Vox Sang. 28: 2 5 3 2 5 6 (1975)

Anti-Kell (Kl) in Ascitic Fluid G. H. LONGSTER and K. E. MAJOR' Leeds Regional Transfusion Centre, and The Hospital for Women, Letds

Abstract. The presence of anti-Kell (K1)in the ascitic fluid of a patient with adenocarcinoma is described. The antibody has persisted for over 3 years. The anti-Kl together with the anti-A and antiB also present in the fluid, is compared with antibodies present in the patient's serum.

This brief report concerns a patient with ovarian adenocarcinoma who is group 0 Rh-positive and who had produced anti-K1 presumably through isoimmunization from either pregnancy or transfusion. This antibody together with anti-A and anti-B can be demonstrated in her ascitic fluid as well as in her serum.

Case History The patient then aged 62 years was found to have adenocarcinoma of the ovary with metastases and ascites in 1970. She had had five normal pregnancies and a miscaniage and had been transfused 17 years ago with seven units of blood without any reaction. The anti-KI was detected during routine compatibility testing. The patient was treated with chemotherapy and recurrent paracentesis until November 1973 when she was readmitted to hospital with a small bowel obstruction. She died of hypostatic pneumonia 23rd November 1973. We wish to thank Dr. J. D. CROSSLAND for his advice and assistance in the preparation of this report.

Received: July 15, 1974; accepted: July 30, 1974.

LONGSTER/MAJOR

254

Methods and Materials Samples of clotted blood and ascitic fluid were taken from the patient in July 1970 when the case was first brought to our attention. The serum and ascitic fluid were tested in parallel, after titration by doubling dilutions, against group 0 K: 1,2 cells at 37°C in saline, albumin (albumin displacement technique) and by the indirect antiglobulin technique. The serum and the fluid were also titrated and tested with group A, K:-1 cells and group B K: 1 cells in saline at 20°C. Further samples of clotted blood and ascitic fluid were taken 3 years later (September 1973),and together with a sample of ascitic fluid taken in July 1970 and stored at - 2 0 T , tested similarly. These samples were also titrated, using the same techniques and the same red cells, after treatment with 2-mercaptoethanol [2]. The group 0 K : 1,2 cells sensitized with the anti-K, from both serum and ascitic fluid, were tested with anti-human globulin reagents specific for IgA, JgG, JgM, ,L?IC/,L?IA,and PIE components of human globulins (antisera obtained from Behringwerke and standardized for use in the Coombs’ test). and RENTON(41. Scoring of the tests was carried out as described by STRATTON

-

Results The group 0 K : 1,2 cells sensitized with anti-K1, from the ascitic fluid and the sera, reacted with the specific anti-human IgG but did not react with any other of the specific anti-human globulin reagents, indicating that the anti-K1 appears to be wholly IgG globulin. The results of the titrations are shown in table I.

Discussion The presence of antibodies other than ABO antibodies in ascitic fluid would appear to be an uncommon occurrence. Anti-Yta [l], anti-c, anti-Lea [3] and anti-E [5] have been reported to be present in ascitic fluid ; however, the presence of anti-K1 (or any other antibody in the Kell system) does not appear to have been previously reported. The anti-K1 in the ascitic fluid would appear to be IgG in nature and of the same potency as that in the serum. It is also potent enough to be of use as a grouping serum. The ascitic fluid also contains anti-A and anti-B although this appears to be of lower titre than the anti-A and anti-B present in the serum. This is possibly due to the fact that whereas the anti-A and anti-B in the ascitic fluid appears to be totally IgG in nature, that in the serum is only partly so and would suggest that in this case only the smaller IgG molecules of anti-A and anti-B have passed into the fluid.

AHG =Anti-human globulin (Coombs') test.

Serum taken July 1970 Ascitic fluid taken July 1970 (not stored) Ascitic fluid taken July 1970 (stored 3 years at -20°C) Ascitic fluid taken July 1970 (stored 3 years at - 20°C) Treated with 2-mercaptoethanol Serum taken September 1973 Serum taken September 1973 Treated with 2-mercaptoethanol Ascitic fluid taken September 1973 Ascitic fluid taken September 1973 Treated with 2-mercaptwthanol

4 10

16 8 9 10

8

16 4 4 4

4 4

10 7

14 3

6

8

14

8

8 2

10

8 4

4

8

score

titre

titre

score

Group B K: - 1 cells 20°C saline

Group A, K:-1 cells 20 "C saline

1 1

1 1

1

1

4 4

titre

1

1

1

1

1

1

score

Group 0 K : 1,2 cells 37°C saline

8 8

8 8

32

32

256 64

titre

10 10

12 11

18

18

score

Group 0 K:1,2 cells 37°C albumin

16 16

16 16

32

32

64 64

titre

12 12

12 12

16

1s

score

Group 0 K: 1,2 cells AHGl

Table I. Comparison of results obtained with various samples of serum and ascitic fluid and of treatment of some samples with 2-mercaptoethanol

E Ul

g

3

g$3..

Y

fj

-

P2.

256

LONGSTER/MAJOR

References I EATON,B. R.; MORTON, J. A.; PICKLES,M. M., and WHITE,K. E.: A new antibody anti-Yta characterizing a blood group of high incidence. Brit. J. Haemat. 2: 333-341 (1 956). 2 MOLLISON, P. L.: Blood transfusion in clinical medicine; 4th ed., p. 730 (Blackwell. Oxford 1967). 3 PICKLES,M. M.: Personal commun.; quoted in RACEand SANGER Blood groups in man; 5th ed., p. 225 (Blackwell, Oxford 1968). 4 STRATTON, F. and RENTON, P. H.: Practical blood grouping, p. 34 (Blackwell, Oxford 1958). 5 ZEITLIN,R. A.: A neglected source of blood group antibodies. Lancet i: 915 (1957).

Request reprints from : Mr. G. H. LONGSTER, Regional Transfusion Laboratory, Bridle Path, Leeds LS15 7TW (England)

Varia

XIV th Congress of the International Society of Blood Transfusion Helsinki, July 27

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Anti-Kell (K1) in ascitic fluid.

The presence of anti-Kell (K1) in the ascitic fluid of a patient with adenocarcinoma is described. The antibody has persisted for over 3 years. The an...
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