Naturally occurring antibody ABO H n n A

Naturally occurring antibody

ABO 基因及H基因 n n 基因 A 產物 galactosaminyltranserase 基因 B 產物galactosyltransferase 基因 0 產物 無 基因H產物：a-2 -L-fucosyltransferase PS H B A

表 1 -2 Blood group transferase Locus 基因 Transferase FUT 1 (H) H h a 1, 2 -L-fucosyltransferase 無 作用於血球之2型鏈 FUT 2 (SE) Se se a 1, 2 -L-fucosyltransferase 無 作用於分泌物之1型鏈 ABO A B O a 1, 3 -N-acetyl-Dgalactosaminyltransferase a 1, 3 -D-galactosyltransferase 無 FUT 3 (Le) Le le a 1, 3/4 -L-fulcosyltransferase 無 註

ABO/H表現型 基因型 表現型 RBC 表 分泌物 面抗原 ABO /H物 質 H/H Se/- ABH-secrector + + H/H se/se ABH-nonsecrector + - h/h Se/- Parabombay - + h/h se/se Bombay - -

A 1 A 2 subgroup system Group Reaction with anti-A No. of Ag per cell Adult Newborn Reaction with anti-A 1 (Dolichos biflorus lectin) Anti-A 1 in serum N-acetyl-galactosaminyl transferase activity A 1 A 2 ++++ ++ 1, 000 310, 000 250, 000 140, 000 ++++ 0 No 1 -8% Normal Decreased

ABO antibodies Specificity Group Incidence Anti-A B All Titer: 32 -2048 Average 1: 256 Primarily Ig. M Anti-B A All Titer: 1: 8 -512 Average: 1: 64 Primarily Ig. M Anti-A, B O, Oh All May have high tier in pregnancy Reactive with Ax, Bx Anti-A 1 A 2 Ax A 2 B 1 -8% Most 22 -35% Anti-H Oh All Some A 1, A 1 B nonsecretors Characterics Usually clinical insignificant Rare transfusion Rxn Usually benign cold autoantibody except in Oh

Some causes of ABO discrepancy Un-expected reactions Forward typing problems (Ag on cell) Reverse typing problems (antibodies in serum) n. Acquired B n. Rouleaux-formation n. Cold autoantibodies n. Room-temperature n. Cell heavily coated with alloantibodies: anti-M, N, P 1 n. Cold autoantibodies n. Passively ABO antibodies warm autoantibodies n. Mis-transfusion Un-expected n. A, B subgroups negative n. Antigen depression due reactions to leukemia state n. Age of patient n. Hypoglobulinemia nimmunosupression

Phases of hemagglutination Phase 1 Reaction Binding characteristics Ag-Ab binding n. Temperature np. H n. Time of incubation Enhancement methods n Neutralize zeta potential (Low ionic strength solution, Polyethylene glycol) n. Temperature n. Time of incubation

Phases of hemagglutination Phase 2 Reaction Aggregation Bridging factors n. Antigen-density n. Antigen accessibility n. Ab concentration n. Types of Ab Enhancement methods n. Centrifugation n. Proteolytic enzyme n. Albumin n. Polycations (polybrene) n. AHG

Technique used in detection irregular antibodies The use of enhancement solution during incubation Enhancement solution LISS (low ionic strength Solution) 15% albumin

Technique used to detect irregular antibodies Use enzyme-treated RBCs instead of the regular RBCs Enzyme (ficin, papain) to expose some antigens.

抗球蛋白試驗: anti-human globulin test Antiglobulin (AHG) Anti-Human globulin: Anti-Ig. G, Anti-C 3 d, Polyspecific: Anti-Ig. G+Anti-C 3 d (mixed) Monospecific: Anti-Ig. G

The recent introduction of “Gel test” as routine Blood bank methods.

抗體篩檢作業-Screening cells Selected from O TYPE blood donors 現在多用三種篩檢細胞

Specificity Rh (reactive in IAT) Kell Duffy Kidd Anti-S, s Anti-P 1, N Anti-M reactive at 37 C Anti-Lea Anti-Leb High titer low avidity antibodies (HTLA) Antibodies against low/high frequency Ag 臨床意義 發血作業選擇 Yes Ag negative Yes Ag negative Rarely 37 C IAT crossmatch Sometimes Ag negative Rarely 37 C IAT crossmatch No Can be ignored Unlikely See advise from blood bank Depending Seek advise from blood on bank specificity

Rh haplotypes nomencaltures Fisher Short notations R 1 % white 41 % Asian 70 CDe Cde R 39 3 c. DE R 2 14 21 c. De R 0 3 3 cd. E Cde r” r’ 1 1 rare 2 CDE Cd. E Rz ry rare 1 rare

P blood group system Phenotype RBC Ag frequency Serum Ab P 1 75% P 1, P, Pk None P 2 25% P, Pk *Anti-P 1 P 1 k Very rare P 1, Pk Anti-P P 2 k Very rare Pk Anti-P p Very rare None Anti-PP 1 Pk (anti-Tja) *Anti-P 1 : frequently seen as naturally occurring antibodies, Clinically insignificant cold reactive antibodies.

Polyagglutination-T activation (T antigen) n n n Red cells agglutinate when exposed to normal sera In normal status: sialic acid and other residue will cover antigenic structure within red cell membrane (cryptantigens) Polyagglutination: in disease status, e. g. bacterial infections, partial desialation of the red cell membrane due to the microbial neuraminase activity.

Polyagglutination-detection by plant lectins Arachis hypogaes Glycine Salvia soja Sclarea Salvia horminum Griffonia simpliafolb ia Vicia cretica (花生水) T + + - - Tn - + + + - - Tk + - - - + - Th + - - + Tx + - - - Cad - + - -

Transfusion Reactions Immune effects n Acute q q q Immediate hemolytic transfusion reaction Febrile non-hemolytic transfusion reaction Allergic reaction Anaphylaxis and anaphylactoid reactions TRALI n Delayed – Delayed hemolytic transfusion reaction – Alloimmunization – Post-transfusion purpura – Transfusion associated –GVHD (graft-versus-hostdisease) – Immunosuppression

Transfusion Reactions(cont) Non immune effects n Immediate – Bacterial contamination – circulatory overload – Physical RBC damage n Delayed – Iron overload

TRANSFUSION RELATED Gv. HD n n n Leukocyte filtration does not offer protection Mortality: 75 -90% Blood from relatives must be irradiated No effective treatment. Almost fatal. Guideline form blood transfusion services of the United Kingdom

Prevention of transfusion-related Gv. HD n n n BMT/PB stem cell transplants should receive irradiated blood components. Allo at least 6 months (some centers recommend indefinitely), auto: at least 3 months. HLA-matched platelets should be irradiated. Patients received purines analogues, Hodgkin’s disease and congenital immune deficiency. All intra-uterine transfusions All granulocyte concentrates. Guideline form blood transfusion services of the United Kingdom

1976 -1985 FDA統計輸血死亡案例—與抗體有關者 事件類別 件數 ABO 抗體 A RBCs→O pt B/AB RBCs →O pt A/AB RBCs →B pt B RBCs →A pt O plasma →A/AB B plasma →AB 小計 80 26 12 6 6 1 131 不規則抗體 Anti-K Anti-E-K-P 1 Anti-Jka+Jkb+JK 3 Anti-JKb Anti-Fya 小計 5 1 1 9

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