T activation haemolysis and death after blood transfusion.

Abstract

A 30 week gestation infant developed necrotising enterocolitis associated with Clostridium perfringens septicaemia at 3 weeks of age. He responded to treatment with intravenous fluids, antibiotics, and blood, but his blood haemolysed. Because of anaemia further blood was given, but, within minutes he died. Examination of his red cells showed an increase in T activation.

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

“…No hemolysis was observed in vitro when serum from the plasma donor was tested against neuraminidase‐treated RBCs, and negative results were obtained for both DAT and elution on RBCs from the patient. Negative DAT results have been reported in all cases of intravascular hemolysis associated with NEC and T activation to date for which DAT results were reported . By contrast, positive DAT with anti‐C3d were reported in a case of T polyagglutination and intravascular hemolysis in an adult patient, and in a number of cases of T activation associated with pneumococcal hemolytic and uremic syndrome (P‐HUS) .…”

“…The agglutination titer and hemolytic activity are usually very weak at 37°C . Furthermore, in reports of NEC complicated by intravascular hemolysis, the direct antiglobulin test (DAT) results, when specified, were always negative . We describe here a case of massive hemolysis after plasma transfusion in a newborn with NEC and RBC T activation.…”

“…S udden massive hemolysis after the transfusion of plasma-containing blood components has occasionally been reported in infants with necrotizing enterocolitis (NEC). [1][2][3][4][5][6][7][8][9] Some authors have suggested that hemolysis results from Thomsen-Friedenreich antigen exposure (T activation) on red blood cells (RBCs) in these infants, together with the passive transfer of anti-T antibodies present in plasma. 10 T antigen is a core disaccharide of O-glycosylated glycoproteins normally hidden by two sialic acid residues.…”

Anti‐T haemolysins: the effects of sialic acid removal and 2‐aminoethylisothiouronium bromide treatment of erythrocytes on immune lysis

“…Naturally occurring IgM antibodies against T antigen are present in virtually all types of blood donor plasma. A large number of cases of acute haemolysis have been reported following blood transfusions in infants with T‐activation, most of them associated with necrotizing enterocolitis [1,6,7]. These reports suggest an association between passively transferred anti‐T and haemolysis.…”

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

“…Two patients who were transfused after the diagnosis and only received washed RBCs, washed platelets (PLTs), albumin, or protein fraction had no evidence of increased RBC destruction. 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 …”