Lab Med Online.  2023 Jan;13(1):42-47. 10.47429/lmo.2023.13.1.42.

Auto-anti-M Antibody Found in a Patient with Acute Myeloid Leukemia: First Report in Korea

• Hong Y
• Kim JS
• Youk HJ
• Chung Y
• Kim H
• Hwang SH
• Oh HB
• Ko DH

• KMID: 2552724
• DOI: http://doi.org/10.47429/lmo.2023.13.1.42

Abstract

The anti-M antibody is a naturally occurring antibody and generally active below 37˚C, with optimum activity at 4˚C. Since auto-anti-M antibody was first reported in 1970, twenty cases have been described. The auto-anti-M antibody could be presented with a negative direct antiglobulin test result and not be associated with anemia or adverse symptoms. Therefore, it is likely to be missed during the routine serologic procedure. Here, we report the first case of auto-anti-M antibody in Korea. A 73-year-old male with relapsed acute myeloid leukemia was admitted with general weakness and atypical pneumonia. The underlying disease created a need for frequent transfusions due to anemia and thrombocytopenia. In the pre-transfusion test, unexpected and not previously seen antibodies were identified as anti-M antibodies and confirmed. The auto-control result was positive. Antigen tests were performed for the antibody’s accurate specification. Finally, it was confirmed that the patient’s red blood cell phenotype had an M antigen and was reported as an auto-anti-M antibody. To our knowledge, this is the first auto-anti-M antibody case in Korea and the Asian region.

Keyword

Auto-anti-M antibody; Antigen test; Pretransfusion test

Reference

1. Daniels GL, Fletcher A, Garratty G, Henry S, Jørgensen J, Judd WJ, et al. Blood group terminology 2004: from the International Society of Blood Transfusion committee on terminology for red cell surface antigens. Vox Sang. 2004; 87:304–16. DOI: 10.1111/j.1423-0410.2004.00564.x. PMID: 15585029.

2. Halawani AJ, Habibullah MM, Dobie G, Alhazmi A, Bantun F, Nahari MH, et al. 2021; Frequencies of MNS blood group antigens and phenotypes in Southwestern Saudi Arabia. Int J Gen Med. 14:9315–9. DOI: 10.2147/IJGM.S344826. PMID: 34887679. PMCID: PMC8650831.

3. Basu D, Basu S, Reddy M, Gupta K, Chandy M. 2017; Clinical and laboratory profile of anti-M. Immunohematology. 33:165–9. DOI: 10.21307/immunohematology-2019-024.

4. Fletcher JL, Zmijewski CM. 1970; The first example of auto-anti-M and its consequences in pregnancy. Int Arch Allergy Appl Immunol. 37:586–95. DOI: 10.1159/000230247. PMID: 4983346.

5. Tegoli J, Harris JP, Nichols ME, Marsh WL, Reid ME. 1970; Autologous anti-I and anti-M following liver transplant. Transfusion. 10:133–6. DOI: 10.1111/j.1537-2995.1970.tb00719.x. PMID: 4987191.

6. Hysell JK, Beck ML, Gray JM. 1973; Additional examples of cold autoagglutinins with M specificity. Transfusion. 13:146–9. DOI: 10.1111/j.1537-2995.1973.tb05462.x. PMID: 4123044.

7. Sangster JM, Kenwright MG, Walker MP, Pembroke AC. 1979; Anti blood group-M autoantibodies with livedo reticularis, Raynaud's phenomenon, and anaemia. J Clin Pathol. 32:154–7. DOI: 10.1136/jcp.32.2.154. PMID: 438345. PMCID: PMC1145601.

8. Dickerman JD, Howard P, Dopp S, Staley R. 1980; Infectious mononucleosis initially seen as cold-induced acrocyanosis: association with auto-anti-M and anti-I antibodies. Am J Dis Child. 134:159–60. DOI: 10.1001/archpedi.1980.02130140033011. PMID: 7352441.

