A Serum Factor Reacting with Acriflavin Causing an Error in ABO Cell Grouping

Abstract

The blood of a donor was investigated because of a discrepancy between cell grouping and serum confirmation. Her whole blood reacted strongly with five commercial preparations of anti‐B sera, yet her serum contained normal anti‐B isoagglutinins. Grouping tests with the donor's washed red cells suspended in saline indicated they were group O. Further tests of the donor's whole blood showed that raw high titered anti‐B did not cause agglutination. The addition of acriflavin (the dye used to color commercial preparation of anti‐B) to the donor's blood caused spontaneous agglutination. The donor's serum plus acriflavin caused agglutination of all random group O red cells. Various antibiotics, drugs and vitamins such as riboflavin, cyanocobalamin, tetracycline, penicillin, chloromycetin, mycostatin, gantrisin, streptomycin, phenacetin, atabrine and quinidine did not cause agglutination. The serum, when tested against her own cells or random group O cells in the presence of acriflavin, was reactive at a titer of 1:64; the reaction was not positive by the antiglobulin test. 2‐Mercaptoethanol destroyed the reactivity of the serum. Inasmuch as the reaction was not complement dependent or enzyme affected, the phenomenon of immune adherence was ruled out. One year later her serum was still reactive at a titer of 1:32. No other example of this serum factor was found in 1,000 random hospital patients. An antigen‐antibody reaction comparable to that observed in phenacetin dependent reactions 3 is postulated.