Anti-i Cold Agglutinins Research Articles

Reduction of High-Titer Cold Agglutinins by Plasmapheresis to Resolve Serological Problem in a Patient

Background: Cold agglutinins are auto-antibodies that can be a nuisance in cross matching and in blood grouping. Here we report an unusual case of a high titer and wide amplitude cold agglutinin reduced by plasmapheresis. Methods and Materials: A 56-year-old man with severe anemia requested a transfusion of red blood cells. However, there was a problem in blood for blood grouping. The discrepancy of blood typing was subsequently resolved using group O absorbed plasma along with repetition of forward grouping with warm-washed red blood cells. The presence of high-thermal-amplitude and a high-titer anti-I cold agglutinin were detected in further serologic investigation. It revealed reactivity against autologous and adult O red blood cells at 37°C by the thermal amplitude screening test, and demonstrated a very high titer of 65,536 against adult O cells by titration studies at 4°C. The patient received two plasma exchange sessions of 1.5 plasma volumes each. There was a significant reduction of the titer of cold agglutinins and of the thermal amplitude by plasmapheresis as well (p < 0.01). Results: After successful cross-matching with post plasma exchanges, four units of red blood cells were infused to the patient without any hemolysis symptoms or signs. Conclusions: We now reported a patient with abnormally ascended titer of cold agglutinins and wide-thermal-amplitude, but we also successfully performed ABO typing and cross matching after 2 plasma exchange sessions of 1.5 plasma volumes each.

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

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.

Development of Mixed-Type Autoimmune Hemolytic Anemia and Evans' Syndrome following Chicken Pox Infection in a Case of Low-Titer Cold Agglutinin Disease

We describe a patient with low-titer cold agglutinin disease (CAD) who developed mixed-type autoimmune hemolytic anemia (AIHA) and idiopathic thrombocytopenia following chicken pox infection. At least 1 year before admission to hospital, the patient had mild hemolytic anemia associated with low-titer cold agglutinins. A severe hemolytic crisis and thrombocytopenia (Evans' syndrome) occurred several days after infection with chicken pox, and the patient was referred to our hospital. Serological findings revealed the presence of both cold agglutinins and warm-reactive autoantibodies against erythrocytes, and the diagnosis was mixed-type AIHA. Following steroid therapy, the hemoglobin (Hb) level and platelet count improved. The patient was closely followed over a 10-year period with recurrent documented hemolysis after viral or bacterial infections. Warm-reactive autoantibodies have not been detected in the last 2 years, and only the immunoglobulin M anti-I cold agglutinins with a low titer and wide thermal amplitude have remained unchanged. Therefore, the patient has received at least 10 mg prednisolone daily to maintain a Hb level of 10 g/dL. To the best of our knowledge, no adult case of low-titer CAD that has evolved into mixed-type AIHA and Evans' syndrome after chicken pox infection has been previously reported in the literature.

The frequent mutation Gly/Asp in CDR1H may determine a cross-reactive idiotope in anti-I cold agglutinins.

Variable domains (VH) of all known anti i/I cold agglutinin (CA) heavy chains are codified by the VH4-21 gene. While anti-i CAs are the expression of gene rearrangement without mutations represented by amino acid changes, anti-1 CAs present, among others, a frequent somatic mutation of Gly by Asp at position 31. The hydropathy profile calculated for the CDR1H (position 30 to position 35), as well as some adjacent positions of the heavy chain belonging to anti-i and anti-I antibodies, showed the conformational changes accompanying the replacement of Gly by Asp. A MoAb (LP91), which had been obtained in BALB/c mice immunized with a Fabmu fragment from a monoclonal IgMkappaIIIb anti-I CA (protein KAU), proved capable of inhibiting human adult erythrocyte cryoagglutination by anti-I CAs but not that of fetal erythrocytes by anti-i CAs. Western blot analysis disclosed that such MoAbs recognized a sequential epitope located in the Fd fragment of all anti-I CAs employed in this study. With the purpose of checking whether Asp(31) was involved in the epitope recognized by the MoAb, two peptides, D and G, were synthesized which mimicked the CDR1H structure of anti-I and anti-i, respectively; the MoAb only reacted with peptide D by ELISA. Subsequent experimental results indicate that the Gly/Asp mutation could be associated with the diverse specificity presented by these autoantibodies, a change determining a characteristic epitope/idiotope, recognized by LP91 in the CDR1H.

