The relation between polyagglutinability of erythrocytes in vivo and the Hübener-Thomsen-Friedenreich phenomenon.

Hubener (1925) and Thomsen (1927a and b, 1928) were the first to report that erythrocytes from old blood samples might sometimes be agglutinated by sera irrespective of their blood groups; in other words, they become panagglutinable. Friedenreich (1930) demonstrated that this phenomenon, which may be a cause of error in blood grouping, was due to contamination of the blood with certain enzymeproducing bacteria which cause a new agglutinogen, " T," to appear at the red cell surface and it reacts with an agglutinin " T " present in all adult sera; it is apparently absent in newborn sera. The transformation process is generally known as the Hubener-Thomsen-Friedenreich phenomenon. The T antibody is a specific cold agglutinin which is adsorbed by " changed" cells only. It exists apart from the other known specific antibodies. Friedenreich (1930) isolated two coryneform bacteria, " M " and " J," from old blood samples. Panagglutinability was induced either by direct inoculation of blood or with culture filtrates of these bacteria. Friedenreich also found that an enzyme with a similar action was produced by some strains of Vibrio, including Vibrio cholerae, and also by a strain of the Coccobacillus pierantonii. Other bacteria were added by later investigators, e.g., some strains of actinomycetes, especially among the acid-forming groups (von Magnus, 1936), a Gram-positive coccus (Terada, 1936), a Gramnegative coccobacillus (Kossovitch and Chabaud, 1938), a corynebacterium similar to the Orla-Jensen type, the Corynebacterium H (Hektoenii) (Davidson and Toharsky, 1940, 1942), and Cl. welchii, Vibrio proteus, pneumococci of all types, and some species of streptococci and staphylococci (Chu, 1948). Viruses of the mumps-influenza group are also capable of forming a T antigen (Burnet, McCrea, and Stone, 1946; Stone, 1947; Chu and Coombs, 1947) and, finally, the same effect results from treatment with snake venom (Briody, unpublished data), potassium periodate (Stewart, 1949; Moskowitz and Treffers, 1950), and also with trypsin under certain conditions (Rosenthal and Schwartz, 1951). A similar phenomenon occurring in vivo has been less frequently observed. This is polyagglutinability of the red cells. Twelve well-documented cases have been described in the literature (Table I). In none of them was there convincing evidence that bacterial infection caused the polyagglutinability in vivo. A further case, in which an organism was isolated from the urine of the patient which was able to render red blood cells panagglutinable in vitro, is described in this paper.