항-K 항체가 검출된 세 예와 한국인에서의 KEL 유전자 빈도 = Three Cases of Anti-K and the KEL Gene Frequency in the Korean Population

다국어 초록 (Multilingual Abstract)

Background: Anti-K is one of the most significant unexpected antibodies that cause hemolytic transfusion reactions. Individuals with anti-K have to be transfused with K antigen-negative red cells. Although Koreans rarely have the K antigen, we have detected three cases of anti-K and we analyzed the Kell blood group genotypes for the KEL*1/KEL*2 alleles at the same time.
Methods: We analyzed the KEL*1/KEL*2 allele genotypes from 261 blood donors at Seoul National University Bundang Hospital. Kell genotyping were carried out using polymerase chain reaction (PCR) and restriction enzyme length polymorphism (RFLP). Identification of anti-K was performed using three kinds of methods;37oC albumin, an anti-human globulin phase tube, a bead cassette and a gel card. Three cases of anti-K also underwent PCR with a sequence specific primer (SSP) for Kell genotyping. For comparison, the KEL*1 allele (698C＞T) was synthesized by site-directed-mutagenesis.
Results: All 261 donors were KEL*2/KEL*2 homozygotes and a digested KEL*1 allele was not found. The three patients with anti-K were also KEL*2/KEL*2 homozygotes and the reactivities of the anti-K identification test were the same.
Conclusion: The KEL gene frequency for the KEL*1/KEL*2 allele corresponded with that of the Kell phenotype,as was previously reported. We experienced three cases of anti-K and two out of the three were assumed that they had been transfused with the K antigen-positive blood of foreigners. This study revealed that the possibility of anti-K alloimmunization and hemolytic transfusion reactions cannot be excluded in Koreans.

참고문헌 (Reference)

1 Song JW, "Unexpected crossmatch-incompatible results by Anti-D in intravenous immune globulin" 10 : 239-243, 1999

2 Daniels G, "The clinical significance of blood group antibodies" 12 : 287-295, 2002

3 Garratty G, "Terminology for blood group antigens and genes-historical origins and guidelines in the new millennium" 40 : 477-489, 2000

4 Brecher ME, "Technical manual. 15th ed" American Association of Blood Banks 773-774, 2005

5 Westhoff CM, "Review: the Kell, Duffy, and Kidd blood group systems" 20 : 37-49, 2004

6 Lee S, "Organization of the gene encoding the human Kell blood group protein" 85 : 1364-1370, 1995

7 Moise KJ Jr, "Non-anti-D antibodies in red-cell alloimmunization" 92 : 75-81, 2000

8 Marsh WL, "Naturally occurring anti-Kell stimulated by E. coli enterocolitis in a 20-day-old child" 18 : 149-154, 1978

9 Lee S, "Molecular basis of the Kell (K1) phenotype" 85 : 912-916, 1995

10 Savalonis JM, "Kell blood group activity of gram-negative bacteria" 28 : 229-232, 1988

11 Daniels GL, "Judd WJ; International Society of Blood Transfusion. Blood group terminology 2004: from the International Society of Blood Transfusion committee on terminology for red cell surface antigens" 87 : 304-316, 2004

12 Han KS, "Irregular blood group antibodies in Korean" 24 : 145-153, 1989

13 Cho HI, "History of blood management in Korea" 2009

14 Rozman P, "Differentiation of autologous ABO, RHD, RHCE, KEL, JK, and FY blood group genotypes by analysis of peripheral blood samples of patients who have recently received multiple transfusions" 40 : 936-942, 2000

15 Rios M, "DNA from urine sediment or buccal cells can be used for blood group molecular genotyping" 15 : 61-65, 1999

16 Abdelaal MA, "Blood group phenotype distribution in Saudi Arabs" 28 : 133-135, 1999

17 Issitt PD, "Applied blood group serology. 4th ed" Montgomery Scientific Publications 1998

18 Chae SL, "A study on the frequencies of U, Diegoa and Kell blood group antigens and anti-Dia and anti-K in Koreans" 23 : 183-188, 1988

19 Baek EJ, "A rare case of transfusion-related Anti-K alloantibodies" 19 : 250-254, 2008