Adverse Transfusion Reactions Associated with a Precipitating Anti‐C4 Antibody of Anti‐Rodgers Specificity¹

Abstract

A patient suffering from chronic hepatitis exhibited severe transfusion reactions after administration of fresh frozen plasma and a plasma fraction: PPSB (prothrombin complex concentrate). 1 month before these reactions, she received fresh frozen plasma during plasma exchange therapy. The patient's serum obtained 1 week and 6 months after the second reaction gave a precipitation arc against PPSB preparations when examined by double-diffusion technique in agarose gel. An antibody of IgG class present in these sera reacted with a purified preparation of the fourth complement component (C4). This was demonstrated by various experiments (protein A radioimmunoassay and passive hemagglutination) using purified C4 as antigen. The antibody had a limited specificity and reacted only with C4 of Rodgers specificity. Phenotype determination of the patient's C4 group showed that she was Chido positive and Rodgers negative. Her HLA group was A1, Aw30; B8,-; DR3,-. The patient had neither detectable anti-IgA nor other anti-immunoglobulin antibodies. She had not received blood or plasma transfusion before her hepatitis. The coexistence of a precipitating anti-C4 antibody and adverse transfusion reactions to plasma fractions containing large amounts of C4 indicates that in the absence of antibodies of other specificities, this antibody can be considered as the cause of the transfusion reaction.

Pulmonary Transfusion Reactions

“…For the majority of these reactions, the underlying pathomechanism is unclear. Although anti-Chido/Rodgers [62,63], antiIgA [31] and anti-haptoglobin antibodies [61] in the recipient have been associated with allergic/anaphylactic reactions, it appears that the vast majority of reactions is not related to these antibody entities [64,65]. Numerous substances released from white blood cells, including bioactive lipids and cytokines, may account for allergic/anaphylactic reactions [65], although a comparison of leukocyte depletion did not find differences with respect to allergic reactions [66,67].…”

Current Understanding of Allergic Transfusion Reactions: Incidence, Pathogenesis, Laboratory Tests, Prevention and Treatment

“…Therefore, Hp-deficiency and Hp antibodies should be considered among Eastern Asians, while IgA deficiency and IgA antibodies should be considered among Europeans, respectively, as the cause of transfusionrelated anaphylactic reactions. Although rare, anaphylactic shock after transfusions has been reported in complement C4-deficient (Lambin et al, 1984;Westhoff et al, 1992) and von Willebrand factordeficient (Bergamaschini et al, 1995) patients. Factor IX inhibitors in haemophilia B patients occasionally induce anaphylactic shock after Factor IX transfusions (Warrier & Lusher, 1998).…”

Appraisal of the Protein Composition of Prothrombin Complex Concentrates of Different Origins

“…This contaminant is certainly undesirable as an anaphylatoxin may be formed. A severe transfusion reaction has been observed after infusion of PPBS to a patient having a precipitating antibody against C4 with anti-Rodgers specificity [ 19], Two distinct antigenic deter minants, Chido and Rodgers, are associated with the C4d fragment of C4 [20]. The enrichment of this component in certain PCCs corresponding to a mixture of these 2 serum groups should be avoided.…”