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Year : 2010  |  Volume : 53  |  Issue : 3  |  Page : 575-577
Anti Kp a antibody: A rare alloantibody in a multitransfused thalassemic of Indian origin


Department of Pathology, Lady Hardinge Medical College, New Delhi- 110 001, India

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Date of Web Publication22-Oct-2010
 

How to cite this article:
Pahuja S, Pujani M, Gupta SK, Chandra J, Jain M, Vasudeva S. Anti Kp a antibody: A rare alloantibody in a multitransfused thalassemic of Indian origin. Indian J Pathol Microbiol 2010;53:575-7

How to cite this URL:
Pahuja S, Pujani M, Gupta SK, Chandra J, Jain M, Vasudeva S. Anti Kp a antibody: A rare alloantibody in a multitransfused thalassemic of Indian origin. Indian J Pathol Microbiol [serial online] 2010 [cited 2019 Jun 24];53:575-7. Available from: http://www.ijpmonline.org/text.asp?2010/53/3/575/68251


Sir,

The treatment of thalassemia is a double edged sword; on the one hand red cell transfusion is a major life saving modality available, while on the other hand multiple transfusions lead to complications like allo-immunization. Immune anti-Kell antibodies are the commonest immune red cell antibody, following ABO and Rh. [1] However, among the anti-Kell antibodies, anti Kp a is extremely rare. We report an interesting case of anti Kell antibody (anti-Kp a ) in a 12-year-old multi transfused thalassemic.

A 12-year-old boy with thalassemia had been receiving transfusions at the thalassemia center of our hospital, since the age of three years at three to four-week intervals to maintain hemoglobin around 10 gm/dl. He had been receiving group specific buffy coat depleted packed red cell transfusions through bedside leuko-filters for the last three years. The child had not undergone splenectomy.

During the routine antibody screening using 3 cell panel (ID Diacell I, II, III; DiaMed ID Micro Typing System), the patient's serum was reacted with the panel of 3 red cell using LISS (low ionic strength saline) Coombs gel cards. Both Coombs and enzyme phase were set up. The results are depicted in [Table 1]. Based on these, the possible antibodies were narrowed down to anti Kp a , anti P and anti N. Antibody identification using the extended 11 cell panel (ID DiaPanel; DiaMed Micro Typing System) confirmed the antibody as anti Kp a [Table 2]. The reaction was enhanced by papain and inhibited by dithiothreitol (DTT). Direct anti-globulin test (DAT) was negative. With test tube method, the antibody was not identifiable in saline phase but was picked up in Coombs phase. No problem was encountered during indirect antiglobulin test cross match in this patient.
Table 1: Anti body Screening results using 3 cell panel

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Table 2: Anti body Identi fi cati on results using 11 cell panel

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Limited studies have been done on the frequency of allo-immunization in thalassemics, particularly of Indian origin. [2] Globally, the allo-immunization rates among thalassemics have ranged from 5 to 30%. [1] The most common alloantibodies are from Rh and Kell systems, the order of immunogenicity of antigens being D>c>K>E>C>e. [3]

The Kell blood group system was named from 'Kelleher', surname of the mother who first developed antibodies against K antigen. Kell antigens are inactivated by reducing agents such as dithiothreitol (DTT) and aminoethyl isothiouronium bromide (AET) which disrupts the disulphide bonds. This can be utilized to confirm the presence of Kell antigens. Kp a is a low prevalence antigen, seen in only 2% of white population but is extremely rare in the blacks. [3] The development of antibody to this rare antigen is exceptional due to the limited exposure to this low frequency antigen among the Indian population. Anti Kp a antibody is usually immune and of IgG type. However, the original example of this antibody was naturally occurring. [4] It has been shown to be clinically significant and has been implicated in hemolytic transfusion reactions as well as hemolytic disease of newborn. [5],[6] Anti Kp a antibody may also occur as an autoantibody. [3]

In our case, the DAT was negative as well as the Kp a antigen was absent on red cells of this patient. Moreover, there was no problem in finding compatible units during indirect antiglobin test cross-match. This can be accounted for by the extremely low prevalence of Kp a antigen in the Indian population.

Complete antigen phenotyping of all thalassemics is imperative. The significance of providing antigen matched blood in multi-transfused thalassemics cannot be overemphasized. Standard national guidelines should be formulated to ensure uniform blood policy for thalassemics to minimize the rate of allo-immunization.

 
   References Top

1.Singer ST, Wu V, Mignacca R, Kuypers FA, Morel P, Vichinsky EP. Alloimmunization and erythrocyte autoimmunization in transfusion dependent thalassemia patients of predominantly Asian descent. Blood 2000;96:3369-73.  Back to cited text no. 1  [PUBMED]  [FULLTEXT]  
2.Jolly JG, Agnihotri SK, Choudhury N, Gupta D. Evaluation of hemotherapy in thalassemias (20 years of Indian experience). J Indian Med Assoc 1992;90:7-9.  Back to cited text no. 2  [PUBMED]    
3.Klein HG, Anstee DJ. Other red cell antigens. In: Klein HG, Anstee DJ. Editors. Mollison's blood transfusion in clinical medicine. 11th ed. Oxford: Blackwell publishing; 2005. p. 209-13.  Back to cited text no. 3      
4.Allen FH, Lewis SJ. Kpa (Penney), a new antigen in the Kell blood group system. Vox Sang 1957;2:81-7.  Back to cited text no. 4      
5.Costamagna L, Barbarini M, Viarengo GL, Pagani A, Isernia D, Salvaneschi L. A case of hemolytic disease of the newborn due to anti-Kpa. Immunohematology1997;13:61-2.   Back to cited text no. 5  [PUBMED]    
6.Lobo G, Nardozza L, Camano L. Non-anti-D antibodies in red-cell alloimmunization. Int J Gynaecol Obstet 2006;94:139-40.  Back to cited text no. 6      

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Correspondence Address:
Mukta Pujani
Department of Pathology, Lady Hardinge Medical College, New Delhi- 110 001
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.68251

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