@article {4134,
	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},
	volume = {55},
	year = {2015},
	month = {2015},
	pages = {115 - 128},
	publisher = {(1) Department of Pathology, University of Michigan, Ann Arbor, Michigan,(2) Department of Nephrology, University of Michigan, Ann Arbor, Michigan,(3) American Red Cross Blood Services, Southern Region, Atlanta, Georgia,(4) Veteran{\textquoteright}s Administration Hospit},
	address = {(C) 2015 John Wiley \& Sons, Ltd},
	abstract = {<p>BACKGROUND: \&quot;Weak P\&quot; is a rare red blood cell (RBC) phenotype, characterized by a global decrease in Pk 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, Pk, 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-PP1Pk, were tested against a panel of GSLs by HPTLC immunostaining., RESULTS: The patient typed P1+, P+, and LKE-N and possessed a \&quot;P-like\&quot; panagglutinin. In a two-stage indirect antiglobulin test, the patient\&$\#$39;s plasma caused hemolysis of LKE-S cells but not p, Pk, or LKE-N cells. Clinically, transfusion of P+ RBCs compatible by a prewarmed technique had shortened RBC survival with laboratory evidence of hemolysis. Analysis of the patient\&$\#$39;s isolated RBC GSLs showed a 30\% relative decrease in Gb3 (Pk) and Gb4 (P) and a 90\% decrease in monosialogalactosylgloboside (MSGG, LKE), accompanied by increased lactosylceramide (CDH), paragloboside, and GM3. On HPTLC immunostaining, the patient\&$\#$39;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 Pk individuals, but not anti-PP1Pk, 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., (C) 2015 John Wiley \&amp; Sons, Ltd</p>},
	keywords = {*Anemia, Anemia, Antibody Specificity, Antineoplastic Combined Chemotherapy Protocols/tu [Therapeutic Use], Autoimmune/bl [Blood], Autoimmune/di [Diagnosis], Autoimmune/ge [Genetics], Autoimmune/im [Immunology], Hemolytic},
	isbn = {0041-1132},
	author = {Cooling, Laura and Dake, Louann and Haverty, Donna and Mullis, Nancy and Ellis, Susie and Shayman, James and Judd, John}
}
