@article {4188,
	title = {A hemolytic anti-LKE associated with a rare LKE-negative, "weak P" red blood cell phenotype: alloanti-LKE and alloanti-P recognize galactosylgloboside and monosialogalactosylgloboside (LKE) antigens.},
	journal = {Transfusion//Transfusion},
	volume = {55},
	year = {2015},
	month = {2015},
	pages = {115 - 28},
	publisher = {Cooling,Laura. Department of Pathology, University of Michigan, Ann Arbor, Michigan.},
	address = {United States},
	abstract = {BACKGROUND: "Weak P" is a rare red blood cell (RBC) phenotype, characterized by a global decrease in P(k) and P antigens. We now describe a second weak P individual who also typed LKE-negative (LKE-N) and possessed a clinically significant anti-LKE., STUDY DESIGN AND METHODS: Patient RBCs and plasma were examined by standard serology and flow cytometry. Glycosphingolipids (GSLs) from patient, P(k) , and LKE-strong (LKE-S) RBCs were isolated and analyzed by high-performance thin-layer chromatography (HPTLC). To confirm antibody specificity, patient serum and 30 human polyclonal controls, including alloanti-P and anti-PP1 P(k) , were tested against a panel of GSLs by HPTLC immunostaining., RESULTS: The patient typed P1 +, P+, and LKE-N and possessed a "P-like" panagglutinin. In a two-stage indirect antiglobulin test, the patient{\textquoteright}s plasma caused hemolysis of LKE-S cells but not p, P(k) , or LKE-N cells. Clinically, transfusion of P+ RBCs compatible by a prewarmed technique had shortened RBC survival with laboratory evidence of hemolysis. Analysis of the patient{\textquoteright}s isolated RBC GSLs showed a 30\% relative decrease in Gb3 (P(k) ) and Gb4 (P) and a 90\% decrease in monosialogalactosylgloboside (MSGG, LKE), accompanied by increased lactosylceramide (CDH), paragloboside, and GM3. On HPTLC immunostaining, the patient{\textquoteright}s plasma strongly bound MSSG with weak binding to galactosylgloboside (Gb5). Binding to MSGG, Gb5, and Gb4 was also observed with some examples of alloanti-P from P(k) individuals, but not anti-PP1 P(k) , autoanti-P, or normal controls., CONCLUSIONS: We describe the first example of a clinically significant anti-LKE in the setting of a rare weak P background. Human alloanti-LKE and some alloanti-P recognized Gb5 and MSGG.Copyright {\textcopyright} 2014 AABB.},
	keywords = {*Anemia, Hemolytic, Autoimmune/bl [Blood], *Globosides/im [Immunology], *Glycosphingolipids/im [Immunology], *Isoantibodies/im [Immunology], *P Blood-Group System/im [Immunology], *Stage-Specific Embryonic Antigens/im [Immunology], Anemia, Hemolytic, Autoimmune/di [Diagnosis], Anemia, Hemolytic, Autoimmune/ge [Genetics], Anemia, Hemolytic, Autoimmune/im [Immunology], Antibody Specificity, Antineoplastic Combined Chemotherapy Protocols/tu [Therapeutic Use], Blood Grouping and Crossmatching/mt [Methods], Chromatography, High Pressure Liquid, Chromatography, Thin Layer, Coombs Test, Erythrocyte Transfusion, Fatal Outcome, Humans, Lymphoma, Large B-Cell, Diffuse/co [Complications], Lymphoma, Large B-Cell, Diffuse/di [Diagnosis], Lymphoma, Large B-Cell, Diffuse/dt [Drug Therapy], Male, Middle Aged, Phenotype, Stage-Specific Embryonic Antigens/ch [Chemistry], Transfusion Reaction/et [Etiology]},
	isbn = {1537-2995},
	author = {Cooling, Laura and Dake, Louann R and Haverty, Donna and Mullis, Nancy and Ellis, Susie and Shayman, James and Judd, W John}
}
