Severe hemolysis after plasma transfusion in a neonate with necrotizing enterocolitis, Clostridium perfringens infection, and red blood cell T‐polyagglutination

Abstract

Anti-T antibodies are unlikely to be the etiologic factor for the hemolytic reactions observed in infants with NEC and T activation. Massive RBC desialylation and the direct action of bacterial toxins are more probable causes. Strict avoidance of plasma-containing blood products does not seem justified in these infants.

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

“…To gain a better understanding of this patient's outcome, they performed a prospective study to more closely examine the relationship between NEC, T‐activation, and hemolysis in patients in the neonatal intensive care unit (NICU). As stated in their introduction, “the causal relationship between T‐activation and hemolysis has been called into question by many clinicians and serologists.” Their work adds more information to this provocative topic and also presents prospective data with more detailed laboratory testing than many previous studies.…”

“…DTT treatment showed that the anti‐T was IgM and the titer at 4°C was 8. No hemolysis of neuraminidase‐treated RBCs was observed in vitro with a serum sample from the plasma donor …”

“…Decades later I became aware of the ongoing controversy surrounding the presence of T‐activation and whether it had a direct role in red blood cell (RBC) destruction after transfusion. In this issue of TRANSFUSION, Moh‐Klaren and colleagues present a case of an infant with necrotizing enterocolitis (NEC) and T‐activation who died in temporal relationship to receiving blood products. To gain a better understanding of this patient's outcome, they performed a prospective study to more closely examine the relationship between NEC, T‐activation, and hemolysis in patients in the neonatal intensive care unit (NICU).…”

“…Since this publication and others cite worse outcomes due to T‐activation and the temporal relationship with the transfusion and hemolysis, some have called for exclusive use of washed and lower‐risk blood products. Conversely, some posit that T‐activation is actually a marker of severity of disease, being associated with an increased risk for the need for surgery, worse outcomes including higher mortality, and the presence of C. perfringens and that the transfusion is not related to hemolysis …”

“…The reported cases are not consistent; some patients with T‐activation do not hemolyze, some without T‐activation hemolyze, some with T‐activation hemolyze with unwashed products, and some with T‐activation hemolyze with washed products. It is important to remember that T‐activation is rare and hemolysis with T‐activation is rare . If there is a true linkage between T‐activation, transfusion, and hemolysis, this variation should not exist.…”