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Addams J, Hasan RA, Saifee NH. How we approach transfusions in a patient with high risk of alloimmunization from McLeod phenotype. Pediatr Blood Cancer 2023; 70:e30119. [PMID: 36495235 DOI: 10.1002/pbc.30119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 10/15/2022] [Accepted: 11/07/2022] [Indexed: 12/14/2022]
Abstract
McLeod phenotype-caused by the missing Xk protein-is a very rare red cell phenotype, one characteristic of McLeod syndrome, and sometimes associated with X-linked chronic granulomatous disease (CGD). Diagnosis of McLeod phenotype is important for appropriate transfusion management, because red blood cells from all healthy donors will have the Xk protein with its Kx antigen and can lead to red cell antibody formation without the ability to find compatible McLeod phenotype blood for transfusion. We offer a review and approach to diagnosis of the McLeod phenotype and special transfusion considerations.
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Affiliation(s)
- Joel Addams
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA.,Department of Laboratory Medicine and Pathology, Seattle Children's Hospital, Seattle, Washington, USA.,Bloodworks Northwest, Seattle, Washington, USA
| | - Rida A Hasan
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA.,Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington, USA
| | - Nabiha H Saifee
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA.,Department of Laboratory Medicine and Pathology, Seattle Children's Hospital, Seattle, Washington, USA
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Murakami T, Abe D, Matsumoto H, Tokimura R, Abe M, Tiksnadi A, Kobayashi S, Kaneko C, Urata Y, Nakamura M, Sano A, Ugawa Y. A patient with McLeod syndrome showing involvement of the central sensorimotor tracts for the legs. BMC Neurol 2019; 19:301. [PMID: 31775676 PMCID: PMC6882147 DOI: 10.1186/s12883-019-1526-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 11/12/2019] [Indexed: 11/17/2022] Open
Abstract
Background McLeod syndrome is a rare X-linked recessive acanthocytosis associated with neurological manifestations including progressive chorea, cognitive impairment, psychiatric disturbances, seizures, and sensorimotor axonal polyneuropathy. However, no studies have investigated the functioning of central sensorimotor tracts in patients with McLeod syndrome. Case presentation A 66-year-old man had experienced slowly progressive chorea and gait disturbance due to lower limb muscle weakness since his early fifties. Blood examinations showed erythrocyte acanthocytosis and the reduction of Kell antigens in red blood cells. Brain magnetic resonance imaging showed atrophy of the bilateral caudate nuclei and putamen. The diagnosis of McLeod syndrome was confirmed by the presence of a mutation of the XK gene on the X chromosome. Somatosensory-evoked potential and transcranial magnetic stimulation studies demonstrated that the central sensory and motor conduction times were abnormally prolonged for the lower extremity but normal for the upper extremity. Conclusions This is the first report of the involvement of the central sensorimotor tracts for the legs in a patient with McLeod syndrome. The clinical neurophysiological technique revealed the central sensorimotor tracts involvements clinically masked by neuropathy.
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Affiliation(s)
- Takenobu Murakami
- Department of Neurology, Fukushima Medical University, Fukushima, Japan. .,Department of Neurology, Tottori Prefectural Kousei Hospital, Kurayoshi, Japan.