Evidence for involvement of a hydrophobic patch in framework region 1 of human V4-34-encoded Igs in recognition of the red blood cell I antigen.

The monoclonal IgM cold agglutinins that bind to the I/i carbohydrate Ags on the surface of RBCs all have Ig H chains encoded by the V4-34 gene segment. This mandatory use indicates that distinctive amino acid sequences may be involved in recognition. Critical amino acids exist in framework region 1 (FR1) of V4-34-encoded Ig, and these generate a specific Id determinant which apparently lies close to the I binding site. However, I binding by Id-expressing Ig can be modulated by sequences in complementarity-determining region (CDR)(H)3. Examination of the crystal structure of an anti-I cold agglutinin has revealed a hydrophobic patch in FR1 involving residue W7 on beta-strand A and the AVY motif (residues 23-25) on beta-strand B. In this study we used mutagenesis to show that each of the strand components of the hydrophobic patch is required for binding the I carbohydrate Ag. In addition, the crystal structure reveals that amino acids in the carboxyl-terminal region of CDR(H)3 form a surface region adjacent to the hydrophobic patch. We propose that the I carbohydrate Ag interacts simultaneously with the entire hydrophobic patch in FR1 and with the outside surface of CDR(H)3. This interaction could leave most of the conventional binding site available for binding other Ags.

A new phosphoglycerolipid, ‘phosphatidylglucose’, found in human cord red cells by multi-reactive monoclonal anti-i cold agglutinin, mAb GL-1/GL-2

Cord red cell membranes express many differentiation-related molecules. To study such molecules, we have established human cell lines, termed GL-1 and GL-2, by the Epstein–Barr virus transformation method, both of which produce monoclonal anti-i cold agglutinin [Y. Nagatsuka et al., Immunol. Lett. 46 (1995) 93–100]. Thin layer chromatography immunoblotting analysis revealed that these antibodies had broad specificities reacting with a variety of glycolipid antigens. Of the immunoreactive lipid antigens, a new phosphoglycerolipid containing glucose from human cord red cells was found. The isolated lipid was unstable to alkaline hydrolysis and contained glucose as a sole sugar. Secondary ion mass spectrum–collision-induced dissociation mass spectrometric analysis of this lipid gave the main molecular ion peak at m/ z 885 corresponding to phosphatidylhexose. This antigen was susceptible to phospholipases A2, C and D but resistant to phosphatidylinositol-specific phospholipase C. Two-dimensional nuclear magnetic resonance spectroscopy confirmed that glucose is linked to the sn-glycerol 3-phosphate residue with a β-anomeric configuration. Based upon these combined results, we identified this lipid as phosphatidyl-β- D-glucose. This is the first report showing the presence of the glucosylated glycerophospholipid in mammalian sources.

Cold Agglutinin Isotypes

Background:Although it is known that IgM ĸ molecules predominate in cold agglutinins (CAs), exact data on the frequency of Ig classes and L-chain types (isotypes) of CAs and their distribution among CAs with different specificities are missing. Material and Methods:384 CAs of our collection were tested for isotypes by double diffusion or 2-mercaptoethanol treatment. CA specificities were determined using untreated, papain- and sialidase-treated red blood cells derived from human adults and newborns. Anti-Pr subspecificities were defined by chemically modified glycophorins and further characterized by specifically α2,3-desialylated red cells. Results:Almost all anti-I CAs are IgM. Almost all IgG and IgA examples are anti-Pr CAs, most of which are IgM. IgG and IgA CAs apparently accumulate within CAs with anti-Pr_1h and anti-Pr_a subspecificities. λ-type IgM CAs are found among anti-I (6.5%) and anti-Pr CAs (8.7%) but are preferentially associated with anti-i CAs (20.6%). Conclusion:Ig class switching is rare in CAs. It is decisive for the mode and extent of red blood cell destruction. Autoimmune hemolysis due to IgM CAs is complement mediated. Red blood cell destruction induced by IgG CAs differs from that caused by IgM CAs, whereas IgA CAs do not cause (intense) immune hemolysis. CA class switching is associated with CA (sub)specificities. They reflect autoantigens capable of inducing class switching.

