Naturally Occurring ‘enzyme only’ Anti-E antibody: A Rare Occurrence

Yousuf, Rabeya; Thalith, Nor Fadzliana Abdullah; Loong, Tang Yee; Leong, Chooi Fun

doi:10.3329/bjms.v18i4.42911

Cited by 5 publications

(5 citation statements)

References 3 publications

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“…Naturally, occurring anti-E has been described, but it is a rare entity and there are no reports of it causing hemolytic disease of the newborn or a DHTR. [20][21][22] These naturally occurring anti-E antibodies often only react with papain treated E-positive RBCs, 21,22 and in our case there was clear reactivity without enzyme treatment. Antibody evanescence is common; one study of alloimmunized patients with SCD found that 81% of patients had at least one RBC alloantibody that evanesced during a 2-year time period.…”

Section: Discussionmentioning

confidence: 51%

“…Over time his anti‐E likely waned, consistent with his negative pre‐transfusion antibody screen upon presentation to our institution. Naturally, occurring anti‐E has been described, but it is a rare entity and there are no reports of it causing hemolytic disease of the newborn or a DHTR 20–22 . These naturally occurring anti‐E antibodies often only react with papain treated E‐positive RBCs, 21,22 and in our case there was clear reactivity without enzyme treatment.…”

Section: Discussionmentioning

confidence: 53%

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Preventing antibody positive delayed hemolytic transfusion reactions in sickle cell disease: Lessons learned from a case

Rankin

Webb

Nickel

2022

Transfusion Medicine

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Introduction: Red blood cell (RBC) transfusions are important in the management of patients with sickle cell disease (SCD). However, a potentially catastrophic complication of transfusion in this population is the delayed hemolytic transfusion reaction (DHTR). The pathophysiology of all DHTRs is not understood, but some are known to be caused by an anamnestic resurgence of RBC alloantibodies. Case presentation:A child with SCD transfused for acute chest syndrome re-presented a week after hospital discharge with severe anaemia, hemolysis, and a newly detected anti-E. This patient had been previously transfused years ago at an outside institution and the anti-E had not been previously documented.Discussion: The presented case of an antibody positive DHTR illustrates several concepts critical to the prevention of this complication. RBC alloantibodies must be detected and this information must be shared. Prophylactic C/c, E/e, K antigen matching is helpful for patients with SCD, but systems must be in place to identify these patients. Patients transfused at multiple different hospitals are especially at risk for this complication and efforts are needed to prevent them from suffering a DHTR.

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Section: Discussionmentioning

confidence: 51%

Section: Discussionmentioning

confidence: 53%

Preventing antibody positive delayed hemolytic transfusion reactions in sickle cell disease: Lessons learned from a case

Rankin

Webb

Nickel

2022

Transfusion Medicine

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“…9,10 ABO antibodies specifically are thought to develop early in life secondary to exposure to microbial glycans that share homology with ABO-antigens. [10][11][12] Rare cases of presumed naturally occurring anti-E and anti-K in the absence of known transfusion-or pregnancy-related exposure have been reported in the literature [12][13][14][15][16][17] and may be secondary to molecular mimicry mechanisms. However, these cases are challenging to confirm definitively due to the fragmentation of the healthcare and medical record system, as well as the potential for exposure to fetal antigens from pregnancy.…”

Section: Discussionmentioning

confidence: 99%

Alloimmunization following antigen‐negative red blood cell transfusion

et al. 2022

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Background Red blood cell (RBC) alloimmunization can occur secondary to transfusion or pregnancy. It is observed most frequently among patients with hemoglobinopathies and myeloid neoplasms. Although previous antigen exposure is generally required for alloimmunization, some alloantibodies may develop naturally without prior exposure. Other alloantibodies may become evanescent, only to reemerge at a detectable titer following a stimulatory event. In a minute fraction of cases, ‘non‐naturally occurring’ alloantibodies may appear without a known antigenic stimulus. Methods and Materials All testing (antibody detection tests and identification, antigen phenotyping, and crossmatching) was performed using the same method and reagents, but occurred at two hospitals within the Yale New Haven Hospital delivery network, and was performed by technologists utilizing different instruments and reagent lots. Results We present two cases of seemingly de novo alloimmunization (anti‐E and anti‐K), and one case of re‐emergence of a known, previously evanescent alloantibody (anti‐K) following transfusion of RBCs that were antigen‐negative for the corresponding antibodies. Conclusion While the exact mechanism underlying the development and/or re‐emergence of RBC alloantibodies in the absence of antigenic stimulation remains unclear, these cases highlight this unusual phenomenon, underscoring the general immunogenicity, as well as the potential consequences, of RBC transfusion and reiterates the importance of concluding an alloantibody specificity, even in the absence of known transfusion of RBCs with a particular antigen.

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“…Furthermore, individual with negative E antigen is common among the Malay population, accounting for about 77% of the population [27]. In addition, anti-E can also be a naturally occurring antibody that may present without a sensitizing event [13,28,29]. However, we could not distinguish between naturally occurring or immune anti-E as all the reactions observed with the cells panel were more intense in the enzymatic medium than in the presence of AHG.…”

Section: Rbc Alloantibody Specificity Among Alloimmunized Patientsmentioning

confidence: 98%

Red Blood Cell Alloimmunization and Its Associated Factors among Chronic Liver Disease Patients in a Teaching Hospital in Northeastern Malaysia

et al. 2023

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Red blood cell (RBC) alloimmunization is an important complication of blood transfusion. Variations in the frequency of alloimmunization have been noted among different patient populations. We aimed to determine the prevalence of RBC alloimmunization and associated factors among chronic liver disease (CLD) patients in our center. This is a case-control study involving 441 patients with CLD who were being treated at Hospital Universiti Sains Malaysia and subjected to pre-transfusion testing from April 2012 until April 2022. Clinical and laboratory data were retrieved and statistically analyzed. A total of 441 CLD patients were included in our study, with the majority being elderly, with the mean age of patients 57.9 (SD ± 12.1) years old, male (65.1%) and Malays (92.1%). The most common causes of CLD in our center are viral hepatitis (62.1%) and metabolic liver disease (25.4%). Twenty-four patients were reported to have RBC alloimmunization, resulting in an overall prevalence of 5.4%. Higher rates of alloimmunization were seen in females (7.1%) and patients with autoimmune hepatitis (11.1%). Most patients developed a single alloantibody (83.3%). The most common alloantibody identified belonged to the Rh blood group, anti-E (35.7%) and anti-c (14.3%), followed by the MNS blood group, anti-Mia (17.9%). There was no significant factor association of RBC alloimmunization among CLD patients identified. Our center has a low prevalence of RBC alloimmunization among CLD patients. However, the majority of them developed clinically significant RBC alloantibodies, mostly from the Rh blood group. Therefore, phenotype matching for Rh blood groups should be provided for CLD patients requiring blood transfusions in our center to prevent RBC alloimmunization.

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Naturally Occurring ‘enzyme only’ Anti-E antibody: A Rare Occurrence

Cited by 5 publications

References 3 publications

Preventing antibody positive delayed hemolytic transfusion reactions in sickle cell disease: Lessons learned from a case

Preventing antibody positive delayed hemolytic transfusion reactions in sickle cell disease: Lessons learned from a case

Alloimmunization following antigen‐negative red blood cell transfusion

Red Blood Cell Alloimmunization and Its Associated Factors among Chronic Liver Disease Patients in a Teaching Hospital in Northeastern Malaysia

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