| | - Dan Abe
- Department of Neurology, Fukushima Medical University, Fukushima, Japan
| | | | - Ryo Tokimura
- Department of Neurology, Fukushima Medical University, Fukushima, Japan
| | - Mitsunari Abe
- Center for Neurological Disorders, Fukushima Medical University, Fukushima, Japan
| | - Amanda Tiksnadi
- Department of Neurology, Fukushima Medical University, Fukushima, Japan
| | | | - Chikako Kaneko
- Department of Neurology, Southern Tohoku General Hospital, Koriyama, Japan
| | - Yuka Urata
- Department of Psychiatry, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Masayuki Nakamura
- Department of Psychiatry, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Akira Sano
- Department of Psychiatry, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Yoshikazu Ugawa
- Department of Neurology, Fukushima Medical University, Fukushima, Japan.,Department of Neuro-regeneration, Fukushima Medical University, Fukushima, Japan
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Roulis E, Hyland C, Flower R, Gassner C, Jung HH, Frey BM. Molecular Basis and Clinical Overview of McLeod Syndrome Compared With Other Neuroacanthocytosis Syndromes. JAMA Neurol 2018; 75:1554-1562. [DOI: 10.1001/jamaneurol.2018.2166] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Eileen Roulis
- Australian Red Cross Blood Service, Kelvin Grove, Queensland, Australia
| | - Catherine Hyland
- Australian Red Cross Blood Service, Kelvin Grove, Queensland, Australia
| | - Robert Flower
- Australian Red Cross Blood Service, Kelvin Grove, Queensland, Australia
| | - Christoph Gassner
- Blood Transfusion Service Zurich, Swiss Red Cross, Schlieren/Zürich, Switzerland
| | - Hans H. Jung
- Department of Neurology, University and University Hospital Zurich, Zurich, Switzerland
| | - Beat M. Frey
- Blood Transfusion Service Zurich, Swiss Red Cross, Schlieren/Zürich, Switzerland
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Gassner C, Brönnimann C, Merki Y, Mattle-Greminger MP, Sigurdardottir S, Meyer E, Engström C, O'Sullivan JD, Jung HH, Frey BM. Stepwise partitioning of Xp21: a profiling method for XK deletions causative of the McLeod syndrome. Transfusion 2017; 57:2125-2135. [PMID: 28555782 DOI: 10.1111/trf.14172] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 04/13/2017] [Accepted: 04/23/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND McLeod syndrome (MLS) is hematologically defined by the absence of the red blood cell (RBC) antigen Kx on the transmembrane RBC protein, XK, representing a highly specific diagnostic marker. Direct molecular assessment of XK therefore represents a desirable diagnostic tool. Whereas pathogenic point mutations may be simply identified, partial and complete deletions of XK on Xp21.1, eventually covering adjacent genes and causing multifaceted "continuous gene syndromes," are difficult to localize. STUDY DESIGN AND METHODS Three different McLeod patient samples were tested using 16 initial positional polymerase chain reaction (PCR) procedures distributed over an approximately 2.8-Mbp Xp-chromosomal region, ranging telomeric from MAGEB16 to OTC, centromeric of XK. The molecular breakpoint of one sample with an apparent large Xp deletion was iteratively narrowed down by stepwise positioning further PCR procedures and sequenced. Two mutant XK genes, one previously published and serving as a positive control, were also sequenced. RESULTS We confirmed the positive control as previously published and listed as XK*N.20 by the International Society of Blood Transfusion (ISBT). The other XK showed a novel four-nucleotide deletion in Exon 1, 195-198delCCGC (newly listed as XK*N.39 by the ISBT). The third sample had an approximately 151-kbp X-chromosomal deletion, reaching from Exon 2 of LANCL3, across XK to Exon 3 of CYBB (newly listed as XK*N.01.016 by the ISBT). Carrier status of the patients' sister was diagnosed using a diagnostic "gap-PCR." CONCLUSIONS The stepwise partitioning of Xp21.1 is pragmatic and cost-efficient in comparison to other diagnostic techniques such as "massive parallel sequencing" given the rarity of MLS. All males with suspected MLS should be considered for molecular XK profiling.
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Affiliation(s)
- Christoph Gassner
- Department of Molecular Diagnostics & Research (MOC), Swiss Red Cross (SRC), Zürich-Schlieren, Switzerland
| | - Chantal Brönnimann
- Department of Molecular Diagnostics & Research (MOC), Swiss Red Cross (SRC), Zürich-Schlieren, Switzerland
| | - Yvonne Merki
- Department of Molecular Diagnostics & Research (MOC), Swiss Red Cross (SRC), Zürich-Schlieren, Switzerland
| | - Maja P Mattle-Greminger
- Department of Molecular Diagnostics & Research (MOC), Swiss Red Cross (SRC), Zürich-Schlieren, Switzerland
| | - Sonja Sigurdardottir
- Department of Molecular Diagnostics & Research (MOC), Swiss Red Cross (SRC), Zürich-Schlieren, Switzerland
