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

Abstract

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.

YTGT: A new high‐prevalence antigen in the Yt blood group system in two unrelated Native Americans and transfusion management

“…Guidelines for patient management and RBC transfusion in urgent situations when serologic compatibility cannot be assured are important, and prophylaxis with IVIG and steroids proved to be beneficial for subsequent transfusions. This approach should be considered as a therapeutic option when transfusion of incompatible blood is necessary [2][3][4]…”

“…To help reduce the risk for additional RBC alloimmunization, units were provided, which were phenotypically matched based on her extended RBC antigen profile (c‐ E‐ K‐ Fy a ‐ S‐). In an attempt to mitigate the risk of another hemolytic transfusion reaction, methylprednisolone 500 mg was given immediately prior to transfusion and IVIG 0.4 g/kg following the transfusion 2–5 . Despite the incompatible crossmatch (2+ IAT), her Hb improved from 3.6 to 5.2 g/dl (Figure 1) in the absence of signs and symptoms of an immediate transfusion reaction, although the total bilirubin and LDH remained elevated and the haptoglobin level <10 mg/dl.…”

“…In an attempt to mitigate the risk of another hemolytic transfusion reaction, methylprednisolone 500 mg was given immediately prior to transfusion and IVIG 0.4 g/kg following the transfusion. [2][3][4][5] Despite the incompatible crossmatch (2+ IAT), her Hb improved from 3.6 to 5.2 g/dl (Figure 1) in the absence of signs and symptoms of an immediate transfusion reaction, although the total bilirubin and LDH remained elevated and the haptoglobin level <10 mg/dl. A second incompatible unit was transfused the following day using the same protocol with steroids and IVIG, with further improvement in Hb to 6.1 g/dl and no clinical signs or symptoms of an adverse reaction.…”

Anti‐IFC antibodies in a patient with CHAPLE syndrome: Implications for blood management

“…8 Furthermore, it should be emphasised that the transfusion reaction described in this report, was observed under an immunosuppressive and immune modulatory therapeutic regimen, which may have affected the clearance mechanism and efficiency of the anti-IFC antibodies. 6,9 Nevertheless, due to the extensive clinical implications of our findings and the scarcity of other known clinical data, clinicians should strive to avoid transfusion of IFC-incompatible blood in patients with CHAPLE syndrome, irrespective of the presence of anti-IFC antibodies. A second, minor, limitation was the preclusion of the use of haptoglobin as a marker of haemolysis, due to the fact that its concentration was already below the detection limit at the start of the test transfusion.…”

Alloantibodies to High-Incidence Antigen: Review of Cases and Transfusion Experiences in Korea

“…있다[44]. 31명의 동종항체를 가진 환자에 게 MMA 검사를 통해 선별된 103 단위의 항원 양 성 혈액제제를 수혈부작용 없이 수혈하였다는 보 고도 있다[45].이외에도 최소부적합 혈액제제 수혈시 정주 면역글로불린(intravenous immunoglobulin, IVIG) 을 함께 시행하여 HTR 없이 수혈하였다는 보고 도 있다[46,47]. 그러나, 이에 대한 보고가 충분하 지 않고 IVIG의 최적용량(optimal dose)이 아직 정 립되지 않았으므로 적용 여부를 신중하게 고려해 야 한다[46].국내대다수의 혈액은행 검사실에서는 고빈도 항원에 대한 항체가 의심되는 경우, 항체의 특이 성을 직접 확인하는 것이 매우 어렵다.…”