ABSTRACTS
Review: phenotyping for
Lewis and secretor histo-blood group antigens
S.M. Henry
Anti-Holley detected
in a primary immune response
V.J. Barrett, M.M. O'Brien, J.J. Moulds, P. Spruell, V. Jackson, and J.R. Stubbs
The second example of Lu:-7 phenotype: serology and
immunochemical studies
M.E. Reid, J. Hoffer, R. Øyen, E. Tossas, M. Sadjadi, and G. Messina
A new form of
polyagglutination related to Cad
R. Leger, E. Lines, K. Cunningham, and G. Garratty
A
review: transfusion reactions
C. Litty
Severe
intravascular hemolysis due to autoantibodies stimulated by blood transfusion
D. Chan, G.D. Poole, M. Binney, M.D. Hamon, J.A. Copplestone, and A.G. Prentice
Leukocyte
reduction of red cells when transfusing patients with autoimmune hemolytic anemia: a
strategy to decrease the incidence of confounding transfusion reactions
J.A. Lumadue, R.S. Shirey, T.S. Kickler, and P.M. Ness
Transfusion-associated
circulatory overload in orthopedic surgery patients: a multi-institutional study
M.A. Popovsky, A.M. Audet, and C. Andrzejewski, Jr.
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V.J. BARRETT, M.M. O'BRIEN, J.J. MOULDS, P. SPRUELL
V. JACKSON, AND J.R. STUBBS
Anti-Holley (Hy) has been reported as an IgG antibody occurring in
previously transfused or multiparous black patients. In this case anti-Hy was identified
in a 16-year-old black, primigravida female admitted at 32 weeks gestation because of
premature rupture of the membranes. On admission, her blood type was determined to be A2B, D-positive and an antibody screen was negative. A second
antibody screen, performed 4 days later, was positive in all three cells. Anti-Hy was
subsequently identified. The antibody was reactive at room temperature, 37oC, and in the antiglobulin phase. IgG and IgM components of anti-Hy
were demonstrated in the maternal serum documenting a primary immune response. This
resulted in serologic findings not previously described for anti-Hy. A direct antiglobulin
test on the newborn red cells was negative and there was no clinical evidence of hemolytic
disease of the newborn (HDN). A monocyte monolayer assay performed with maternal serum
yielded negative results. Recent scientific information has resulted in the placement of
Hy in the Dombrock blood group system. Alloantibodies to Dombrock system antigens have not
been associated with severe HDN. Immunohematology 1996;12:2
Vicki J. Barrett, MS, MT(ASCP)SBB, Assistant Professor and Clinical
Director, University of South Alabama, Department of Medical Technology, 1504 Springhill
Avenue, Room 2309, Mobile, AL 36604-3273 (reprint requests); M. Margaret O'Brien, MD,
Department of Pathology, University of South Alabama Medical Center, Mobile, AL; John J
Moulds, MT(ASCP)SBB, President and Chief Operations Officer, Gamma Biologicals, Inc.,
Houston, TX; Peggy Spruell, MT(ASCP)SBB, Consultation and Education, Gamma Biologicals,
Inc.; Valerie Jackson, MT(ASCP)SBB, Assistant Director, Reference and Consultation,
American Red Cross Blood Services, Gulf Coast Region, Mobile, AL; James R. Stubbs, MD,
Director, Transfusion Service, Department of Pathology, University of South Alabama
Medical Center, Mobile, AL.
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D. CHAN, G.D. POOLE, M. BINNEY, M.D. HAMON,
J.A. COPPLESTONE, AND A.G. PRENTICE
Autoantibodies may cause severe hemolytic anemia but only rarely are they
the cause of a hemolytic transfusion reaction due to the destruction of transfused
allogeneic blood. In two patients, autoantibody was detected shortly after blood
transfusion. The first case was a D-negative patient who produced an auto anti-Ce and
subsequently developed hemoglobinuria and hyperbilirubinemia. The second case was a
patient who developed an autoanti-Wrb that caused severe
hemolysis that resulted in death. Immunohematology 1996;12:2
Dr. D. Chan, MRCP, MRCPath, National Blood Service, South West,
Southmead Road, Bristol BS10 5ND, UK; Mr. G.D. Poole, Bsc, Msc, FIBMS, and Mr. B.
Ainsworth, FIBMS, National Blood Service, Southwest, Bristol, UK; Mr. M. Binney, FIBMS,
Dr. M.D. Hamon, MRCP, MRCPath, Dr. J.A. Copplestone, MRCP, MRCPath, and Dr. A.G. Prentice,
FRCP, FRCPath, Department of Haematology, Derriford Hospital, Plymouth, UK.
