Asian Journal of Transfusion Science
Home About Journal Editorial Board Search Current Issue Ahead of print Back Issues Instructions Subscribe Login  Users: 80 Print this page  Email this page Small font sizeDefault font sizeIncrease font size 


 
CASE REPORT Table of Contents   
Year : 2020  |  Volume : 14  |  Issue : 2  |  Page : 198-199
Adding further evidence for clinically significant anti-Leb antibody in a voluntary blood donor


1 Department of Transfusion Medicine, All India Institute of Medical Sciences, Rishikesh, India
2 Department of Transfusion Medicine, Post Graduate Institute of Medical Education and Research PGIMER, Chandigarh, India
3 Fatima Hospital, Gorakhpur, Uttar Pradesh, India

Click here for correspondence address and email

Date of Submission22-Jun-2019
Date of Decision24-Dec-2019
Date of Acceptance12-Apr-2020
Date of Web Publication19-Dec-2020
 

   Abstract 

Herein, we report a case of naturally occurring anti-Leb alloantibody identified in the plasma of a first time voluntary blood donor. The immunohematology workup was done on the pilot sample tubes collected during blood donation by the conventional tube technique and using ID-Micro Column System Glass Beads card (anti-IgG, C3d; Ortho-Clinical Diagnostics, Raritan, New Jersey, USA). Blood group of the donor was confirmed to be B RhD positive, and the alloantibody in his plasma was identified as anti-Leb, having clinically significant characteristics. Since in this particular case, anti-Leb was IgM and IgG in nature, it was clinically significant and can lead to hemolytic transfusion reaction, especially if such fresh frozen plasma unit is transfused to Leb negative patients.

Keywords: Anti-Leb antibody, blood donor, hemolytic transfusion reaction

How to cite this article:
Negi G, Malhotra S, Meinia SK, Kaur D, Rai D. Adding further evidence for clinically significant anti-Leb antibody in a voluntary blood donor. Asian J Transfus Sci 2020;14:198-9

How to cite this URL:
Negi G, Malhotra S, Meinia SK, Kaur D, Rai D. Adding further evidence for clinically significant anti-Leb antibody in a voluntary blood donor. Asian J Transfus Sci [serial online] 2020 [cited 2021 Jan 22];14:198-9. Available from: https://www.ajts.org/text.asp?2020/14/2/198/304040



   Introduction Top


Antibodies to the Lewis blood group antigens are primarily formed as naturally occurring IgM immunoglobulin, sometimes, however, may have an IgG component with a few rare examples of IgG type.[1],[2],[3] They most often occur in the sera of Le (a-b-) individuals and may contain a mixture of anti-Lea, anti-Leb, and anti-Leab (an antibody capable of recognizing both Le (a+) and Le (b+) on the red blood cells (RBCs).[1] Anti Lewis antibodies rarely cause acute hemolytic transfusion reactions since they usually do not react at 37°C. In addition, transfused RBCs often lose their Lewis antigens into the recipient's plasma.[4] Furthermore, the Lewis antigens being present as the blood plasma antigen, the antibody in the recipient, if present, gets neutralized before reacting with the transfused RBCs.[4] Herein we report a case of naturally occurring anti-Leb alloantibody identified in the plasma of a first time voluntary blood donor.


   Materials and Methods Top


The blood group of the donor was done by the conventional tube technique (CTT) on the pilot sample tubes collected during blood donation. Further immunohematology (IH) workup included direct and indirect antiglobulin tests with polyspecific antihuman globulin (AHG-IgG+C3d) performed by CTT as well as by column agglutination technique (CAT) using ID Micro Column System Glass Beads card (anti IgG, C3 d; Ortho-Clinical Diagnostics, Raritan, New Jersey, USA).

His blood sample was sent to the reference laboratory for antibody identification and further workup.


   Results Top


A 19-year-old male, the first time donor donated blood in our department of transfusion medicine. There were no relevant histories of any recent infection or any chronic disease, transfusion, or drug intake. Blood group performed in IH laboratory showed B RhD positive by forward (cell) grouping by CTT. In reverse (serum) grouping, there was agglutination (1+) with pooled group O red cells. The indirect antiglobulin test (IAT) was positive (2+ and 3+ by CTT and CAT respectively) while direct antiglobulin test (DAT) and auto-control were found to be negative.

The results from the reference laboratory confirmed his blood group to be B RhD positive and the alloantibody in his plasma was identified as anti-Leb, having clinically significant features, reactive at the broad thermal amplitude of 22°C–37°C. IgM and IgG antibody titers of anti Leb were 2 and 4, respectively, by CAT. Donor's RBCs were typed as Leb negative. The most frequent alloantibodies (0.13%) identified among alloimmunized blood donors in our center, were of Lewis blood group system (14/10,390).


