Cryptantigens: time to uncover the real significance of T‐activation

Roseff, Susan D.

doi:10.1111/trf.14366

Cited by 4 publications

(9 citation statements)

References 37 publications

(115 reference statements)

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“…17 However, this association is not consistent among case reports, arguing against a direct causal link. 2,18 Among our patients with detectable T-antigen activation, 7 of 10 had laboratory evidence of hemolysis. Furthermore, in serological studies, most anti-T antibodies are IgM agglutinins reactive at cold temperature without reactivity at higher thermal amplitudes.…”

Section: Discussionmentioning

confidence: 95%

“…20 Thus, T-antigen activation may instead correlate with the amount of circulating bacterial toxin and serve as a surrogate marker for disease severity. 2 Hemolysis may occur independently of transfusion with anti-T-containing serum, and may be the result of sepsis or disseminated intravascular coagulation.…”

Section: Discussionmentioning

confidence: 99%

“…In contrast, Tn is caused by a somatic mutation in an X-linked gene required for a functional glycosyltransferase and is persistent. 2 The specific type of T-antigen activation does not appear to impact the clinical course. 3 T-antigen activation has been reported in neonates with necrotizing enterocolitis (NEC), especially in the setting of severe disease (e.g.…”

mentioning

confidence: 99%

“…Severe hemolysis following transfusions has been reported in patients with T-antigen activation, but authors have debated whether donor-derived anti-T is the cause because the association is not consistent. 2 One alternative theory is that bacteria-induced alteration or breakdown of the sialic acid, rather than anti-T binding, weakens the cell's resistance to hemolysis, or that T-antigen activation may serve as a general marker of severe disease. 16 However, given that T-antigen activation may be detected without any evidence of clinical hemolysis or other manifestations of disease, the true risk of providing plasmacontaining products to this population is unknown.…”

mentioning

confidence: 99%

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Erythrocyte T‐antigen activation in children: Patient characteristics and the hemolytic risk of transfusion

Jacquot

Pary

Babu

et al. 2021

Pediatric Blood & Cancer

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Background: T-antigen activation usually occurs upon red blood cell (RBC) membrane cryptantigen exposure due to bacterial enzymes. Although uncommon, the condition is probably underrecognized. There is concern about hemolysis after plasma and plasmacontaining platelet transfusions due to naturally occurring anti-T antibody in healthy blood donors. However, experts have debated the extent and severity of clinical hemolysis due to anti-T. Procedure:We retrospectively identified patients who tested positive for polyagglutination with Arachis hypogea and Glycine max lectins from 2008 to 2019. The records of the patients were reviewed to determine clinical symptoms, laboratory evidence of hemolysis, need for transfusion, and clinical outcomes.Results: Ten patients were identified. At diagnosis, all were anemic and four had thrombocytopenia. Severe Streptococcus pneumoniae infection affected seven patients; one died. Seven of 10 patients (70%) had laboratory evidence of hemolysis. Peripheral blood smear findings in six patients included RBC agglutination and changes suggesting hemolysis (spherocytes and schistocytes), but three had unremarkable RBC morphology. Four patients required plasma or platelet transfusions; all survived to discharge. Conclusions:T-antigen activation is a rare entity. Most patients diagnosed at our hospital had hemolytic anemia and severe pneumococcal infection. Hemoglobin decreased after plasma and platelet transfusions in all patients assessed, but these transfusions were necessary to support treatment. RBCs were given to maintain appropriate hemoglobin levels.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Erythrocyte T‐antigen activation in children: Patient characteristics and the hemolytic risk of transfusion

Jacquot

Pary

Babu

et al. 2021

Pediatric Blood & Cancer

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“…There has been variation in clinical practice in the transfusion management of neonates and children with T activation, with some clinicians using washed cellular components in this situation and in atypical haemolytic uraemic syndrome. However, there is no evidence to support the use of washed cells in this setting when standard red cells are suspended in additive solution with little residual plasma [10]. Washed red cells are no longer indicated in transfusion management of paroxysmal nocturnal haemoglobinuria [11,12].…”

Section: Current Indications For Washed Red Cellsmentioning

confidence: 99%

Washed red cells: theory and practice

et al. 2020

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Washing of red cells is sometimes performed to reduce allergic reactions due to contaminating plasma proteins or to reduce the concentration of potassium accumulating in the supernatant of red cells during storage as an alternative to transfusion of fresher red cells in patients at risk of hyperkalaemia. There are a variety of methods for washing red cells, and the laboratory data suggest that variables such as age of red cell before washing, washing method and solution, storage medium and length of storage time after washing can all effect the final red cell quality. Studies suggest that washing removes 90-95% plasma, but the proportion of units below 0Á05 mg/dl IgA (equivalent to IgA deficient) is variable dependent upon methods used. Although potassium levels are reduced immediately following washing, the rate of leakage following subsequent storage is method-dependent, requiring careful consideration of shelf life if potassium reduction is the goal. Other markers of red cell quality such as haemolysis are negatively impacted by washing so a reduced shelf life compared to standard red cells is appropriate, especially following irradiation. Data from animal models and clinical studies on possible additional benefits of washing, such as reduced lung or kidney injury, are mixed, ranging from some benefit to some harm, and further studies are warranted.

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