‘Chameleonic' Serological Findings Leading to Life-Threatening Hemolytic Transfusion Reactions

Introduction: Uncrossmatched ABO-compatible red blood cells (RBCs) are generally recommended in patients with life-threatening massive bleeding. There is little data regarding RBC transfusion when patients are transfused against clinically significant alloantibodies because compatible RBCs are not immediately available. Methods/Patients: All patients reviewed in this study (n = 6,109) required emergency blood transfusion and were treated at the Charité – Universitätsmedizin Berlin between 2001 and 2015. Primary uncrossmatched O Rh(D)-positive or -negative RBC units were immediately transfused prior to complete regulatory serological testing including determination of ABO group, Rhesus antigens, antibody screening, and crossmatching. Results: Without any significant change in the protocol of emergency transfusion of RBCs, a total of 63,373 RBC units were transfused in 6,109 patients. Antibody screening was positive in 413 patients (6.8%), and 19 of these patients received RBC units against clinically significant alloantibodies. None of these patients appeared to have developed significant hemolysis, and only one patient with anti-D seems to have developed signs of insignificant hemolysis following the transfusion of three Rh(D)-positive units. One patient who had anti-Jka received unselected units and did not develop a hemolytic transfusion reaction. Conclusion: Transfusion of uncrossmatched ABO-compatible RBCs against alloantibodies is highly safe in patients with life-threatening hemorrhage.

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“…The remaining 4 patients received blood transfusion against alloantibodies which usually do not cause HTR (patient Nos. 3,4,5,18).…”

Section: Resultsmentioning

confidence: 99%

Safety of Uncrossmatched ABO-Compatible RBCs in Alloimmunized Patients with Bleeding: Data from Two Decades: Results of a Systematic Analysis in 6,109 Patients

Ringel

Schoenfeld

Bali

et al. 2021

Transfus Med Hemother

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“…Serological testing of red blood cells (RBCs) was performed in all patients using the standard gel technique. The presence of "true" RBC autoantibodies was confirmed by testing the eluate of patients' RBCs [8]. The concentrations of IgG, IgA, and IgM were measured in 160 patients using rate nephelometry (Beckman Coulter, Krefeld, Germany) and ELISA (IMTEC Immundiagnostika, Berlin, Germany).…”

Section: Methodsmentioning

confidence: 99%

Is Autoimmune Thrombocytopenia Itself the Primary Disease in the Presence of Second Diseases Data from a Long-Term Observation

Aboud

Depré

Salama

2016

Transfus Med Hemother

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Background: Dependent on the absence or presence of associated diseases, autoimmune thrombocytopenia (ITP) can be classified as primary or secondary form. The manifestation of the associated diseases is not temporally defined and may occur during observation. Thus the question which disease is the primary one remains unanswered. Methods: All 386 patients included in this study were treated by a single primary physician between 1996 and 2015 at the Charité Berlin and met current ITP criteria. Medical records and investigations were reviewed to assess diseases associated with ITP. Results: Initially, the vast majority of patients presented with primary ITP (isolated disease). Based on our findings, ITP was found to be associated with other abnormalities in most cases. These abnormalities included: positive direct antiglobulin test in 49 of 386 tested patients (13%), affections of the thyroid gland in 41 of 386 tested patients (11%), infections in 30 (8%), solid malignancies in 20 (5%) and hematological malignancies in 10 patients (3%), as well as many other miscellaneous diseases. Moreover, of 160 patients who did not receive prior intravenous immunoglobulin treatment, 40 (25%) showed antibody deficiency. Conclusion: In conclusion, the incidence of ‘true' ITP as a primary disease is less common than has yet been suggested. Additionally, there is evidence that ITP itself predispose affected subjects toward development of other diseases.

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“…There is no agreement on the transfusion policy, whether to ignore or respect the autoantibody specificity. Some authors recommend ignoring the specificity of the autoantibody and this indication has been demonstrated to be safe and effective [9][10][11].…”

Section: Editorialmentioning

confidence: 99%

The clinical dilemma and management of red cell autoantibodies

Barcellini

2016

Expert Review of Hematology

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‘Chameleonic' Serological Findings Leading to Life-Threatening Hemolytic Transfusion Reactions

Cited by 5 publications

References 20 publications

Safety of Uncrossmatched ABO-Compatible RBCs in Alloimmunized Patients with Bleeding: Data from Two Decades: Results of a Systematic Analysis in 6,109 Patients

Safety of Uncrossmatched ABO-Compatible RBCs in Alloimmunized Patients with Bleeding: Data from Two Decades: Results of a Systematic Analysis in 6,109 Patients

Is Autoimmune Thrombocytopenia Itself the Primary Disease in the Presence of Second Diseases Data from a Long-Term Observation

The clinical dilemma and management of red cell autoantibodies

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