| | - Eduardo Meyer
- Department of Quality Control and FACS Analysis, Swiss Red Cross (SRC), Zürich-Schlieren, Switzerland
| | - Charlotte Engström
- Department of Immunohematology, Swiss Red Cross (SRC), Zürich-Schlieren, Switzerland
| | - John D O'Sullivan
- School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Hans H Jung
- Department of Neurology, University and University Hospital Zürich, Zurich, Switzerland
| | - Beat M Frey
- Blood Transfusion Service Zürich, Swiss Red Cross (SRC), Zürich-Schlieren, Switzerland
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Walker RH. Management of Neuroacanthocytosis Syndromes. Tremor Other Hyperkinet Mov (N Y) 2015; 5:346. [PMID: 26504667 PMCID: PMC4613733 DOI: 10.7916/d8w66k48] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 09/24/2015] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND The two core neuroacanthocytosis (NA) syndromes, chorea-acanthocytosis (ChAc) and McLeod syndrome, are progressive neurodegenerative disorders that primarily affect the basal ganglia. The characteristic phenotype comprises a variety of movement disorders including chorea, dystonia, and parkinsonism, as well as psychiatric and cognitive symptoms attributable to basal ganglia dysfunction. These disorders are symptomatically managed on a case-by-case basis, with very few practitioners seeing more than a single case in their careers. METHODS A literature search was performed on PubMed utilizing the terms neuroacanthocytosis, chorea-acanthocytosis, and McLeod syndrome, and articles were reviewed for mentions of therapies, successful or otherwise. RESULTS There have been no blinded, controlled trials and only one retrospective case series describing ChAc. The various therapies that have been used in patients with NA syndromes are summarized. DISCUSSION Management remains at present purely symptomatic, which is similar in principle to other more common basal ganglia neurodegenerative disorders such as Huntington's disease (HD) and Parkinson's disease (PD). However, there are some specific issues particular to NA syndromes that merit attention. An integrated multidisciplinary approach is the ideal management strategy for these complex and multifaceted neurodegenerative disorders.
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Affiliation(s)
- Ruth H. Walker
- Department of Neurology, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA
- Department of Neurology, Mount Sinai School of Medicine, New York City, NY, USA
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Neurodegeneration in the elderly – When the blood type matters: An overview of the McLeod syndrome with focus on hematological features. Transfus Apher Sci 2015; 52:277-84. [DOI: 10.1016/j.transci.2015.04.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Walker RH. Untangling the Thorns: Advances in the Neuroacanthocytosis Syndromes. J Mov Disord 2015; 8:41-54. [PMID: 26090076 PMCID: PMC4460540 DOI: 10.14802/jmd.15009] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 04/27/2015] [Accepted: 04/28/2015] [Indexed: 12/25/2022] Open
Abstract
There have been significant advances in neuroacanthocytosis (NA) syndromes in the past 20 years, however, confusion still exists regarding the precise nature of these disorders and the correct nomenclature. This article seeks to clarify these issues and to summarise the recent literature in the field. The four key NA syndromes are described here-chorea-acanthocytosis, McLeod syndrome, Huntington's disease-like 2, and pantothenate kinase- associated neurodegeneration. In the first two, acanthocytosis is a frequent, although not invariable, finding; in the second two, it occurs in approximately 10% of patients. Degeneration affecting the basal ganglia is the key neuropathologic finding, thus the clinical presentations can be remarkably similar. The characteristic phenotype comprises a variety of movement disorders, including chorea, dystonia, and parkinsonism, and also psychiatric and cognitive symptoms attributable to basal ganglia dysfunction. The age of onset, inheritance patterns, and ethnic background differ in each condition, providing diagnostic clues. Other investigations, including routine blood testing and neuroimaging can be informative. Genetic diagnosis, if available, provides a definitive diagnosis, and is important for genetic counseling, and hopefully molecular therapies in the future. In this article I provide a historical perspective on each NA syndrome. The first 3 disorders, chorea-acanthocytosis, McLeod syndrome, Huntington's disease-like 2, are discussed in detail, with a comprehensive review of the literature to date for each, while pantothenate kinase-associated neurodegeneration is presented in summary, as this disorder has recently been reviewed in this journal. Therapy for all of these diseases is, at present, purely symptomatic.
