The agglutinin‐inhibiting substance in human serum

Abstract

THE rapid increase in the use of serum, plasma and universal donor blood for transfusion has renewed interest in the possible dangers of high-titre iso-agglutinins. !I'he view is widely held that such agglutinins are dangerous. Witebsky et al. (1940), in a recent review of the literature, conclude that the transfusion of 0 blood into A and B patients causes a larger percentage of reactions than the use of homologous blood, these additional reactions being attributed to the effect of the anti-A and anti-B iso-agglutinins. Hesse (1935), who has investigated the problem of reactions from 0 blood, states that a high agglutinin titre may sometimes be responsible. He takes the rather extreme view that over 30 per cent. of group 0 donors have dangerously high titres. Wiener (1939, pp. 49 and 92) and Riddell (1939, p. 53) advise against the use of group 0 donors with high iso-agglutinin titres. Some writers, however, think that the strength of the iso-agglutinins in the plasma of donors can safely be ignored. Tatum et al. (1939) state that plasma can be transfused without typing or cross-agglutinating. Brines and Manning (1941 a and b )report a considerable number of transfusions of plasma, in 50 per cent. of which the plasma contained iso-agglutinins for agglutinogens in the recipient's red cells, without a single reaction. They consider that the agglutinin titre is of no practical importance. These references, which are by no means exhaustive, serve to show the diversity of views held. 81)

The Occurrence of Blood-Group Specific Material in the Plasma and Serum of Stored Blood

“…As noted by other wor kers, a small change in an inhibition titer was more readily detected when A2 cells were used as the indicator cells [3]. The extent of hemo lysis of cells, as judged by the color of the plasma and serum, did not appear to alter appreciably the titers observed, a finding in agree ment with that made earlier by Aubert et al [1], who were unable to detect the liberation of blood-group active materials from cells that were hemolysed mechanically, and with more recent work which failed to demonstrate A-active material in the supernatant water hemolysates of A cells [5]. The stored, clotted blood samples showed more extensive hemolysis earlier in the experiment than did those collected in ACD solution.…”

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It has been established that substances having blood-group-specific activity are present in the plasma and serum of healthy individuals [1,2]. The amount of active substance, as determined by hemaggluti nation inhibition tests, appears to vary in the same individual, and the amount in serum is greater in secretors than non-secretors [3].

Group specific material is present in the serum of the fetus and infant, and here too appears to be related to secretor status [4].

The present study to determine the effect of storage of blood on the amount of group specific material in plasma and serum, was undertaken during the course of investigations on the extraction of blood-group substance from human red cells.

Materials and Methods

The samples examined were obtained from a belonging to group At.

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A Patient with Apparently Normal AiB Red Cells whose Serum Contains Anti-B

“…It is therefore assumed that any B substance present in the serum is neutralized by the ex cess of anti-B and that none remains in the free state. As has previ ously been shown [2], it is more difficult to demonstrate B substance in group B donors than A substance in group A donors, and it was not possible to test further for this serum factor in the present case.…”

The Antigenic Substances ‘A’ and ‘B’ in the Sera of Healthy Subjects

“…The discrepancy is attributable to differences in the method of examination as well as in definitions; Aubert et al [1] considered as inhibitors all persons whose serum neutralized one or more tubes, without any distinction being made on the basis of degree of inhibi tion. By their criteria, 50.6% were inhibitors in group A and 84.9% in group B.…”