Delayed Hæmolytic Transfusion Reaction With Renal Failure

Meltz, DavidJ.; David, DavidS.; Bertles, JohnF.; Deciutiis, AlfredC.

doi:10.1016/s0140-6736(71)92363-4

Cited by 25 publications

(5 citation statements)

References 12 publications

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“…Delayed haemolytic transfusion reactions presenting with haemoglobinuria are of rare occurrence, and appear to be related to the rate of haemolysis or the specificity of the antibody rather than to the involvement of complement [9], In 10 reported cases of haemoglobinuria developing between 6 and 13 days after the transfusion of 2-10 U of blood, antibodies with the following speci ficities were present in the patient's serum: anti-U [8,14], anti-c [15], anti-c +-M [1], anti-Jka [13], anti-Jkb [4,7], anti-HI, -Jkb, -S, -Fya [3], anti-E, -K, -S, -Fya [10] and anti-C, -E, -Jkb [6]. A similar range of anti body specificities, but excluding anti-U, has been reported in cases of delayed haemolytic transfusion reactions presenting with jaun dice or anaemia [1, 2, 11 -13, 16].…”

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confidence: 99%

Delayed Haemolytic Transfusion Reactions due to Anti-C

et al. 1978

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In 5 patients of phenotype ccDEe or ccDEE, the transfusion of 2-14 U of C-positive blood was followed 5-9 days later by haemoglobinuria lasting 2-4 days. Anti-C was the only antibody present in all 5 cases but was always of low titre; with CC cells the maximum titre recorded with the indirect antiglobulin test was 8 and with the agglutination of enzymetreated cells, 128. The discordance between the weakness of the antibody in vivo and the amount of haemoglobin released intravascularly is surprising but may be related to the type of IgG molecule of which anti-C is composed.

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confidence: 99%

Delayed Haemolytic Transfusion Reactions due to Anti-C

et al. 1978

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“…Anti‐U is a clinically significant antibody; it is known to cause either acute and delayed HTRs in all case reports described in the literature to date, and therefore must be treated with caution. Case reports of anti‐U in the literature include descriptions of one case of a fatal acute HTR and several examples of delayed HTRs . with no published cases describing outcomes of transfusion in patients with anti‐U with no adverse side effects.…”

Section: Discussionmentioning

confidence: 99%

“…Anti‐U is an immunoglobulin G antibody, formed as a consequence of blood transfusion or pregnancy. Anti‐U is clinically significant and is known to cause acute and delayed hemolytic transfusion reactions (HTRs) and hemolytic disease of the fetus and newborn (HDFN) . Every attempt should must be made to provide U– units to patients with anti‐U.…”

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confidence: 99%

Prevention of hemolytic transfusion reactions with intravenous immunoglobulin prophylaxis in U– patients with anti‐U

et al. 2019

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BACKGROUND The U– phenotype is extremely rare and is found predominantly in black African populations at a frequency of between 0.2 and 1.7%. In European populations, U– units are therefore rare, with limited availability in the United Kingdom. Anti‐U is clinically significant and is known to cause hemolytic transfusion reactions (HTRs) and hemolytic disease of the fetus and newborn. It has been suggested that intravenous immunoglobulin (IVIG) may be considered as an option among supportive therapy for urgent transfusion when clinically significant antigen‐matched units are not available. We report three cases with anti‐U transfused with least‐incompatible RBC units, their outcomes, and their clinical management. STUDY DESIGN AND METHODS Intravenous immunoglobulin was prescribed when least‐incompatible units must be issued in patients with anti‐U to ameliorate acute HTR and prevent the development of delayed HTR. We report the outcome of these cases. RESULTS Of the case reports described, one patient with weak anti‐U developed a delayed HTR after transfusion with incompatible units due to an anamnestic response. Two additional patients are described, with the use of IVIG as a precautionary measure to prevent the development of HTRs when transfused with antigen‐positive incompatible units. No acute HTRs or delayed HTRs were noted upon follow‐up. CONCLUSION U– units are not always readily available and transfusion support requires close collaborative working among a multidisciplinary team. Transfusion with antigen‐positive incompatible units with IVIG cover both ameliorates acute HTRs and prevents the development of delayed HTRs.

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“…Although the literature contains many cases of antibody-mediated delayed hemolytic transfusion reaction (DHTR) in which subsequent retesting of pretransfusion specimens showed no antibody by "usual" or "standard" techniques, no information about what serum: cell ratio was employed is provided.4, 8-11, [14][15][16][17]20,21,[24][25][26][27]32 In order to minimize errors in in vitro tests for detection of clinically significant antigens and antibodies, it is important to I) standardize pretransfusion test methodology by adopting an optimum serum:cell ratio, 2) test the drop delivery volume of dropper pipettes used in antibody detection! compatibility tests as part of the quality control of equipment, 3) promote standardization of the concentration of commercial reagent red blood cells and the drop delivery volume of their vial droppers, and 4) save pretransfusion samples for 14 days after the patient's transfusion.…”

Section: Discussionmentioning

confidence: 99%

Control of the antigen‐antibody ratio in antibody detection/compatibility tests

Km¹

1980

Transfusion

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An evaluation was made of the variation and importance of dropper volume delivery on pretransfusion testing in ten hospital transfusion services which annually perform a combined total of 225,000 compatibility tests on the serum of approximately 70,000 patients. The pretransfusion testing by these institutions typifies practices throughout the United States in that serum and red blood cells are used with little awareness of actual volumes used and the resultant proportion of one reactant to the other. Tests of the hospitals' dropper pipettes showed a range of serum delivery per test of 0.0465 to 0.1155 ml. Commercial reagent red blood cell vial droppers delivered (according to cell concentration) from 0.00166 to 0.00294 ml packed red blood cells (pcv). From these findings, it could be shown that the serum to cell ratio in the tests done in two transfusion services was as low as 19 to 1 and that the highest ratio of 70 to 1 was used in only one institution. In none was the serum-cell ratio the optimum of 80 to 1.

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Delayed Hæmolytic Transfusion Reaction With Renal Failure

Cited by 25 publications

References 12 publications

Delayed Haemolytic Transfusion Reactions due to Anti-C

Delayed Haemolytic Transfusion Reactions due to Anti-C

Prevention of hemolytic transfusion reactions with intravenous immunoglobulin prophylaxis in U– patients with anti‐U

Control of the antigen‐antibody ratio in antibody detection/compatibility tests

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