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Affiliation(s)
- Ruth H. Walker
- Department of Neurology, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA
- Department of Neurology, Mount Sinai School of Medicine, New York, NY, USA
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Boturão-Neto E, Yamamoto M, Chiba AK, Kimura EYS, de Oliveira MDCVC, do Monte Barretto CL, Nunes MMA, Albuquerque SRL, de Deus Santos MD, Bordin JO. Molecular Basis of KELnull Phenotype in Brazilians. Transfus Med Hemother 2014; 42:52-8. [PMID: 25960716 DOI: 10.1159/000370232] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 05/27/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND KELnull (K0) persons can produce clinically significant anti-KEL5 antibody after transfusion and/or pregnancy, requiring K0 blood transfusion when indicated. 37 K0 alleles have been reported in studies over different populations, but none in Amerindian-Caucasian descendants from South America. The aim of this study was to identify the molecular basis of K0 phenotype in Brazilians. METHODS We investigated three K0 samples from different Brazilian blood banks (Recife, Manaus, and Vila Velha) in women with anti-KEL5. KEL antigen typing was performed by serologic techniques, and the K0 status was confirmed by flow cytometry. PCR-RFLP and DNA sequencing of the KEL coding and exon-intron regions were also performed. RESULTS RBCs of the 3 patients were phenotyped as KEL:-1,-2,-3,-4,-7. The 3 patients had the same KEL*02/02 genotype and were negative for KEL*02.03 and KEL*02.06 alleles. The Recife K0 patient was homozygous for IVS16 + 1g>a mutation (KEL*02N.31 allele). The flow cytometry with anti-KEL1, anti-KEL2, anti-KEL3, anti-KEL4, and anti-CD238 confirmed the K0 phenotype. In addition, we found the c.10423C>T mutation (KEL*02N.04 allele) in both the Manaus K0 and the Vila Velha K0 patients. CONCLUSION This report represents the first study of K0 molecular basis performed in Amerindian-Caucasian descendants from South America.
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Affiliation(s)
- Edmir Boturão-Neto
- Universidade Federal de São Paulo, Hematology and Transfusion Medicine Department, São Paulo, SP, Brazil
| | - Mihoko Yamamoto
- Universidade Federal de São Paulo, Hematology and Transfusion Medicine Department, São Paulo, SP, Brazil
| | - Akemi Kuroda Chiba
- Universidade Federal de São Paulo, Hematology and Transfusion Medicine Department, São Paulo, SP, Brazil
| | - Elisa Yuriko Sugano Kimura
- Universidade Federal de São Paulo, Hematology and Transfusion Medicine Department, São Paulo, SP, Brazil
| | | | | | | | | | | | - José Orlando Bordin
- Universidade Federal de São Paulo, Hematology and Transfusion Medicine Department, São Paulo, SP, Brazil
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Monfort M, Peyrard T, Arnaud L, Helias V, Maggipinto G, Gérard C. [A KEL*02mod allele responsible for an apparent maternity exclusion]. Transfus Clin Biol 2013; 20:490-5. [PMID: 23727116 DOI: 10.1016/j.tracli.2013.03.278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Accepted: 03/19/2013] [Indexed: 11/17/2022]
Abstract
The patient's rare KEL:1,-2 phenotype was highlighted in course of a routine preoperative erythrocyte typing. Unexpectedly, her two daughters presented a KEL:-1,2 phenotype what appeared first as an apparent maternity exclusion. Flow cytometry, genotyping and adsorption-elution analyses were then performed for those three patients. KEL genotyping showed that the patient's genotype was KEL*01/KEL*02 whereas that of her daughters was KEL*02/KEL*02. By using polyclonal anti-KEL2 reagent, weak amount of KEL2 was identified on the patient's erythrocytes, a result which was confirmed by both flow cytometry and adsorption-elution assays, suggesting that patient's phenotype was in fact KEL:1,2w. These results are in favour of a weak expressed KEL*02 allele (KEL*2mod) transmission coding for a KEL2 antigen detected in some technical conditions only. Those results allowed to explain the apparent maternity exclusion based on initial KEL phenotype. This study also seems to confirm the presence of a compensatory mechanism of the KELmod allele deficient expression in heterozygote patients. A KEL phenotype retrospective study of 80,000 subjects showed a local KEL:1,-2 frequency four times lower than that described in literature. Moreover, a significant number of those individuals would in reality be KEL:1,2w, what still would decrease the real frequency of the KEL:1,2 subjects.
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Affiliation(s)
- M Monfort
- Laboratoire d'immunohématologie, centre hospitalier universitaire de Liège, Liège, Belgique.
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Hönig M, Flegel WA, Schwarz K, Freihorst JF, Baumann U, Seltsam A, Debatin KM, Schulz AS, Friedrich W. Successful hematopoietic stem-cell transplantation in a patient with chronic granulomatous disease and McLeod phenotype sensitized to Kx and K antigens. Bone Marrow Transplant 2009; 45:209-11. [PMID: 19503108 DOI: 10.1038/bmt.2009.115] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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