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Original Article
A new look at an old case: An auto-anti-P with pseudo-LKE activity
Laura Cooling1
1Associate Professor, Department of Pathology, University of Michigan, Ann Arbor, MI.

Article ID: 100010IJBTILC2013

Address correspondence to:
Laura Cooling
MD, MS, Associate Professor, Pathology, University of Michigan Hospitals
2F225 UH Blood Bank, Box 0054
1500 East Medical Center Drive, Ann Arbor, MI
USA 48109-0054
Phone: (734) 936-6776
Fax: (734) 936-6885

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How to cite this article:
Cooling L. A new look at an old case: An auto-anti-P with pseudo-LKE activity. International Journal of Blood Transfusion and Immunohematology 2013;3:1–12.

Aims: LKE is a high-incidence, minor RBC glycosphingolipid, related to both Pk and P antigens. Approximately 1% individuals are LKE-negative. However, antibodies against LKE are rare, with only six cases mentioned in literature. Past examples of anti-LKE have relied on serologic testing, with no direct testing against RBC glycosphingolipid (GSL). To test a historical 'anti-LKE' against a panel of RBC and glycosphingolipid standards by high performance thin layer chromatography and standard serology.
Methods: Serum samples included human polyclonal anti-LKE, alloanti-P, alloanti-PP1Pk and untransfused controls. Hemagglutination was performed by gel method with ficin-treated RBC of known LKE, P and P1 phenotype. P antigen expression was determined by titration with a well characterized alloanti-P. Antibody specificity was determined by incubating serum against glycosphingolipids on high performance thin layer chromatography plates. Results: The patient's serum reacted with most LKE+ RBC but not ficin-treated p, Pk, or LKE-negative donors, consistent with an anti-LKE. However, on direct testing, the patient's antibody failed to recognize monosialogalactosylgloboside, the LKE antigen. The patient's serum did recognize globoside (P) antigen. This was confirmed by hemagglutination, which showed a correlation between LKE phenotype, P antigen expression and serum reactivity. The patient's weak auto-anti-P was not inhibited by solubilized globoside.
Conclusion: This historical anti-LKE is an auto-anti-P with 'pseudo-LKE' activity due to differences in P antigen expression between LKE+ and LKE-donors.

Key Words: LKE, Glycosphingolipid, P blood group

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Author Contributions:
Laura Cooling – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
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The corresponding author is the guarantor of submission.
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Conflict of interest:
Authors declare no conflict of interest.
© Laura Cooling et al. 2013; This article is distributed the terms of Creative Commons attribution 3.0 License which permits unrestricted use, distribution and reproduction in any means provided the original authors and original publisher are properly credited. (Please see Copyright Policy for more information.)