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Red cells of the McLeod phenotype in the Kell blood group system have an acanthocytic morphology. The membrane protein composition analyzed on sodium dodecyl-sulfate-polyacrylamide gel electrophoresis, the ATP level and the activities of a large number of intracellular enzymes appear to be normal. Membranes prepared from McLeod red cells incubated with gamma AT[32P] and MgCl2 incorporated twice as much radioactivity into spectrin and also showed a slight elevation of phosphorylation in band 3 protein when compared to membranes from normal cells. Intact normal red cells incubated with carrier-free [32P] incorporated radioactivity into several proteins, with most incorporation in spectrin and band 3 protein. In comparison, McLeod cells incorporated three times more radioactivity into spectrin and band 3 protein but increased phosphorylation also occurred in other, but not all, membrane proteins. Intact McLeod red cells also showed increased phosphorylation of membrane phospholipids, but they incorporated [32P] into intracellular nucleotide phosphates in a normal manner.

A patient with Hodgkin's disease became temporarily Wj-negative with alloanti-Wj in his serum. Four human autoantibodies, and 1 of 2 murine monoclonal antibodies, with serological characteristics of anti-Wj were nonreactive with his red cells, confirming that they have anti-Wj specificity. Six siblings of the patient are all Wj-positive. The patient was also temporarily Anton-negative, and cross-testing between Wj and Anton red cells and antisera showed mutual compatibility, indicating that the antigens are the same. The patient and 3 of his 6 siblings are also of the rare Lu: - 13 phenotype, providing the first evidence that this is an inherited characteristic.

An example of auto-anti-Kpb in a Kp(a+b-) patient is described. The antibody present in the patient's serum and in eluates from her red cells was IgG. It did not bind complement, and did not cause in vivo hemolysis. 9 months after recognition of the autoimmune state the direct antiglobulin test had become negative and anti-Kpb was no longer detectable. It is postulated that autoimmunity involving the Kell blood group may be precipitated by antigens or enzymes of microbial origin.

Leukocyte-platelet concentrates prepared from blood of Gerbich (Ge) positive donors possess the capability of absorbing anti-Ge. Leukocytes from Ge-negative donors do not absorb the antibody, thus confirming the Ge antigen specificity. Tests with separated leukocyte types suggest that the Ge antigen is present on neutrophils and possibly monocytes, but absent from lymphocytes and platelets.

Leukocytes of nine unrelated boys with X-linked chronic granulomatous disease lack Kx antigen. In three of these cases, the red cells also lack Kx and have the McLeod phenotype and abnormal morphology. X-linked chronic granulomatous disease CGD can thus be separated into two types. Type I cases have an antigenic deficiency that is restricted to the phagocytic leukocytes while in type II, the deficiency involves both leukocytes and red cells. Red cells of type II CGD patients have enhanced i antigen activity suggesting that they are under hemopoietic stress. Normal Kx synthesis is directed by an X-linked gene named X1k. Three variants, X2k, X3k, and X4k order the different permutations of leukocyte and red cell Kx antigen production that have been recognized.

McLeod phenotype red cells of the Kell blood group system have acanthocytic morphology and reduced in vivo survival. The phenotype has an X-linked mode of inheritance and is found in some males who have no abnormality of leukocyte function and in some who have X-linked chronic granulomatous disease (CGD). We now describe an association between the McLeod phenotype and an abnormal elevation of serum creatine phosphokinase (CPK). The increase is of the MM isoenzyme type, derived from skeletal muscle or cardiac muscle, and muscle biopsy shows evidence of muscle cell changes. All of 11 males who have McLeod syndrome but do not have CGD have high levels of serum CPK. Males with McLeod syndrome and CGD may have normal or high levels of the enzyme. Individuals with other variant phenotypes in the Kell system have normal levels of serum CPK. Studies on a large kindred, which includes 5 people of McLeod phenotype, show high CPK levels only in the members of McLeod type. We conclude that the high level of CPK in the serum of these people is a reflection of a muscle cell anomaly and that in these individuals it is a pleiotropic effect of the X-linked gene that produces the McLeod red cell phenotype.

Anti-Sdx is an IgM complement-binding autoantibody that defines a red cell antigen which is independent of I, i, Sp1 (Pr) and Gd. Hemagglutination by the antibody is unusually sensitive to variation in pH, salt, or other charged molecular species. The antibody is inhibited by urine from Sd(a+) persons, but inhibition is a nonspecific effect caused by charged molecules. No specific Sdx substance could be demonstrated, and Sdx antigen does not appear to be directly associated with the Sid blood group. In view of these findings we propose that this antibody should be renamed anti-Rx.

Serological studies on a patient whose red cells are polyagglutinable due to T activation have demonstrated concomitant T activity of the separated leukocytes and platelets. Normal leukocytes and platelets are not T active, but activation can be induced in vitro by treatment with neuraminidase or with pneumococcus type III filtrate. Such T-active cells absorb anti-T from Arachis hypogea lectin. Tests on idfferent types of separated leukocytes show that both neutrophils and lymphocytes have latent T antigen receptors. Neuraminidase treatment of platelets does not change their ability to promote clot retraction, to aggregate with ADP, or to take up serotonin.

A case of auto-immune hemolytic anemia caused by auto anti-K13 is described. Direct antiglobulin tests using monospecific reagents showed that IgG and the C3 component of complement were present on the patient's red cells. Eluted auto-antibody did not react with Ko or with K:--13 cells. Kell blood group antigenicity of the patient's red cells did not appear to be reduced.

A 'new' Lutheran-related antibody, named anti-Lu14, reacts with approximately 2.4% of random bloods. Red cells of the rare Lu:-8 phenotype are Lu:14. The data indicate, with a high probability, that the Lu 14 antigen is a product of an allele of Lu8 and that Lu14 and Lu8 comprise a third pair of alleles at the Lutheran locus. Red cells of the original Sw (a+) propositus are Lu:14. By coincidence, he has inherited two low-incidence genes. This observation may explain the discrepancy in different families concerning a possible relationship between Swa and Lutheran. Pedigree information now suggests that Swa is not a Lutheran gene.

A new antibody, designated anti-K18, reacts with a high frequency red cell antigen that is related to the Kell blood group system. All of more than 2,000 bloods were K:18 but K-0 phenotype red cells are K:-18.