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S. HENRY
This review covers the basics of Lewis antigens
and their associated phenotypes, and discusses present problems in serology and future
prospects. It briefly examines the molecular basis for the antigens and presents the
potential biologic significance of Lewis antigens in fields other than transfusion
medicine. For more comprehensive reviews on the Lewis histo-(tissue-cell) blood group
system and associated secretory phenotypes the reader is referred elsewhere.
Steven M. Henry, PhD, Dr Med Sc, Research Fellow, Department of
Clinical Chemistry and Transfusion Medicine, G÷teborg University, S-413 45, G÷teborg,
Sweden.
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R. LEGER, E. LINES, K. CUNNINGHAM, AND G. GARRATTY
Four phenotypes of Cad (Cad 1-4) have been characterized by a continuum of
polyagglutinability and reactivity with lectins, the strongest Cad+ red blood cells (RBCs)
being polyagglutinable because of the presence of anti-Cad (anti-Sda)
in most normal sera. Over a period of 7 years, a French male blood donor demonstrated
polyagglutinability with 50 percent to 70 percent of normal adult sera. The reactivity was
characteristic of anti-Sda (refractile agglutination at
4¦C, 20¦C, 37¦C, and anti-human globulin test), and was inhibitable by two examples of
Sd(a+) urine, but not by Sd(a-) urine or dialysate from Sd(a+) urine. The donor's RBCs
reacted 1+ with Glycine max, but did not react with Dolichos biflorus, Leonurus
cardiaca, Salvia horminum, or Arachis hypogaea. The first four of these lectins
were reactive with five of five Cad+ RBCs, including one example of Cad 4 RBCs.
Polybrene« aggregated the donor RBCs. Dilutions of nine samples of anti-Sda reacted more strongly with the donor RBCs than with normal RBCs.
Even though lectin studies failed to classify this donor's RBCs as Cad, the persistent
polyagglutinability and serologic characteristics are consistent with Cad and demonstrate
the heterogeneity of this antigen. Immunohematology 1996;12:2
Regina M Leger, BA, MT(ASCP)SBB, Research Associate, American Red Cross
Blood Services, Southern California Region, 1130 South Vermont Avenue, Los Angeles,
California; Elfreda J. Lines, FIBMS, Senior of Blood Transfusion, and Keith Cunningham,
MB, BS, FRCPath, Director of Laboratories and Blood Bank, King Edward VII Memorial
Hospital, Paget, Bermuda; George Garratty, PhD, FRCPath, Scientific Director, American Red
Cross Blood Services, Southern California Region, Los Angeles, California.
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C. LITTY
Generally, transfusion of blood components is a
safe and often life-saving procedure. However, there are instances when transfusion can
lead to an adverse outcome and even death. These fatalities may result from
"transfusion reactions," the transmission of infectious agents that lead to, for
example, acquired immunodeficiency syndrome (AIDS), hepatitis, or disease states induced
by transfusion in susceptible persons, such as posttransfusion purpura (PTP) or iron
overload.
This article limits this discussion to those events commonly
referred to as transfusion reactions, specifically, hemolysis, acute and delayed; febrile
reactions; anaphylaxis; sepsis; acute lung injury; transfusion-associated
graft-versus-host disease; and transfusion-associated circulatory overload. For further
discussion of transfusion-transmitted infectious disease, PTP, and iron overload, the
reader is referred to the transfusion medicine literature.
Cathy Litty, MD, Assistant Medical Director, American Red Cross Blood
Services, Musser Blood Center, 700 Spring Garden Street, Philadelphia, PA 19123.
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J.A. LUMADUE, R.S. SHIREY, T.S. KICKLER, AND P.M. NESS
Autoimmune hemolytic anemia (AIHA) presents a difficult challenge to
clinicians and blood bankers alike. Autoantibodies in the serum significantly complicate
serologic evaluation, and necessitate performing procedures such as adsorptions to
eliminate the possibility of underlying alloantibodies. In many instances the blood that
is issued may be phenotypically similar but remains crossmatch incompatible, generating a
considerable degree of anxiety among the clinical staff who are responsible for
transfusing the patient. We report a case of warm autoimmune hemolytic anemia (WAIHA) in
which the transfusion of red cells was complicated by a febrile transfusion reaction.
Evaluation of the reaction resulted in a significant delay in transfusion therapy.
