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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 crossreactions of formaldehyde related antibodies with N antigens of normal red blood cells.