engleski

Anti-Landsteiner-Wiener (LW) ab antibody in patient with cervical tumor and transient loss of LW antigens

LWa and LWab are the commonly expressed combination of LW antigens found in more than 99% whites. The LW glycoprotein is associate with the Rh proteins in red blood cell membrane as part of a multiprotein macromolecular complex. Individuals who are D antigen positive (D+) have increased expression of LW antigens compared to those individuals who are D antigen negative (D-). These antigens show strong expression on cord blood cells. Antibodies to LW antigens are usually IgG. They have been associated with no to mild HDN or HTR. Production of autoantibodies may occur in conditions associated with transient loss of LW antigens (pregnancy, Hodgkin disease, solid tumors, malignant lymphoma). Aim was to present a case of anti- Landsteiner-Wiener (LW) ab antibody in patient with cervical tumor and transient loss of LW antigens. 85 year old patient with cervical tumor infiltrating parametrium and vagina. She has never been transfused but she had born three children. IAT antibody identification with Ortho Clinical Diagnostics and DiaMed ID panels in polyspecific micro cards was performed. Enzyme panel (ficin treated test cells) Ortho clinical Diagnostics was performed. Immediate spine tube test at +20°C and +4°C was performed. DAT was performed in DiaMed DC-screening micro cards and in BioVue poly specific micro cards. Eluat in IAT (Ortho Clinical Diagnostics) (both untreated and ficin treated) was done. Cross match with 2 cord blood RBCs group was done. Reactions with all test cells with plasma and serum were positive (1+ to 3+) but stronger with D+ (3+) than with D- cells (1+). With enzyme treated test cells positive reactions (1+ to 4+) were given (stronger reactions with RhD + cells again). Immediate spine tube test at +20° and +4°C were negative. DAT in DiaMed micro cards positive reaction (1+) and in BioVue (2+ to 3+) were given. Patient was typed as group A1B, CcDee, kk, Fy(a+b-), Jk(a+b-), MMss. Cross match with cord blood RBCs positive reactions were given Liss-IAT tube test with serum week positive reactions (1+) were given. Our test results indicated presence of anti-LW, because patient's plasma showed characteristic reactivity for anti-LW in being more strongly reactive with D+ than with D- adult cells and strongly reactive with cord cells, but we couldn't prove it. Therefore we sent our samples to IBGRL, Red Cell Reference, Bristol, UK. They had verified our results and confirmed the presence of anti-LWab with the fact that patient's plasma were compatible with two RHnull and one LW (a-b-) but incompatible with LW(a-b+) cells. They remarked that patient's cells were very weakly positive (with equivalent strength positive DAT) with a range of anti-LW antisera, most likely due to transient suppression of LWa antigen.

anti-Landsteiner-Wiener (LW) ab antibody; transient loss of LW antigens

DOI: 10.1111/vox.12155