Formaldehyde-related antibodies in hemodialysis patients

In a study of anti-N-like antibodies, we tested sera from 93 hemodialysis patients for hemagglutination reactions with untreated and formaldehyde-treated reagent red blood cells. Six of 22 sera from patients who had been dialyzed with formaldehyde-sterilized membranes had anti-N-like activity and 20 (91%) specifically agglutinated formaldehyde-treated red blood cells. Sera from 71 patients dialyzed with disposable membranes neither had anti-N-like activity nor agglutinated formaldehyde-treated red blood cells. The agglutination of formaldehyde-treated red blood cells by sera from hemodialysis patients was unrelated to MNU phenotypes and, therefore, identified a second serologic specificity, provisionally termed "anti-formaldehyde." "Anti-formaldehyde" was absorbed by and eluted from NN red blood cells as well as from formaldehyde-treated red blood cells regardless of MNU phenotype. All eluates and sera containing anti-N-like activity also agglutinated formaldehyde-treated red blood cells, typically after the addition of anti-human serum. These findings are consistent with the hypothesis that anti-N-like reactions of hemodialysis patients' sera represent cross reactions of formaldehyde related antibodies with N antigens of normal red blood cells.