[Autoimmune haemolytic anemias. Part 1].
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Biomedical subjects
Publications and source records attributed to C Salmon.
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Members of six unrelated families from Japan, France, Belgium and Poland were studied in parallel. Major immunological features characteristic of the phenotype produced by the Cis AB complex are the following: 1) The red cell A reactivity is close to normal, is beyond the values of agglutination scores by Helix and by anti-A from B; likewise, with percent agglutination measurements, A reactive appears hiher than that of A2B cells; one sample only is slightly detected by anti-A from Dolichos. 2) The B reactivity, on the contrary, is lower than that of normal AB cells. A single sample is detected by anti-B from A1. All samples are well detected by anti-B from AW, Aend, Ax, Am but none is detected by anti-B from ABx, Cis AB, or by an auto-anti-B. Under standard conditions, percent aggutination is around 80, very close to that of normal AB cells, thus differentiating Cis AB from AB3 (some of which only reach this figure), and from ABx which are very far from this value. 3) An abnormally high reactivity to anti-H antibody is observed, higher than that of normal A2B, similar to that of A2 red cells. 4) Among secretors, A substance is found to be normal or in excess, H substance is in excess, while B substance is only detected by Cis AB red cells inhibition. 5)An anti-B antibody was identified in the samples studied; however, we recently received from Germany a Cis AB samples, the serum of which did not contain anti-B antibody. By these main characteristics, the studied samples seem to be identical; however, agglutination kinetics and thermodynamic methods show that they differ by their reaction with a same anti-B antibody in standard conditions. The reactive structures of the various samples are indeed different from one family to another. The main point is that identical values were observed in all samples within a same family. Thus, the various Cis AB can be considered as different families mutants.
A high titre cold autoagglutinin with anti-B specificity was found in the serum of an A1B group individual. It was associated with a low titre anti-I. This anti-B agglutinated most cells having a B antigen (normal B, A1B, A2B, from adult and cord bloods, B3), but failed to agglutinate Bx Cis-AB and Bh cells. Nevertheless, all these cells absorbed the anti-B SER at low temperatures. Fixation elution tests were also positive on the patient's cells and three consecutive absorptions on these cells completely removed the anti-B activity. The Coombs test was positive with anti-complement anti-globulin when the cells were sensitized by the serum at 4 degrees C. It was negative when the cells were sensitized at 37 degrees C. The patient did not show any sign of haemolysis. The anti-B was a IgM Kappa. Its reaction with normal B cells had an enthalpy change of - 36-000 cal./mole, i.e. very different from O ANd A individuals, but similar to that of the erythrocytic I antigen - anti-i antibody reaction. Quantitative measurements showed the erythrocyte B antigen similar to that of control A1B cells.
The principle of coagglutination, the specific agglutination of uncoated red cells by antibody coated ones was applied to the two conventional continuous flow agglutination systems (bromelin-methylcellulose and polybrene-Na-citrate). The technique was used to study a large number of allo- and auto-antibodies of various specificities as well as some drug related antibodies. The sensitivity of the technique proved not to be higher than that of similar systems using free antibodies. It was however shown to be still more economical and elegantly allowed to avoid manual absorption-elution steps prior to investigation of antibody or antigen specificity.
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A second example of anti-Pra was recognized in a newborn infant which exhibited several signs of development disease. The antibody was complement-fixing 19S IgM and showed a high thermal range but no detectable haemolytic anaemia was associated. It gave negative reactions with a panel of animal cells as well as with two samples of human En(a-) cells. The latter, however, could absorb the antibody.
Three 'A1 weak B' blood groups found in two generations of a Romanian family were studied with quantitative and thermodynamic assays in order to determine if they derive from 'A1Bx' or from 'cis AB' genotypes, what cannot be achieved by the genetics.
A simple, sensitive and highly reproducible method is described using a particle counting procedure for the study of agglutination percentage of red cells as a function of time. The method may advantageously be used for the current study of zygosity and other antigenic variations especially in family investigation.
50 Cad (+) blood samples were tested using various anti-Cad reagents. Results demonstrated a wide Cad antigenic expression, even among the members of one family. In particular experimental procedures, almost all Cad (+) cells were polyagglutinable.
The study of the alpha-N-acetylgalactosaminyltransferase in the sera of 19 individuals belonging to the rare Am blood group makes it possible to confirm the heterogeneity of this phenotype established on genetical and immunological criteria. Two groups of subjects, Am and Ay, can be distinguished. For the individuals of the first group, named Am, 15 samples (7 families) have been studied, the phenotype is inherited as an allele at the ABO locus. 14 of these subjects, have an alpha-N-acetylgalactosaminyltransferase whose kinetic properties were similar to those of A1 subjects. In one family, however, the A transferase detected is of the A1 type. On a quantitative level, the enzyme activities of these sera only reached 30-50 percent of the average value observed for A1 or A2 subjects, respectively. These facts suggest the existence of a genetic inhibitor, possibly linked to the ABO locus, preventing either an A1 or A2 gene from acting at the level of some cellular lines and leading therefore to the recognition of phenotypes named A-m-A1 and A-m-A2. On the contrary, under the experimental conditions used, no alpha-N-acetylgalactosaminyl-transferase activity was detected among the four individuals of the second group, named A-y by Weiner et al. (37), and whose appeareance in siblings results from the action of a recessive modifying y-A gene.
A high titre cold auto-agglutinin with anti-B activity was found in the serum of an A1B group individual. The B/anti-B reaction was thermodynamically investigated and quantitative analysis of the patient's B antigen revealed no abnormality.
The AutoAnalyzer was used for quantitative measurements of antibody agglutinating activity by a Polybrene agglutination technique. Since the continuous flow system introduces an experimental error to the determination of true agglutination percentage, it is necessary to apply a correction factor. The experimental method of correction is described.
Nine cases of acquired B antigen were studied. By quantitative methods the variation of the A reactivity and of the number of A sites was found to be inversely related to the variation of the B reactivity. By agglutination kinetics using an immune anti-B, the acquired B reactive structure was found to differ from that of a normal B. Agglutination variation, with pH, points out to the part played by one electrically charged chemical group. No transferase galactosyl activity was found in the serum, and no B substance in the plasma. According to these results the B reactive structure must have been formed at the expense of the A reactive structure. This "acquired B" type may have arisen as a result of the action of a bacterial deacetylase, transforming the A reactive N-acetyl galactosamine into galactosamine.
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