9. Lown JA, Barr AL, Kelly A. 1980; Auto anti-M antibody following renal transplantation. Vox Sang. 38:301–4. DOI: 10.1111/j.1423-0410.1980.tb04495.x. PMID: 7001749.

10. Vale DR, Harris IM. 1980; An additional example of autoanti-M. Transfusion. 20:440–2. DOI: 10.1046/j.1537-2995.1980.20480260276.x. PMID: 7404642.

11. Chapman J, Murphy MF, Waters AH. 1982; Chronic cold haemagglutinin disease due to an anti-M-like autoantibody. Vox Sang. 42:272–7. DOI: 10.1111/j.1423-0410.1982.tb00756.x. PMID: 7101838.

12. Steenssens L, Boulvin S, Van Camp B. 1983; Occasional detection of auto-anti-M antibodies in two patients. Acta Clin Belg. 38:43–8. DOI: 10.1080/22953337.1983.11718904. PMID: 6845948.

13. Sacher RA, Abbondanzo SL, Miller DK, Womack B. 1989; Auto anti-M. Clinical and serologic findings of seven patients from one hospital and review of the literature. Am J Clin Pathol. 91:305–9. DOI: 10.1093/ajcp/91.3.305. PMID: 2646908.

14. Combs MR, O'Rourke MM, Issitt PD, Telen MJ. 1991; An auto-anti-M causing hemolysis in vitro. Transfusion. 31:756–8. DOI: 10.1046/j.1537-2995.1991.31892023504.x. PMID: 1926323.

15. Cohn CS, Delaney M, et al. 2020. Technical manual. 20th ed. Bethesda, MD: American Association of Blood Banks.

16. Ok S-J, Kim S-Y, Kim I-S, Lee E-Y, Kim H-H. 2013; Eleven years' experience with unexpected antibody screening tests including a Dia cell in transfusion candidates. Korean J Blood Transf. 24:64–70.

17. Wikman A, Edner A, Gryfelt G, Jonsson B, Henter JI. 2007; Fetal hemolytic anemia and intrauterine death caused by anti-M immunization. Transfusion. 47:911–7. DOI: 10.1111/j.1537-2995.2007.01209.x. PMID: 17465958.

18. Thompson DJ, Stults DZ, Daniel SJ. 1989; Anti-M antibody in pregnancy. Obstet Gynecol Surv. 44:637–41. DOI: 10.1097/00006254-198909000-00001. PMID: 2771305.

19. Delaney M, Harris S, Haile A, Johnsen J, Teramura G, Nelson K. 2015; Red blood cell antigen genotype analysis for 9087 Asian, Asian American, and Native American blood donors. Transfusion. 55:2369–75. DOI: 10.1111/trf.13163. PMID: 26018321.

20. Hillyer CD, Shaz BH, Winkler AM, Reid M. 2008; Integrating molecular technologies for red blood cell typing and compatibility testing into blood centers and transfusion services. Transfus Med Rev. 22:117–32. DOI: 10.1016/j.tmrv.2007.12.002. PMID: 18353252.

21. Fürst D, Tsamadou C, Neuchel C, Schrezenmeier H, Mytilineos J, Weinstock C. 2020; Next-generation sequencing technologies in blood group typing. Transfus Med Hemother. 47:4–13. DOI: 10.1159/000504765. PMID: 32110189. PMCID: PMC7036580.

22. Youk H-J, Kim JS, Yang JJ, Kim H, Ko D-H. 2022; Annual report of the Korean external quality assessment service on transfusion medicine (2021). Lab Med Qual Assu. 44:10–20. DOI: 10.15263/jlmqa.2022.44.1.10.

23. Muniz JG, Arnoni C, Medeiros R, Vendrame T, Cortez A, S Afonso J, et al. 2021; Antigen matching for transfusion support in Brazilian female patients with sickle cell disease to reduce RBC alloimmunization. Transfusion. 61:2458–67. DOI: 10.1111/trf.16544. PMID: 34121200.