Serological characteristics of Lewis antibodies and their clinical significance - A case series

Subramaniyan, Rajeswari

doi:10.1016/j.htct.2021.07.007

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Hematology, Transfusion and Cell Therapy

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Original article • Hematol., Transfus. Cell Ther. 45 (2) • Apr-Jun 2023 • https://doi.org/10.1016/j.htct.2021.07.007 copy

Serological characteristics of Lewis antibodies and their clinical significance - A case series

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Introduction

Lewis antibodies have been thought to play a small role in clinical transfusion practice, but recent reports suggest that they have gained more importance in the context of transfusion and transplantation. Data regarding the prevalence of Lewis antibodies and their clinical significance in the Indian context is very limited. Hence, this study was aimed at analyzing the serological characteristics and clinical significance of Lewis antibodies encountered in our patient and donor populations.

Methods

The retrospective data analyzed the records of red cell antibody screening results and the additional serological evaluation performed on the donor and patient samples included in the study.

Results

A total of 26 study subjects were noted to have Lewis antibodies (including 6 healthy donors and 20 patients). Of them, 13 individuals had anti-Le^b, 10 had anti-Le^a and the remaining three had an anti-Le^a/Le^b mixture. IgG Lewis antibodies were detected in 7 individuals. All cases of IgM Lewis antibodies detected were reacting at 37°C. Two patients were suspected of having hemolytic transfusion reactions due to Lewis antibodies. Antigen-negative cross-match compatible units were provided for transfusion in the recipients.

Conclusion

Lewis antibodies of the IgM class reacting at 37°C should be regarded as clinically important. The present study findings urge that the lab personnel look for the thermal amplitude of Lewis antibodies, irrespective of the fact that the antibody class and antigen-negative crossmatch compatible units should be provided to avoid hemolytic transfusion reactions.

Keywords
Lewis blood group system; Antigen; Antibody; Transfusion

Characteristics	N= 20
Mean Age in years (range)	43.7 (20 -78)
Gender
Male	6
Female	14
Diagnosis
Pregnant women	7
Chronic kidney disease	2
Hematological disorder/malignancy	2
Coronary artery disease	2
Diabetes mellitus	2
Neurological disorder	2
Chronic liver disease	1
Intertrochanteric fracture	1
Solid organ malignancy	1
Blood group distribution
A	4
B	6
AB	7
O	3
No of individuals previously transfused	2
No. of samples with anti-Le^a	7 (5 IgM, 2 IgG)
No. of samples with anti-Le^b	11(10 IgM, 1 IgG)
No. of samples with anti-Le^a/Le^b	2 (1 IgM, 1 IgG)

