of safety because AHG giving a false negative test with weak antibody in a serum sample may still show a reassuringly strong positive in the control test. "In-house" assessment of all staff and automatic cell-washers by blind replicate tests is recommended as an effective way of improving AHG test performance, thus reducing many of the errors involving false negative AHG tests seen year after year in External Proficiency Trials.
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In the present study, we show, on the basis of serology, absorption experiments, and one-dimensional isoelectric focusing, that the well-defined HLA-Aw33 antigen can be separated into two subtypes, provisionally called Aw33.1 and Aw33.2, which differ in race distribution and linkage disequilibrium.
Subtypes of B27 have been identified by cytotoxic T lymphocytes, biochemistry, molecular biology, and murine monoclonal antibodies. In the present study we describe seven B27 subtype-specific pregnancy sera. The reaction pattern of these B27 subtype-specific sera closely parallels the recognition pattern of B27 subtype-specific cytotoxic T lymphocytes. Because the complete amino acid sequence of the studied B27 subtypes (B27W, B27K, B27C, B27D) is known, it can be determined which amino acid substitutions are responsible for recognition by subtype-specific sera and by cytotoxic T lymphocytes, respectively. It is proposed that B27 subtype-specific sera and B27 subtype-specific cytotoxic T lymphocytes recognize the same epitopes or that a single amino acid change can induce multiple antigenic determinants, which are recognized differentially by antibodies and T cells.
The determination of the subclasses of IgG antibodies against blood groups A and B is important in order to improve our understanding and predict haemolytic disease of the newborn due to IgG anti-A or -B. We describe two techniques that circumvent the problem of the agglutination of A and B red cells by the corresponding IgG antibodies in saline: an antiglobulin consumption test and a modified solid-phase micro-immunofluorescence test. The results of the two techniques are compared with the results obtained in the indirect antiglobulin test beyond the saline agglutination titre in a microplate technique. The solid-phase micro-immunofluorescence test was the most sensitive for the determination of the subclasses of IgG anti-A and -B. Usually sera contained IgG2 anti-A, B in a higher titre than antibodies of other subclasses.