Acute extravascular hemolytic transfusion reaction due to anti-Kpa antibody missed by electronic crossmatch

Padmore, Ruth; Berardi, Philip; Erickson, Kathy; Desjardins, Diana; Giulivi, Antonio; Tokessy, Melanie; Neurath, Doris; Saidenberg, Elianna

doi:10.1016/j.transci.2014.08.011

Cited by 6 publications

(4 citation statements)

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“…Concerning the role of immunohematological testing in detection of red cell alloantibody, Padmore et al have reported on the implication of anti-Kp a in causing an acute extravascular haemolytic reaction in a patient, where the antibody was missed by electronic cross-match [13]. Therefore, despite the nature of antibody, red cell antibody if detected in pre-transfusion testing and found to be reacting at 37…”

Section: Discussionmentioning

confidence: 99%

“…The frequency of Kp a antigen accounts for less than 2% of individuals globally and varies from 0 to 0Á01% in Asian ancestry [1,2]. Though the original report of anti-Kp a was naturally occurring [3], the later anti-Kp a reports were identified in patients who had a prior red cell sensitizing event [4][5][6][7][8][9][10][11][12][13][14][15]. Many Gram-negative intestinal flora is known to act as primary immune stimuli for the development of naturally occurring antibodies, and several authors have shown Escherichia coli infection to stimulate antibody production against K antigen of Kell blood group system [16][17][18].…”

Section: Introductionmentioning

confidence: 99%

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Naturally occurring anti‐Kp^a in an infant with recurrent bacterial infection: A case report and review of the literature

et al. 2021

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Naturally occurring anti-Kp a antibody is extremely rare and was first reported in 1957, named after the first producer 'Penney'. However, the subsequent anti-Kp a reports presented were all anti-Kp a due to isoimmunization. Individuals with severe bacterial infections particularly Gram-negative bacteria are known to be capable of producing cross-reactive antibodies against Kell blood group system. However, such uncommon antibodies like anti-Kp a can be easily missed in routine pre-transfusion testing unless the panel cells containing low incidence antigen are used for antibody screening. Here, we report a case of naturally occurring anti-Kp a antibody, identified incidentally during pre-transfusion testing of a 12-month-old female infant with the diagnosis of Niemann-Pick disease and recurrent bacterial (Escherichia coli) infection.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Naturally occurring anti‐Kp^a in an infant with recurrent bacterial infection: A case report and review of the literature

et al. 2021

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“…However, this technique cannot detect the warm, incomplete antibodies and complement. The risk of acute hemolytic transfusion reaction due to the missed antibody of low-frequency antigen has been estimated at 1 per 650,000crossmatchess using immediate spin or electronic crossmatch technology (11).…”

Section: Discussionmentioning

confidence: 99%

Acute Hemolytic Transfusion Reaction Due to Anti-c Rhesus Antibody in a Patient With Subdural Hematoma: A Case Report Emphasizing the Shortcoming of Spin Cross-Match

Niazkar

Ghorbani

Maleki

et al. 2020

ACTA

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The Rh blood group system is a complex blood group which includes different antigen specificities such as c antigen. Anti-c antibody is associated with both acute and delayed hemolytic transfusion reactions as well as hemolytic disease of the newborn (HDN). Rh mediated hemolytic transfusion reactions (HTR) are mostly immunoglobulin G (IgG) mediated and results in extravascular hemolysis and delayed HTR (DHTR). However, we are presenting a case of acute intravascular hemolytic transfusion reaction due to anti-c in a patient with acute subdural hematoma. A 77-year-old woman was referred to our hospital with a loss of conscious and left-sided hemiparesis. After an emergency MRI, she was diagnosed with Acute Subdural hematoma, and an emergency craniotomy was performed. Since Acute Subdural hematoma is a neurosurgery emergency, laboratory technician performed an Immediate-spincrossmatchedd for blood bag to preserve time. During the transfusion of the first packed cell, the patient developed severe hypotension and tachycardia. Thus, the transfusion was stopped. Laboratory results raised the suspicion of an Acute Intravascular Hemolysis. Antibody identification revealed that the patient had an irregular blood phenotype (C2+/c-/E-/e3+/K-), and the presence of alloantigen-c Rh antibody confirmed the suspicion of HTR. In patients with multi transfusion history and pregnant women, pre-transfusion screening of irregular antibodies must be performed. The immediate spincrossmatchh must be prevented in patients with a history of multi transfusions, even in emergency situations.