Cytotoxicity of Murine B Lymphocytes Induced by Human VH4-34 (VH4.21) Gene-Encoded Monoclonal Antibodies

We have previously described specific binding and cytotoxicity of human B lymphocytes by VH4-34 gene-derived anti-i cold agglutinin (CA) mAbs. Here we demonstrate that the carbohydrate ligand recognized by human VH4-34 anti-i CA mAbs is also expressed on murine B lymphocytes. Similar to human B cells, binding of murine B lymphocytes by VH4-34-derived anti-i CA mAbs leads to rapid cytotoxicity of target cells as tested bothin vitroandin vivo.Moreover, the mechanism leading to murine B cell death is also similar to human B cells, since morphologically identical membrane pores were detected within 15 min of mAb exposure by scanning electron microscopy. The conservation of the carbohydrate ligand across species provides an ideal system to study the function of human VH4-34 gene derived Abs in immune regulation.

Structural Analysis of VH4–21 Encoded Human IgM Allo‐ and Autoantibodies Against Red Blood Cells

We have sequenced the variable heavy chain regions of a number of VH4-21 encoded monoclonal IgM anti-Rh(D) antibodies produced in response to deliberate immunization. These were compared with the sequences of similarly encoded IgM anti-I cold agglutinins (CA) derived from patients with lympho-proliferative diseases. The anti-Rh(D) antibodies show evidence of clonal expansion and somatic diversification. Even though they are produced in response to an antigenic stimulus, they demonstrate limited hypermutation in the variable heavy chain (VH) segments and there is no evidence of selective pressure acting on the complementarity determining regions (CDRs). The CA demonstrate a higher rate of mutation and yet this results in a lower ratio of replacement to silent mutations (R:S) in the CDRs than seen in the anti-Rh(D) antibodies. It is not clear whether the different pattern of mutations seen in the CA is related to their auto-reactivity or their tumour origin. In both groups of antibodies the region encoded by the VH4-21 segment can be found in germline configuration at the amino-acid level indicating that other V-gene structures, i.e. light chains or CDRH3s, are crucial to the generation of either specificity. A role of the CDRH3 is indicated by the identification of a motif shared by four CAs and one Rh(D) antibody which also demonstrates CA activity independent of its anti-Rh(D) specificity. Amongst the anti-Rh(D) antibodies there seems to be an obligatory combination with VL having closest homology to the DPL16 germline segment indicating this as particularly important in generation anti-Rh(D) specificity.

Anti-j: human cold agglutinins recognizing linear (i) and branched (I) type 2 chains.

Two IgM lambda cold agglutinins (CAs) reacted with protease- and sialidase-resistant antigens expressed in equal strength on human adult (I), newborn (i), i adult, rabbit (I) and rhesus monkey (i) erythrocytes. The antibodies were inhibited by the linear type 2 sequence lacto-N-neotetraose and the branched type 2 sequence lacto-N-neohexaose. Endo-beta-galactosidase treatment of red cells, which splits type 2 chains from the surface, abolished CA reactivity. The CAs expressed the idiotype recognized by the anti-idiotype 9G4 specific for anti-I and anti-i CAs. The data suggest that the two CAs recognize linear (i) as well as branched (I) type 2 chains. It is proposed to term these CAs anti-j.

Characterization of a monoclonal IgMK (IgMGAS) anti-Gd cold agglutinin (CA). Its coexistence with a monoclonal IgG3K (IgGGAS) without CA activity that might be clonally related to IgMGAS

A monoclonal IgMK (IgMGAS) cold agglutinin (CA) of the infrequent anti- Gd specificity, found in a patient with Waldenstrom macroglobulinemia, has been characterized. IgMGAS uses a VH gene homologous (93.7%) to the reported VH251 germ-line, one of the two functional genes of the VH5 family, with differences in both framework regions and complementary determining regions (CDR). The VL gene is homologous to the reported 15AVK1 germ-line gene, recently described in an anti-i CA, with differences mostly clustered in CDR. In the patient's serum, IgMGAS coexisted with a monoclonal IgG3K (IgGGAS) that lacked CA activity but expressed the private idiotopes found on IgMGAS. Both Ig lacked reactivity with antibodies detecting VH1 or VHIII or VKIII subgroup regions or the VH4–21 gene product that is expressed by anti-I/i CAs. The K chains from both Igs showed the same isoelectrical mobility. Moreover, the k chains from both serum Igs showed the same N-terminal amino acid sequence. This sequence was identical to that predicted by the nucleotide sequence of VK1GAS gene segment, including one discrepancy at position 15 (Ile for Val) with respect to the consensus VK1 subgroup regions. Although these data do not exclude a possible independent clonal origin, they are consistent with the notion that IgGGAS might be clonally related to IgMGAS.

