A Hemolytic Reaction Implicating Sd^a Antibody Missed by
Immediate Spin Crossmatch

Reznicek, Mary J.; Cordle, Delores. G.; Strauss, Ronald G.

doi:10.1159/000462193

Cited by 5 publications

(7 citation statements)

References 5 publications

(6 reference statements)

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“…Due to the generally low expression of SDa on RBC in most individuals, the rarity of CAD individuals and the low level and low‐temperature reactivity of anti‐SDa IgM, the SDa antigen, and antibody do not create a significant transfusion risk. Rare hemolytic reactions have been reported, however, in association with RBCs with high levels of SDa expression . This suggests that porcine ECs and organs expressing SDa (discussed below) may be at risk of early antibody‐mediated immune injury.…”

Section: The Sda Human Blood Groupmentioning

confidence: 99%

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B4GALNT2 and xenotransplantation: A newly appreciated xenogeneic antigen

Byrne

Ahmad-Villiers

et al. 2018

Xenotransplantation

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Analysis of non-Gal antibody induced after pig-to-baboon cardiac xenotransplantation identified the glycan produced by porcine beta-1,4-N-acetyl-galactosaminyltransferase 2 (B4GALNT2) as an immunogenic xenotransplantation antigen. The porcine B4GALNT2 enzyme is homologous to the human enzyme, which synthesizes the human SDa blood group antigen. Most humans produce low levels of anti-SDa IgM which polyagglutinates red blood cells from rare individuals with high levels of SDa expression. The SDa glycan is also present on GM2 gangliosides. Clinical GM2 vaccination studies for melanoma patients suggest that a human antibody response to SDa can be induced. Expression of porcine B4GALNT2 in human HEK293 cells results in increased binding of anti-SDa antibody, and increased binding of Dolichos biflorus agglutinin (DBA) a lectin commonly used to detect SDa. In pigs, B4GALNT2 is expressed by vascular endothelial cells and endothelial cells from a wide variety of pig backgrounds stain with DBA suggesting that porcine vascular expression of B4GALNT2 is not polymorphic. Mutations in B4GALNT2 have been engineered in mice and pigs. In both species, the B4GALNT2-KO animals are apparently normal and no longer show evidence of SDa antigen expression. Pig tissues with a mutation in B4GALNT2, added to a background of alpha-1,3-galactosyltransferase deficient (GGTA1-KO) and cytidine monophosphate-N-acetylneuraminic acid hydroxylase deficient (CMAH-KO), show reduced antibody binding, confirming the presence of B4GALNT2 dependent antibodies in both humans and nonhuman primates. Preclinical xenotransplantation using B4GALNT2 deficient donors has recently been reported. Elimination of this source of immunogenic pig antigen should minimize acute injury by preformed anti-pig antibody and eliminate an induced clinical immune response to this newly appreciated xenotransplantation antigen.

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Section: The Sda Human Blood Groupmentioning

confidence: 99%

“…Clear evidence supporting the classification of SDa as a high-frequency polyagglutinable antigen 28 SDa expression. 32,33 This suggests that porcine ECs and organs expressing SDa (discussed below) may be at risk of early antibodymediated immune injury.…”

Section: The S Da H Uman B Lood G Roupmentioning

confidence: 99%

B4GALNT2 and xenotransplantation: A newly appreciated xenogeneic antigen

Byrne

Ahmad-Villiers

et al. 2018

Xenotransplantation

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“…There are a considerable number of reports of hemolytic transfusion reactions caused by antibodies that were not detected by antibody screen or by IS-XM, but that would have been detected by IAT-XM. [5][6][7][8] Even though those antibodies mainly are cold-reactive or are against low-incidence antigens, the odds of encountering them increase in patients who are immunologic responders and consequently prone to RBC alloimmunization. 9 Indeed, the decision to eliminate IAT-XM is associated with a risk of hemolytic transfusion reactions of 1:2000 transfused units, 10 which is a significant value, especially in large transfusion laboratories.…”

Section: Discussionmentioning

confidence: 99%

Indirect antiglobulin test-crossmatch using low-ionic-strength saline–albumin enhancement medium and reduced incubation time: effectiveness in the detection of most clinically significant antibodies and impact on blood utilization

Dinardo¹,

Bonifácio²,

Mendrone

2014

Immunohematology

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Indirectantiglobulin test-crossmatch (IAT-XM) using enhancement media such as low-ionic-strength saline (LISS) and polyethylene glycol (PEG) usually requires 15 minutes of incubation. These methods are necessary when testing samples from blood recipients who have a higher risk of alloimmunization. In emergency situations, IAT-XM can be time-consuming and can influence presurgery routine, resulting in more red blood cell (RBC) units being tested and stored to avoid the transfusion of uncrossmatched ones. The objective of this study was to evaluate the performance of a LISS-albumin enhancer to intensify antigen-antibody reaction after 5 minutes of 37°C incubation and compare this performance with that of other enhancers, gel, and conventional tube testing. Second, the study evaluated the impact of this method's implementation in the C:T ratio (crossmatched to transfused RBC units) of a transfusion laboratory. Ninety serum samples containing alloantibodies of potential clinical significance were tested against phenotyped RBCs using four different methods: (1) tube with LISS-albumin enhancer (5 minutes of incubation), (2) tube with LISS-albumin and PEG (15 minutes of incubation), (3) gel, and (4) conventional tube method (60 minutes of incubation). In parallel, the study compared the C:T ratio of a tertiary-hospital transfusion laboratory in two different periods: 3 months before and 3 months after the implementation of the 5-minute IAT-XM protocol. The use of LISS-albumin with 5 minutes of incubation exhibited the same performance as LISS-albumin, PEG, and gel with 15 minutes of incubation. Conventional tube method results were equally comparable, but reactions were significantly less intense, except for anti-c (p = 0.406). Accuracy was 100 percent for all selected methods. After the implementation of the 5-minute IAT-XM protocol, the C:T ratio fell from 2.74 to 1.29 (p < 0.001). IAT-XM can have its incubation time reduced to 5 minutes with the use of LISS-albumin enhancement. We suggest this strategy should be used to quickly prepare RBC units for surgical patients, keeping transfusion safety without compromising blood supplies.

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“…Most survival studies with 51 Cr -labelled cells in patients with anti -Sd a have shown insignifi cant reduction in red cell survival, even when Sd(a ++ ) cells were used [24,25] . A couple of HTRs, allegedly caused by transfusion of Sd(a ++ ) cells to a patient with IgM anti -Sd a , are reported [24,25] .…”

Section: Anti-sd Amentioning

confidence: 99%