Sex	Age	Associated clinical condition	Blood group	Transfusion history	DAT	Antibody characteristics			Secretor status	Lewis phenotype	Transfusion details(*)
						Specificity	Type	Thermal amplitude
F	30	Antenatal	B negative	No	negative	Anti-Le^a	IgG	37⁰C	Secretor	Le (a-b-)
F	25	Antenatal	A negative	No	negative	Anti-Le^a	IgM	4⁰C, 22⁰C, 37⁰C	Secretor	Le (a-b-)
F	20	Antenatal	B positive	No	negative	Anti-Le^b	IgM	4°C, 22°C, 37⁰C	Non- Secretor	Le (a-b-)
F	23	Antenatal	AB negative	No	negative	Anti-Le^b	IgM	4⁰C, 22⁰C, 37⁰C	Secretor	Le (a-b-)
F	26	Antenatal	O negative	No	negative	Anti-Le^a	IgG	37⁰C	Secretor	Le (a-b-)
F	23	Antenatal	AB negative	No	negative	Anti-Le^b	IgM	4⁰C, 22⁰C, 37⁰C	Secretor	Le (a-b-)
F	24	Antenatal	AB negative	No	negative	Anti-Le^b	IgM	4°C, 22°C, 37⁰C	Secretor	Le (a-b-)
M	37	CKD	AB positive	No	negative	Anti-Le^b	IgM	4⁰C, 22⁰C, 37⁰C	Non- Secretor	Le (a-b-)	1 unit Le^b - transfused
F	34	CKD	AB positive	No	negative	Anti-Le^a/Le^b	IgG	37⁰C	Secretor	Le (a-b-)
M	64	Low grade lymphom-a	O negative	Multiple, Last transfusion - a week before admission	C3d (1+)	Anti-Le^a	IgM	4⁰C, 22⁰C, 37⁰C	Secretor	ND*	2 units Le^a-transfused
F	78	Chronic anemia	O positive	Multiple, Last transfusion- two days before admission	C3d(3+)	Anti-Le^b	IgM	4°C, 22°C, 37⁰C	Non-Secretor	ND*
F	65	CAD	B positive	No	negative	Anti-Le^a	IgM	4⁰C, 22⁰C, 37⁰C	Secretor	Le (a-b-)	1 unit Le^a-transfused
M	42	CAD	A positive	No	negative	Anti-Le^b	IgM	4°C, 22°C, 37⁰C	Non-Secretor	Le (a-b-)
F	58	DKA	B positive	No	negative	Anti-Le^b	IgM	4⁰C, 22⁰C, 37⁰C	Non-Secretor	Le (a-b-)
M	71	Diabetic foot ulcer	B positive	No	negative	Anti-Le^b	IgM	4°C, 22°C, 37⁰C	Non-Secretor	Le (a+b-)
F	28	Acute SDH	A positive	No	negative	Anti-Le^a	IgM	4⁰C, 22⁰C, 37⁰C	Secretor	Le (a-b-)	1 unit Le^a- transfused
F	70	Myasthenia gravis	AB positive	No	negative	Anti-Le^b	IgM	4°C, 22°C, 37⁰C	Non secretor	Le(a+b-)	2 units of Le^b- transfused.
M	42	CLD	A positive	No	negative	Anti-Le^a	IgM	4°C, 22°C, 37⁰C	Secretor	Le (a-b-)	1 unit Le ^a- transfused
M	67	Inter-trochanteric fracture	B positive	No	negative	Anti-Le^b	IgG	37⁰C	Non- Secretor	Le (a-b-)	1 unit Le ^b- transfused
F	48	Carcino-ma ovary	AB positive	No	negative	Anti-Le^a/Le^b	IgM	4°C, 22°C, 37⁰C	Secretor	Le (a-b-)

Characteristics	N= 6
Mean Age in years (range)	29.8 (23-54)
Gender
Male	6
Female	nil
Blood group distribution
A	2
B	2
AB	1
O	1
No of individuals previously transfused	Nil
No. of samples with anti-Le^a	3(1 IgM, 2 IgG)
No. of samples with anti-Le^b	2(1 IgM, 1 IgG)
No. of samples with anti-Le^a/Le^b	1(IgM only)

Sex	Age	Blood group	Transfusio-n history	DAT	Antibody characteristics			Secretor status	Lewis phenotype
					Specificity	Type	Thermal amplitude
M	54	AB positive	No	negative	Anti-Le^b	IgM	4°C, 22°C, 37⁰C	Non-Secretor	Le (a-b-)
M	25	B positive	No	negative	Anti-Le^a	IgG	37⁰C	Secretor	Le (a-b-)
M	23	O positive	No	negative	Anti-Le^a	IgM	4°C, 22°C, 37⁰C	Secretor	Le (a-b-)
M	24	A positive	No	negative	Anti-Le^a	IgG	37⁰C	Secretor	Le (a-b-)
M	23	B positive	No	negative	Anti-Le^b	IgG	37⁰C	Non-Secretor	Le (a-b-)
M	30	A Positive	No	negative	Anti-Le^a/Le^b	IgM	4⁰C, 22⁰C, 37⁰C	Secretor	Le (a-b-)

Associação Brasileira de Hematologia, Hemoterapia e Terapia Celular (ABHH) R. Dr. Diogo de Faria, 775 cj 133, 04037-002, São Paulo / SP - Brasil - São Paulo - SP - Brazil
E-mail: htct@abhh.org.br

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