Characterization of a Monoclonal IgMK (IgMGAS) Anti-Gd Cold Agglutinin (CA). Its Coexistence With a Monoclonal IgG3K (IgGGAS) Without CA Activity That Might Be Clonally Related to IgMGAS

AbstractA monoclonal IgMK (IgMGAS) cold agglutinin (CA) of the infrequent anti-Gd specificity, found in a patient with Waldenström macroglobulinemia, has been characterized. IgMGAS uses a VH gene homologous (93.7%) to the reported VH251 germ-line, one of the two functional genes of the VH5 family, with differences in both framework regions and complementarity determining regions (CDR). The VL gene is homologous to the reported 15AVK1 germ-line gene, recently described in an anti-i CA, with differences mostly clustered in CDR. In the patient’s serum, IgMGAS coexisted with a monoclonal lgG3K (IgGGAS) that lacked CA activity but expressed the private idiotopes found on IgMGAS. Both Ig lacked reactivity with antibodies detecting VH1 or VHIII or VKIII subgroup regions or the VH4-21 gene product that is expressed by anti-I/i CAs. The K chains from both Igs showed the same isoelectrical mobility. Moreover, the k chains from both serum Igs showed the same N-terminal amino acid sequence. This sequence was identical to that predicted by the nucleotide sequence of VK1GAS gene segment, including one discrepancy at position 15 (He for Val) with respect to the consensus VK1 subgroup regions. Although these data do not exclude a possible independent clonal origin, they are consistent with the notion that IgGGAS might be clonally related to IgMGAS.

Anti-j: Human Cold Agglutinins Recognizing Linear (i) and Branched (I) Type 2 Chains

Two IgMa cold agglutinins (CAs) reacted with protease- and sialidase-resistant antigens expressed in equal strength on human adult (I), newborn (i), i adult, rabbit (I) and rhesus monkey (i) erythrocytes. The antibodies were inhibited by the linear type 2 sequence lacto-N-neotetraose and the branched type 2 sequence lacto-N-neohexaose. Endo-ß-galactosidase treatment of red cells, which splits type 2 chains from the surface, abolished CA reactivity. The CAs expressed the idiotype recognized by the anti-idiotype 9G4 specific for anti-I and anti-i CAs. The data suggest that the two CAs recognize linear (i) as well as branched (I) type 2 chains. It is proposed to term these CAs anti-j.

Variable Region Gene Analysis of Pathologic Human Autoantibodies to the Related i and I Red Blood Cell Antigens

Abstract To investigate the molecular basis of the autoimmune response to the related i and I carbohydrate antigens, we studied cold agglutinins (CA) from B-cell clones and from the peripheral circulation of patients with lymphoproliferative syndromes. Sequence analyses of expressed variable region genes indicate that both anti-i and anti-I specificities from B- cell clones from two patients are encoded by the VH4.21 or a very closely related VH4 heavy chain gene, whereas the expressed light chain genes differed. The anti-i-secreting B-cells express unmutated germline- encoded VH4.21 and VKI gene sequences. The VH region gene encoding anti- I has the closest homology (97%) to the VH4.21 germline gene and differs at the protein level by only three amino acids. In contrast, while the VL region gene encoding anti-I is most homologous (96%) to the VKIII, kv328 germline gene, there are seven amino acid differences due to nonrandom replacement mutations, which suggests a role for antigen-mediated selection in the anti-I response of this individual. These studies were extended by a structural survey of 20 additional serum CA using antipeptide antibodies specific for determinants in VH and VL regions. All anti-I and anti-i CA were shown to express VH4 heavy chains, and 14 of 17 CA expressed a previously described VH4 second hypervariable region determinant, termed VH4-HV2a. We also found that 13 of 14 anti-I CA used VKIII light chains, while the anti-i CA used light chains from at least three VL families. Taken together, the data show that anti-i and anti-I CA probably both derive from the VH4.21 gene (or a closely related gene). Furthermore, the restricted VH and different VL gene use in anti-i and anti-I CA may reflect the close structural relationship of the i and I antigens.

