Life‐threatening hemolytic anemia due to an autoanti‐Pr cold agglutinin: evidence that glycophorin A antibodies may induce lipid bilayer exposure and cation permeability independent of agglutination
- 1 February 2010
- journal article
- case report
- Published by Wiley in Transfusion
- Vol. 50 (2), 292-301
- https://doi.org/10.1111/j.1537-2995.2009.02445.x
Abstract
The hemoglobin of a 29-year-old man fell below 35 g/L over 5 days, despite 14 units of red blood cells (RBCs), due to an anti-Pr cold agglutinin (CA). His hemolytic anemia necessitated respiratory support in intensive care for 4 weeks. The hemolysis was investigated by the effects on blood group-compatible RBCs of this anti-Pr and an anti-I CA and of a rabbit anti-human glycophorin A (GPA) immunoglobulin G (IgG) antibody on Ca(2+) permeability and of phosphatidylethanolamine (PE) exposure. 1) The anti-Pr CA (in a plasmapheresis product from the patient) was absorbed and eluted from RBC ghosts and its immunophenotype was determined by agarose electrophoresis and immunofixation. 2) Ca(2+) permeability was measured by the response of Fluo-3-labeled RBCs to addition of external Ca(2+). 3) Exposed PE was measured with streptavidin-labeled biotinylated peptide Ro 09-0198 (cinnamycin). 1) The patient's anti-Pr CA was a polyclonal IgG. 2) The anti-Pr and the rabbit anti-human glycophorin IgG, but not an anti-I CA, rapidly increased Ca(2+)-dependent fluorescence upon addition of external Ca(2+) in a fraction (15%-25%) of RBCs that also became positive for cinnamycin. 3) Trypsin treatment of RBCs reduced the Ca(2+) influx due to the anti-Pr IgG, but neither trypsin nor neuraminidase changed the responses to the rabbit anti-human GPA IgG. The anti-Pr CA and rabbit anti-human GPA increased exposure of PE and increased membrane Ca(2+) permeability that may have caused hemolysis. The difference in the responses to these antibodies to enzyme treatment of RBCs suggests that they react with different epitopes on GPA.Keywords
This publication has 50 references indexed in Scilit:
- Autoimmune hemolytic anemia caused by IgG λ‐monotypic cold agglutinins of anti‐Pr specificity after rubella infectionTransfusion, 2001
- alpha2,3-Specific Desialylation of Human Red Cells: Effect on the Autoantigens of the Pr, Sa and Sia-I1, -b1, -Ib1 SeriesVox Sanguinis, 1998
- Dependence of Cardiac Cell Ca2+Permeability on Sialic Acid-containing Sarcolemmal GangliosidesJournal of Molecular and Cellular Cardiology, 1998
- Haemolytic anaemia caused by anti‐Pra following rubella infectionTransfusion Medicine, 1993
- Refractory Immune Hemolytic Anemia With A High Thermal Amplitude, Low Affinity IgG Anti-PraCold AutoantibodyAutoimmunity, 1992
- Effects of neuraminidase on cellular calcium and contraction in cultured cardiac myocytesJournal of Molecular and Cellular Cardiology, 1991
- Life‐threatening, antiglobulin test‐negative, acute autoimmune hemolytic anemia due to a non‐complement‐activating IgG1 kappa cold antibody with Pra specificityTransfusion, 1990
- Cold AgglutinationTransfusion Medicine Reviews, 1989
- Signal transduction by glycophorin A: role of extracellular and cytoplasmic domains in a modulatable process.The Journal of cell biology, 1988
- The function of calcium in the potassium permeability of human erythrocytesBiochimica et Biophysica Acta, 1958