TRANSFUSION 198%Vol. 29. No. 6 LElTERS TO THE EDITOR 559

TABLE 1. HBV markers and anti-pre-S2 in 46 Italian hemophiliacs

HBV serology

HBsAg+ HBsAg-neg HBsAg-neg HBsAg-neg anti-HBc+ anti-HBc-neg anti-HBc+ anti-HBc-neg

anti-HBs+ anti-HBs-neg anti-HBs-neg anti-HBsS

Number of cases 4 6 20 16 Anti-pre-SP positive 0 4(66%) 1 0 (50%) 5 (31 ‘10)

These findings suggest that a significant proportion of hemo- philiacs have experience of HBV-2 infection, probably as a consequence of parenteral exposure to commercial blood deriv- atives.

GIUSEPPE TAGARIELLO, MD AGOSTINO TRALDI, MD

Servizio di Irnrnunoernatologia e Trasfusionule Centro Anti-ernofdico E . Tosatti,

Castelfranco Veneto e Montebelluna Treviso, Italy

DANIELA CAVALLETTO, MD PATRIVA PONTISSO, MD ALFREDO ALBERTI, MD

Instituto di Medicinu Clinica Clinica Medica II

Universita di Padova Padua, Italy

References Coursaget P, Yvonnet B, Bourdil C, et al. HBsAg positive reactivity in man not due to hepatitis B virus. Lancet 1987;2: 1354-8. Budkowska A, Dubreuil P, Ouattara A, et al. Hepatitis B virus type 2. Lancet 1988;1:990. Budkowska A, Dubreuil P, Ouattara A, Pillot A. Anti-pre S2 as only marker: possible relation to HBV, infection. Lancet 1988;1:656. Wu JS, KO YC, Liu WT. Hepatitis B virus type 2. Lancet 1988; 1:990.

Hydrocortisone-associated hemagglutination in a pregnant woman

To the Editor: The serum of a 32-year-old white woman, in her first month of

pregnancy, was found to agglutinate any red cell sample sus- pended in the diluent of one manufacturer (Ortho Diagnostics, Raritan, NJ) but not washed, saline-suspended cells or cells suspended in the diluent of a different manufacturer (Biotest, GmbH, Frankfurt, FRG). The agglutinin, which had no blood group specificity, was denatured by 2-mercaptoethanol and by heating at 56”C, and therefore was presumably IgM in nature. Tests on red cells suspended in solutions of individual con- stituents of the diluent showed that hydrocortisone, but not neomycin, gentamycin, chloramphenicol, or sodium caprylate, supported agglutination. Inhibition tests confirmed the anti- hydrocortisone (anti-steroid factor[sJ) specificity. The patient had never been treated with steroids, so that the antibody appeared to be physiologic in nature. To our knowledge, hydrocortisone-supported agglutination has only occasionally been reported previously. ‘7 ’

P. P. PAGLIARO, MD G. VENERONI, MD

Ospedale Fatebenefratelli ed Oftalrnico Milan, Italy

References I . Pinto M, Rimon A. Anti-steroid factor@) in normal and pathological

2. Mann JM. Hydrocortisone-associated hemagglutination property of human sera. Vox Sang 1970; 18: 155-62.

human sera (abstract). Transfusion 1973; I3:346.

False positive reactions with chemically modified anti-D To the Editor:

In their recent paper Judd et al. ’ asked some questions about our paper on chemically modified anti-D.* In answer to those questions: 1 . The ABO and Rh typings were performed at the same time using a tube technique in accordance with the manufacturer’s instructions. 2. The false positive reactions were with unwashed cells. As stated the agglutination was not seen or was weaker when washed red cells were used.

Although Judd et al’ did not agree with our recommendations, we find that they confirm our findings with chemically modified anti-D and report a false positive rate of 0.9%. They also agree with our finding that ABO grouping tests are not an adequate control for tests with chemically modified anti-D. The current move to monoclonal ABO typing reagents underscores this point. They disagree with our recommendation of an Rh control and feel that a mistake in D typing can be avoided by:

1. Reliance on previous records. While there is no doubt about the value of records, first-time patients have none.

2. Investigating any reaction that is not “greater than 2+ .” We cannot accept this suggestion because:

a It is not in accord with the manufacturer’s instruc- tions. No claims are made that reactions will be stronger than 2+. Instead it is stated that any macro- scopically visible agglutination indicates a positive result.

b It would necessitate many additional investigations and cause delays in results being available (20% of tests in one of our laboratories). This would com- pletely negate any cost benefit.

c It would cause difficulties in interpretation because the difference between Rh positive and Rh negative would be based on the difference between “a number of large agglutinates” and “one or two large aggl~tinates.”~ We believe that this also would prompt additional investigations since typings close to 2+ would be investigated to avoid mistakes.

In short we cannot accept that the many investigations

MARGARET SINCLAIR, FCSLT Vancouver Red Cross

4750 Oak Street Vancouver, B.C. V6H 2N9

Canada

proposed by Judd et al. would result in a cost benefit.