Variable region gene analysis of pathologic human autoantibodies to the related i and I red blood cell antigens

To investigate the molecular basis of the autoimmune response to the related i and I carbohydrate antigens, we studied cold agglutinins (CA) from B-cell clones and from the peripheral circulation of patients with lymphoproliferative syndromes. Sequence analyses of expressed variable region genes indicate that both anti-i and anti-I specificities from B-cell clones from two patients are encoded by the VH4.21 or a very closely related VH4 heavy chain gene, whereas the expressed light chain genes differed. The anti-i-secreting B-cells express unmutated germline-encoded VH4.21 and VKI gene sequences. The VH region gene encoding anti-I has the closest homology (97%) to the VH4.21 germline gene and differs at the protein level by only three amino acids. In contrast, while the VL region gene encoding anti-I is most homologous (96%) to the VKIII, kv328 germline gene, there are seven amino acid differences due to nonrandom replacement mutations, which suggests a role for antigen-mediated selection in the anti-I response of this individual. These studies were extended by a structural survey of 20 additional serum CA using antipeptide antibodies specific for determinants in VH and VL regions. All anti-I and anti-i CA were shown to express VH4 heavy chains, and 14 of 17 CA expressed a previously described VH4 second hypervariable region determinant, termed VH4-HV2a. We also found that 13 of 14 anti-I CA used VKIII light chains, while the anti-i CA used light chains from at least three VL families. Taken together, the data show that anti-i and anti-I CA probably both derive from the VH4.21 gene (or a closely related gene). Furthermore, the restricted VH and different VL gene use in anti-i and anti-I CA may reflect the close structural relationship of the i and I antigens.

Sia‐b1 and I antigens recognized by Mycoplasma pneumoniae‐induced human cold agglutinins

Postinfection cold agglutinins (CAs) with anti-Sia-b1 (i.e., anti-Sialo-branched) specificity frequently occurring together with anti-I CAs recognize antigenic determinants that are present on Oh red cells and are partially destroyed by endo-beta-galactosidase on the red cell surface. They differ markedly from the monoclonal anti-Sia-b1 FI CA, which recognizes an epitope not expressed on Oh cells, and resistant to the enzyme. On the other side, Sia-b1 determinants reacting with postinfection CAs share the characteristics of I determinants, with the exception that Sia-b1 determinants require sialyl groups as an immunodominant component. Five sera containing coexisting anti-Sia-b1 and anti-I CAs were tested against Oh and enzyme-treated group O red cells. The results are consistent with a postinfection autoimmune response against a sialo-type 2 structure common for Sia-b1 and I determinants, which could serve as a receptor for Mycoplasma pneumoniae.

Structural characterization of human monoclonal cold agglutinins: Evidence for a distinct primary sequence‐defined VH4 idiotype

Cold agglutinins that bind the developmentally regulated I red cell determinant occur naturally among human monoclonal IgM proteins. These autoantibodies are known to use light chains that derive mainly from the minor kappa III (kappa III) variable region subgroup. The kappa III subgroup is also highly expressed in monoclonal rheumatoid factors. However, while most monoclonal rheumatoid factors use structurally homologous heavy chains that derive from the VH1 family, information regarding the structure of the cold agglutinin heavy chains remains fragmentary. We demonstrate here that the kappa III cold agglutinin autoantibodies exclusively use heavy chains that derive from the VH4 family. Furthermore, these autoantibody heavy chains all express the same primary sequence-defined idiotype, corresponding to the second hypervariable region. These data indicate that cold agglutinins use a remarkably homogeneous subset of heavy chain variable regions. Moreover, unique patterns of preferential VH and VL pairing clearly distinguish the anti-I cold agglutinins from all other known monoreactive autoantibodies.

Influence of monoclonal IgM cold agglutinins on adhesiveness, phagocytosis, and bactericidal activity on human granulocytes and monocytes.