   Discussion Top


Antibodies in the Lewis blood group system are capable of activating complement and occasionally cause in vivo and or in vitro hemolysis.[4] Study by Thakral et al. has demonstrated the frequency of Le (a+b-), Le(a-b+), and Le(a-b-) in the Indian population to be 20.8%, 60.6%, and 18.6%, respectively.[5] Similarly, Nanu and Thapliyal found the frequency to be 13.3%, 61.0%, and 23.9%, respectively.[6] In the majority of cases, Lewis antibodies are naturally occurring, however, sometimes RBC transfusion may stimulate their production. Promwong et al. studied alloantibodies in the donor population where they found a frequency of anti-Leb to be 18.9%.[7] Keokhamphoui et al. found it to be 0.42%.[8] Garg et al. and Makroo et al. found these frequencies to be 2.1% and 1.31%, respectively.[9],[10] The prevalence of anti-Leb among our donor population was found to be 0.13%.

Antibodies to Lewis blood group system are rarely clinically significant. In this case, there was a naturally occurring alloanti Leb identified in the donor's plasma with both IgM and IgG components,, having a broad thermal amplitude (22°C–37°C), thereby making it clinically significant. Since in this particular case, anti-Leb was IgM and IgG in nature, it was clinically significant and can lead to hemolytic transfusion reaction, especially if such fresh frozen plasma unit is transfused to Leb negative patients. A special IH report indicating the presence of alloanti Leb in his plasma with an advice to transfuse B RhD positive, Leb antigen negative AHG (anti human globulin) phase crossmatch compatible red cells in case any such need arises in future as well as to refrain from further blood donations.


   Conclusion Top


Screening for the presence of alloantibodies in donated blood is a vital step to provide compatible blood to the recipients.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Fung MK, Grossman BJ, Hillyer CD, Westhoff CM, editors. ABO, H, and Lewis Blood Groups and Structurally Related Antigens. In: Technical Manual. 18th ed. Bethesda, USA: AABB; 2014. p. 305-6.  Back to cited text no. 1
    
2.
Spitalnik S, Cowles J, Cox MT, Blumberg N. Detection of IgG anti-Lewis(a) antibodies in cord sera by kinetic Elisa. Vox Sang 1985;48:235-8.  Back to cited text no. 2
    
3.
Mollison PL, Engelfriet CP, Conteras M. The Rh blood group system. In: Blood Transfusion in Clinical Medicine. 9th ed. Oxford: Black well Scientific Publication; 1993. p. 2008-9.  Back to cited text no. 3
    
4.
Leger RM. Blood group terminology and other blood groups. In: Harmening DM, editor. Modern Blood Banking and Transfsuion Practices. 6th ed. USA: F.A. Davis; 2012. p. 172-215.  Back to cited text no. 4
    
5.
Thakral B, Saluja K, Sharma RR, Marwaha N. Phenotype frequencies of blood group systems (Rh, Kell, Kidd, Duffy, MNS, P, Lewis, and Lutheran) in north Indian blood donors. Transfus Apher Sci 2010;43:17-22.  Back to cited text no. 5
    
6.
Nanu A, Thapliyal RM. Blood group gene frequency in a selected north Indian population. Indian J Med Res 1997;106:242-6.  Back to cited text no. 6
    
7.
Promwong C, Siammai S, Hassarin S, Buakaew J, Yeela T, Soisangwan P, et al. Frequencies and specificities of red cell alloantibodies in the Southern Thai population. Asian J Transfus Sci 2013;7:16-20.  Back to cited text no. 7
[PUBMED]  [Full text]  
8.
Keokhamphoui C, Urwijitaroon Y, Kongphaly D, Thammavong T. Red cell alloantibodies in Lao blood donors. Southeast Asian J Trop Med Public Health 2014;45:194-7.  Back to cited text no. 8
    
9.
Garg N, Sharma T, Singh B. Prevalence of irregular red blood cell antibodies among healthy blood donors in Delhi population. Transfus Apher Sci 2014;50:415-7.  Back to cited text no. 9
    
10.
Makroo RN, Rajput S, Agarwal S, Chowdhry M, Prakash B, Karna P. Prevalence of irregular red cell antibody in healthy blood donors attending a tertiary care hospital in North India. Asian J Transfus Sci 2018;12:17-20.  Back to cited text no. 10
[PUBMED]  [Full text]  

Top
Correspondence Address:
Dr. Sheetal Malhotra
Department of Transfusion Medicine, Post Graduate Institute of Medical Education and Research PGIMER, Chandigarh
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ajts.AJTS_68_19

Rights and Permissions




 

Top
 
  Search

  
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Email Alert *
    Add to My List *
* Registration required (free)  


    Abstract
   Introduction
    Materials and Me...
   Results
   Discussion
   Conclusion
    References

 Article Access Statistics
    Viewed176    
    Printed2    
    Emailed0    
    PDF Downloaded5    
    Comments [Add]    

Recommend this journal

Association Contact us | Sitemap | Advertise | What's New | Feedback | Copyright and Disclaimer

2006 - Asian Journal of Transfusion Science | Published by Wolters Kluwer - Medknow
Online since 10th November, 2006