Atypical Warm Isoagglutinins

Abstract

Zacho 1 reported an instance of premature separation of the placenta with a transfusion-accident, attributable to an atypical isoag-glutinin active on the donor's cells. This agglutinin had the unique property of greater activity at 37° C than at lower temperature. Although Zacho's case was the first and only published instance of this sort, it is likely that hitherto antibodies of this character may have been overlooked. In support of this, case reports are presented of 5 patients whose blood recently investigated were found to contain such agglutinins. A brief discussion of the properties and the origin of these agglutinins forms the basis of this communication.

One of these cases was observed in a patient† (B.M.) transfused 6 times because of bleeding from a duodenal ulcer. Apparently, this agglutinin was induced as a result of the antigenic stimulus of repeated transfusions. No such history could be elicited in the remaining 4 instances, nor in the case of Zacho, all of which were observed in women suffering from a variety of complications of pregnancy.

In one patient (G.B.) who gave a history of 2 miscarriages, the present pregnancy was complicated by death of the fetus during labor. A second patient (H.H.) had 3 consecutive miscarriages and in the present pregnancy delivery was by Caesarian section because of uterine inertia. A third patient (D.D.) who suffered from persistent vomiting from the fourth to the seventh months had fever and premature rupture of the membranes a few days before delivery which was followed by a parametritis. The fourth patient (A.H.) died of an induced septic abortion. (Zacho's patient gave a history of 4 consecutive stillbirths preceding the last pregnancy.)

The correlation of atypical agglutinins in general with certain complications of pregnancy has been mentioned elsewhere. 2