Subsequent administration of leukocyte-poor red cells resulted in uneventful transfusions
with a good therapeutic response. Serum analysis of the pretransfusion sample demonstrated
significant levels of anti-neutrophil antibodies. This case resulted in the establishment
of our policy to administer all red cell transfusions to patients with autoantibodies
(warm or cold) as leukocyte-poor red cells. Immunohematology 1996;12:2
Jeanne A. Lumadue, MD,PhD, Clinical Fellow, Department of Pathology,
Division of Transfusion Medicine, The Johns Hopkins Hospital, 600 N. Wolfe Street,
Baltimore, MD 21287; Rosetta Sue Shirey, MS,MT(ASCP)SBB, Technical Specialist, Division of
Transfusion Medicine, The Johns Hopkins Hospital, Baltimore, MD; Thomas S. Kickler, MD,
Associate Director, Division of Transfusion Medicine, The Johns Hopkins Hospital,
Baltimore, MD; Paul M. Ness, MD, Director, Division of Transfusion Medicine, The Johns
Hopkins Hospital, Baltimore, MD.
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M.A. POPOVSKY, A.M. AUDET, AND C.ANDRZEJEWSKI, Jr.
Although recognized as a serious complication of hemotherapy, few data are
available on the incidence of transfusion-associated circulatory overload (TACO). Detailed
demographic and clinical information was obtained from records of 382 Medicare patients at
five Massachusetts hospitals undergoing total hip or knee replacements (and receiving
transfusions) from January 1992 to December 1993. Seventy-eight percent of the patients
were women with a mean age of 77 years. Thirty-two percent had co-morbidities including
myocardial or coronary disease. Transfusion-related complications and co-morbidities were
identified and reviewed by transfusion experts. Patients were excluded from consideration
if non-transfusion factors such as myocardial disease could have contributed to the
development of acute pulmonary edema. Four (3 females, 1 male) patients [1.05%] developed
TACO post-operatively. Mean age of these patients was 84 years (range, 75-101) versus 77
years for non-TACO. The mean intraoperative estimated blood loss was 375 mL. Each patient
received only 1-2 units of red blood cells prior to onset of TACO and in two cases only
autologous blood was used. The mean positive fluid balance was 2,480 mL. The mean
pretransfusion hematocrit prior to circulatory overload (CO) was 26.0 percent. Symptoms
were reversed with diuretics. Length of stay was significantly prolonged by these
incidents. TACO is a frequent and serious event in an orthopedic surgical setting. It is
associated with advanced age, increased health care costs, and may occur in the setting of
modest transfusion volumes. The utilization of conservative transfusion criteria and fluid
management in the perioperative setting may decrease the incidence of this complication in
this population. Immunohematology 1996;12:2
Mark A. Popovsky, MD, Chief Medical Officer, American Red Cross Blood
Services, New England Region, 180 Rustcraft Road, Dedham, MA 02026, and Adjunct Clinical
Professor of Pathology & Laboratory Medicine, Boston University Hospital Medical
Center, Boston, MA; Anne-Marie Audet, MD, MSc, FACP, Massachusetts Peer Review
Organization, Inc., Waltham, MA; Chester Andrzejewski, Jr., PhD, MD, Department of
Pathology, Baystate Medical Center, Springfield, MA, and Tufts University School of
Medicine, Boston, MA.
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J.A. LUMADUE, R.S. SHIREY, T.S. KICKLER, AND P.M. NESS
Autoimmune hemolytic anemia (AIHA) presents a difficult challenge to
clinicians and blood bankers alike. Autoantibodies in the serum significantly complicate
serologic evaluation, and necessitate performing procedures such as adsorptions to
eliminate the possibility of underlying alloantibodies. In many instances the blood that
is issued may be phenotypically similar but remains crossmatch incompatible, generating a
considerable degree of anxiety among the clinical staff who are responsible for
transfusing the patient. We report a case of warm autoimmune hemolytic anemia (WAIHA) in
which the transfusion of red cells was complicated by a febrile transfusion reaction.
Evaluation of the reaction resulted in a significant delay in transfusion therapy.
Subsequent administration of leukocyte-poor red cells resulted in uneventful transfusions
with a good therapeutic response. Serum analysis of the pretransfusion sample demonstrated
significant levels of anti-neutrophil antibodies. This case resulted in the establishment
of our policy to administer all red cell transfusions to patients with autoantibodies
(warm or cold) as leukocyte-poor red cells. Immunohematology 1996;12:2
Shirey, MS,MT(ASCP)SBB, Technical Specialist, Division of Transfusion
Medicine, The Johns Hopkins Hospital, Baltimore, MD; Thomas S. Kickler, MD, Associate
Director, Division of Transfusion Medicine, The Johns Hopkins Hospital, Baltimore, MD;
Paul M. Ness, MD, Director, Division of Transfusion Medicine, The Johns Hopkins Hospital,
Baltimore, MD.
