Red cell antigen loss in a patient with chronic myeloid leukemia: a case of ABO discrepancy

Transient suppression of high-prevalence Kell blood group antigens and concomitant development of a Kell-related antibody that appears to recognize a high-prevalence Kell antigen not previously defined

A previously healthy 32-year-old male patient was admitted to hospital with malaise, dyspnea, anemia, thrombocytopenia, and leukopenia. Anemia and thrombocytopenia worsened during the third week. Considering the possible need for transfusion, routine ABO and D typing and an antibody detection test were performed. Antibody detection test was positive, necessitating fur ther immunohematologic investigation that revealed an antibody with Kell-related specificity and suppression/alteration of several high-prevalence Kell blood group system antigens. Autocontrols and direct antiglobulin tests (DATs) were negative in several samples during the disease course. Sequencing of the patient's KEL and XK genes did not reveal any mutations. Initial tentative diagnosis was myeloid neoplasm based on dyserythropoiesis in the bone marrow smear and no obvious biochemical signs of hemolysis. Azacitidine treatment was initiated, accordingly, but had to be interrupted when the patient's hemoglobin (Hb) dropped to 4.6 g/dL in 3 days, and he experienced more severe anemia symptoms (fatigue, nausea, and heart palpitations). Platelet concentrates, and 3 very rare Kellnull packed RBC concentrates, imported from abroad, were transfused. However, no increase in Hb was achieved. Platelet autoantibodies were not detected. Suspecting an autoimmune etiology, intravenous immunoglobulin and high-dose glucocorticoids were given. The patient responded to the latter treatment; he felt much better and regained his daily activity, and his Hb value and platelet count normalized on day 45. The steroid dose was tapered during the next 6 months until it was discontinued. His RBCs had normal Kell antigen expression, and the antibody was undetectable on day 105. Therefore, we concluded that an autoimmune etiology was the most plausible cause for the patient's condition despite a negative DAT. The immunohematologic investigation showed disease-related transient loss and/or alteration of several Kell system high-prevalence antigens and a Kell-related antibody that appeared to recognize a unique high-prevalence Kell antigen with a not-yet fully defined epitope.

Mixed-field ABO front typing as an early sign of disease recurrence in ABO-matched stem cell transplantation

ABO group testing is critical for allogeneic stem cell transplantation because mismatches can cause both transfusion and engraftment challenges. Even with ABO-matched donor-recipient pairs, ABO group determination may provide valuable insight into allograft status. Herein, we report a case of a 76-year-old female patient with myeloid neoplasm who underwent ABO-matched stem cell transplantation and in whom mixed-field ABO antigen expression during routine follow-up testing post-transplantation was the first sign of a change in transplant graft status; the mixed-field findings pre-dated changes in formal chimerism testing. This case underscores the potential of mixed-field ABO typing as an early indicator of disease recurrence in ABO-matched stem cell transplants and suggests that, in such cases, more sensitive forms of chimerism testing and/or closer monitoring for disease recurrence, particularly in the clinical setting of myeloid neoplasms, may be warranted.

Association of Leukemia With ABO Blood Group Distribution and Discrepancy: A Review Article

The ABO system is an essential blood group in clinical transfusion medicine implicated in several human diseases. The ABO system has been investigated for over a century, with various studies exploring potential links to disease susceptibility. The study examines the possible relationship between leukemia and the distribution and the ABO blood group system discrepancy. A comprehensive review was conducted on the recommended databases to review the ABO blood groups, their association with leukemia, and the expected changes in blood groups among leukemia patients. The study highlights different kinds of leukemia, such as acute lymphocytic leukemia (ALL), acute myeloid leukemia (AML), chronic myeloid leukemia (CML), and chronic lymphocytic leukemia (CLL), their characteristics, and their relationship with ABO blood groups. The document concludes that studying ABO blood group distributions among leukemia patients showed that the most common blood group in acute leukemia is the A group, while in chronic leukemia, the O group is predominant; more studies are required. This study also confirmed an association between leukemia and ABO blood group discrepancy.

[Effects of DNA methylation on ABO gene expression in leukemia]

Objective: To investigate the impact of promoter CpG island methylation on ABO mRNA expression in leukemia. Methods: 25 cases of leukemia and 20 cases of normal control were studied, and the leukemia cell lines K562、HL-60 and Jurkat were treated with different concentrations of decitabine. PCR-SSP was used to identify ABO genotype, RQ-PCR for ABO mRNA expression and bisulfite sequencing PCR for DNA methylation status. Results: ① The methylation of ABO promoter in acute myeloid leukemia patients (10 cases) and acute lymphoblastic leukemia patients (10 cases) were 53.85% and 18.22% respectively, which were obviously higher than those in control (20 cases, 2.33%) and chronic myeloid leukemia patients (5 cases, 2.12% ). ② ABO genotype of K562 was O1O1, which has changed little before and after decitabine treatment. ABO genotype of HL-60 and Jurkat could not been identify before treatment, but showed as O1A1 and A1O2 after treatment. ③ABO mRNA expression of K562 was 1 275.67 ± 35.86, which was obviously higher than that in HL-60 (0.54 ± 0.07, P<0.05) and Jurkat (0.82±0.16, P<0.05). ④The methylation of ABO promoter in K562, HL-60 and Jurkat were 0, 58.14%, and 96.74%. As concentration of decitabine increased, the methylation of ABO promoter were decreased and the expressions of ABO mRNA were increased in HL-60 and Jurkat, which had significant differences compared with that before treatment (P<0.05). Conclusion: The methylation of ABO promoter shows a negative correlation with ABO mRNA expression. DNA methylation was an important aspect of ABO antigens decrease in acute leukemia.