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“…Therefore, most commercially available screening kits do not contain Kp a -positive cells. Nonetheless, it is widely acknowledged that anti-Kp a antibody may cause severe HTR and HDFN [16,17,18,19,20,21,22]. Indeed, despite the infrequent occurrence, its investigation through Kp a -positive screening cell panels is undoubtedly worthy in clinical practice.…”

Section: Discussionmentioning

confidence: 99%

Red Cell Alloantibody Screening: Comparative Analysis of Three Different Technologies

Orlando¹,

Bianchi²,

Valentini³

et al. 2018

Transfus Med Hemother

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Background: The detection of irregular antibody is a critical issue in the management of red blood cell transfusion according to the Type & Screen (T&S) practice. In order to implement the T&S procedure at our blood bank, we compared three different automated analyzers based on column agglutination technique (CAT) or solid phase red cell adherence assay (SPACA) methods. Methods: Pre-transfusion antibody screening was performed in 986 patients candidate to elective surgery at low risk for red blood cell transfusion. We tested the following kits: the three-cell panel micro-CAT system ID-DiaCell I-II-III (DiaMed), the four-cell panel solid-phase system Capture-R Ready Screen-4 (Immucor), and the four-cell panel micro-CAT system Serascan Diana-4 (Grifols). Positive results were further investigated using corresponding identification panels, and discrepant results were investigated with all the antibody identification systems. Results: Among 986 samples, we observed 967 concordant negative results (98.1%), 8 concordant positive results (0.8% of cases), and 11 discrepant results (1.1%). Among discrepant samples, an alloantibody could been identified in two patents (anti-M, detected by Serascan Diana-4 and ID-DiaCell I, II, III; anti-Kp^a, detected by Capture-R Ready Screen-4 and Serascan Diana-4). Conclusion: Among the evaluated technologies, the four-cell panel micro-CAT system displayed the highest sensitivity and specificity with an optimal negative predictive value. These features might be relevant to the routine implementation of the T&S transfusion strategy.

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Acute extravascular hemolytic transfusion reaction due to anti-Kpa antibody missed by electronic crossmatch

Abstract: Acute extravascular hemolytic transfusion reaction may occur due to undetected anti-Kpa alloantibody. Various strategies for crossmatching are discussed in the context of antibodies to low incidence antigens.

Cited by 6 publications

References 10 publications

Naturally occurring anti‐Kp^a in an infant with recurrent bacterial infection: A case report and review of the literature

Naturally occurring anti‐Kp^a in an infant with recurrent bacterial infection: A case report and review of the literature

Acute Hemolytic Transfusion Reaction Due to Anti-c Rhesus Antibody in a Patient With Subdural Hematoma: A Case Report Emphasizing the Shortcoming of Spin Cross-Match

Red Cell Alloantibody Screening: Comparative Analysis of Three Different Technologies

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Acute extravascular hemolytic transfusion reaction due to anti-Kpa antibody missed by electronic crossmatch

Abstract: Acute extravascular hemolytic transfusion reaction may occur due to undetected anti-Kpa alloantibody. Various strategies for crossmatching are discussed in the context of antibodies to low incidence antigens.

Cited by 6 publications

References 10 publications

Naturally occurring anti‐Kpa in an infant with recurrent bacterial infection: A case report and review of the literature

Naturally occurring anti‐Kpa in an infant with recurrent bacterial infection: A case report and review of the literature

Acute Hemolytic Transfusion Reaction Due to Anti-c Rhesus Antibody in a Patient With Subdural Hematoma: A Case Report Emphasizing the Shortcoming of Spin Cross-Match

Red Cell Alloantibody Screening: Comparative Analysis of Three Different Technologies

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Naturally occurring anti‐Kp^a in an infant with recurrent bacterial infection: A case report and review of the literature

Naturally occurring anti‐Kp^a in an infant with recurrent bacterial infection: A case report and review of the literature