Mechanism of the Albumin Agglutination Phenomenon

Abstract

The albumin agglutination phenomenon is due to antibodies which cause agglutination of all human red cells when these cells are suspended in an albumin medium. Two sera with this property were studied. We suggest that the reaction is due to non-specific adsorption of antigen-antibody complex onto red cells. The antibody is a gamma globulin directed at albumin which has been altered by the addition of acetyl tryptophanate or caprylate. These chemicals are added as stabilizers in the manufacture of albumin to prevent dénaturation when the albumin is heated. Since unaltered (native) albumin does not react with these antibodies, blood or plasma transfusion to patients with this serologic abnormality should present no unusual hazard. A non-reactive albumin should be used in crossmatching blood for such patients. Therapeutic human serum albumin and plasma products containing stabilized albumin are probably contraindicated in these patients.

Incompatibility in vitro and in vivo Demonstrated Only with Saline-Suspended Red Cells

“…The survival of these and McGinniss [4] and Golde et al [5,6] subsequently demonstrated that these sera react with the short-chain fatty acid stabi lizers, such as sodium caprylate, present in commercial albumin. Although 51Cr in vivo studies have not been done, patients with al bumin-agglutinating sera have received com mercial albumin infusions with no ill-effects cells was 77% at lh ( fig.…”

An Enhancing Effect of Albumin on the Determination of Cold Hemagglutinins

“…The phenomenon is distinguishable, by its temperature de pendence and its occurrence in other potentiating media, from the rare condition of pseudoagglutination in albumin reported recently by Taylor [7] and earlier by Weiner et al [8]. Golde et al [5] have presented convincing evidence that the pseudoagglutination pheno menon results from alteration of albumin by the stabilizers acetyl tryptophanate or caprylate added to prevent dénaturation when albumin is heated. In the present studies, unstabilized albumin (22% BSA, Pentex, table VI) effected enhanced agglutination comparable to that observed with stabilized albumins.…”

Caprylate-Dependent Auto-Anti-e

“…Golde et al [4,5] suggested that capry late-dependent antibodies have specificity for albumin. The antibodies were thought to form an immune complex with albumin conformationally altered by caprylate.…”

“…A number of sera panagglutinate red cells in an albu min medium in the presence of caprylic acid. These agglutinins had no specificity for red cell antigens [4,8]. This paper pre sents a patient who had a caprylate-depend ent autoantibody with specificity for the e antigen of the red cell.…”