Monoclonal IgM cold agglutinins (CA) bind and, in the presence of complement, are cytotoxic to various mammalian cells. The impact of these autoantibodies on functional capacity of phagocytes has not been studied until now. Herein we report that sera with monoclonal IgM anti-I and anti-i CA significantly reduce adhesiveness, phagocytosis, phagocytic index, and intracellular bactericidal activity of human peripheral blood polymorphonuclear cells (PMNs) at 37 degrees C and 24 degrees C. Anti-i CA were more active than anti-I. Sera with monoclonal IgMs without CA activity reduced the total number of ingested bacteria but otherwise had no effect on phagocytic functions. There was no difference in the degree of inhibition when anti-i and anti-I CA were tested against cord, maternal, and adult PMNs. Chromatographically purified a-I and a-i CA inhibited markedly phagocytosis in concentrations as low as 1 mg/ml. Phagocytic activity of peripheral blood monocytes was inhibited by CA at 18 degrees C but not at 24 degrees C or 37 degrees C. Pepsin digestion or reduction and alkylation of chromatographically pure IgM CA abolished completely their inhibitory activity. Thus, in physiological temperatures, monoclonal IgM cold agglutinins impair various phagocytic functions of human phagocytes. It may add to the susceptibility to infections in patients in which such autoantibodies are synthesized.

Structural concepts of the human blood group A, B, H, Le(a), Le(b), I and i active glycoproteins purified from human ovarian cyst fluid.

Regardless of the A, B, H, Le(a), Le(b), I and i activity, purified water-soluble blood group glycoproteins from human ovarian cyst fluid have a similar overall structure. They are polydisperse macromolecules (Mr 2.0 x 10(5) to several million) of similar composition (75 to 85% carbohydrate, 15 to 20% protein) and consist of multiple heterosaccharide side chains attached by an O-glycosidic linkage at their internal reducing ends to serine or threonine of the polypeptide backbone. About 90% of these carbohydrate side chains range in size from one to less than twenty-four sugar residues (twelve sugars in the internal structure and twelve key sugars specific as blood group determinants). Three-fourths of these side chains contain fewer than twelve sugars. A generalized blood group active carbohydrate chain is shown above. Three disaccharide units-Type I chain (Gal beta 1----3GlcNAc beta 1----3), Type II chain (Gal beta 1----4GlcNAc beta 1----6) and T determinant [Gal beta 1----3GalNAc alpha 1----Ser(Thr)]-are used to elucidate the internal structure of the carbohydrate chains. The complete internal structure is considered to have a core structure with four branches, to which the blood group key sugars are attached at the appropriate locations. The core structure is a tetrasaccharide, composed of one unit of Type I chain at the nonreducing end and the T determinant at the other end, linked to Ser or Thr of the protein moiety. Branch I is Type I chain and Branch II is Type II chain. They are linked to Gal at the nonreducing end of the core structure. Branch III is usually a Type II chain, but may sometimes be a Type I chain, linked to the GalNAc of the reducing end. The length of Branch III can be increased by adding one or more monosaccharides of Type I chain sequence such as Gal beta 1----3GlcNAc beta 1----3Gal beta 1----4GlcNAc beta 1----6GalNAc alpha 1----Ser(Thr), a combination of Type I and Type II chains. A new Branch IV is made up of Type II chain, which in turn is linked to the Gal end of the T determinant. The Type II chains react with the antibody to the type XIV pneumococcal capsular polysaccharide and with the anti-I(Ma) cold agglutinin.(ABSTRACT TRUNCATED AT 400 WORDS)

Blood group antigens on fetal red cells obtained by umbilical vein puncture under ultrasound guidance: a rapid hemagglutination test to check for contamination with maternal blood.

Seventy-two fetal blood samples obtained by umbilical vein puncture under ultrasound guidance for prenatal diagnosis and monitoring purposes were tested for the expression of 38 blood group antigens. The gestational age at sampling ranged from 18 to 34 wk with 76% of fetuses between 20 and 25 wk. Compared to adult red blood cells, the following antigens showed either abnormally decreased frequency, or significantly reduced expression: A, B, A1, H, Lua, Lub, Lea, Leb, P1, P, and I. Selected anti-I and anti-i cold agglutinins, active at room temperature, were used at appropriate dilution, in a rapid slide or spin test to check for possible mixture of the sample with maternal blood and were shown to detect contaminations up to 5%. The test has proved particularly helpful for immediate and in process assessment of foetal origin of the sampled blood.