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Jash A, Pridmore T, Collins JB, Hay AM, Hudson KE, Luckey CJ, Zimring JC. Complement C3 and marginal zone B cells promote IgG-mediated enhancement of RBC alloimmunization in mice. J Clin Invest 2024; 134:e167665. [PMID: 38618959 PMCID: PMC11014669 DOI: 10.1172/jci167665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 02/27/2024] [Indexed: 04/16/2024] Open
Abstract
Administration of anti-RhD immunoglobulin (Ig) to decrease maternal alloimmunization (antibody-mediated immune suppression [AMIS]) was a landmark clinical development. However, IgG has potent immune-stimulatory effects in other settings (antibody-mediated immune enhancement [AMIE]). The dominant thinking has been that IgG causes AMIS for antigens on RBCs but AMIE for soluble antigens. However, we have recently reported that IgG against RBC antigens can cause either AMIS or AMIE as a function of an IgG subclass. Recent advances in mechanistic understanding have demonstrated that RBC alloimmunization requires the IFN-α/-β receptor (IFNAR) and is inhibited by the complement C3 protein. Here, we demonstrate the opposite for AMIE of an RBC alloantigen (IFNAR is not required and C3 enhances). RBC clearance, C3 deposition, and antigen modulation all preceded AMIE, and both CD4+ T cells and marginal zone B cells were required. We detected no significant increase in antigen-specific germinal center B cells, consistent with other studies of RBC alloimmunization that show extrafollicular-like responses. To the best of our knowledge, these findings provide the first evidence of an RBC alloimmunization pathway which is IFNAR independent and C3 dependent, thus further advancing our understanding of RBCs as an immunogen and AMIE as a phenomenon.
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Affiliation(s)
- Arijita Jash
- University of Virginia School of Medicine, Charlottesville Virginia, USA
- Carter Immunology Center, University of Virginia, Charlottesville, Virginia, USA
| | - Thomas Pridmore
- University of Virginia School of Medicine, Charlottesville Virginia, USA
| | - James B. Collins
- University of Virginia School of Medicine, Charlottesville Virginia, USA
- Carter Immunology Center, University of Virginia, Charlottesville, Virginia, USA
| | - Ariel M. Hay
- University of Virginia School of Medicine, Charlottesville Virginia, USA
- Carter Immunology Center, University of Virginia, Charlottesville, Virginia, USA
| | - Krystalyn E. Hudson
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York, USA
| | - Chance John Luckey
- University of Virginia School of Medicine, Charlottesville Virginia, USA
| | - James C. Zimring
- University of Virginia School of Medicine, Charlottesville Virginia, USA
- Carter Immunology Center, University of Virginia, Charlottesville, Virginia, USA
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2
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Kenneday G, Chih HJ, Finch S, Ellery P. Does decreasing the incubation period used in the antibody screen affect its sensitivity? Transfus Med 2023; 33:379-389. [PMID: 37728214 DOI: 10.1111/tme.13009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 07/13/2023] [Accepted: 09/09/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND Pre-transfusion testing (PTT) encompasses a set of mandatory laboratory tests performed before red blood cell transfusion. The antibody screen, one component of PTT, commonly includes a 10-20 min incubation. The primary aim of this study was to determine if this period can be reduced when using current immunohematology methodologies. METHODS AND MATERIALS Antibody screens were performed on reagent samples using Glass or Gel-based column agglutination technologies (CAT) and a solid phase red cell adherence (SPRCA) assay, with incubation periods of 1, 5, 10 and 15 min, and 20 min (SPRCA assay only). For each method, the shortest period producing a minimum of a 1+ reaction with all reagent samples was considered optimal. The sensitivity of each assay using the optimal period was calculated after performing antibody screens on 100 patient samples. RESULTS AND DISCUSSION It was demonstrated that the incubation period in the SPRCA and Glass CAT systems can be reduced to 5 and 10 min, respectively, while achieving high assay sensitivity (98.9% in both). The incubation period in the Gel CAT system cannot be reduced from 15 min. Significant association between titre and reaction strength was observed for all three screening methods (p < 0.001 for both CAT methods, p = 0.041 for SPRCA). This study demonstrates that the incubation period used in the antibody screen can be reduced when using systems employing the Glass CAT and SPRCA methods, without affecting assay sensitivity. If confirmed, it could result in faster completion of PTT.
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Affiliation(s)
- Grace Kenneday
- Curtin Medical School, Curtin University, Perth, Western Australia, Australia
| | - Hui Jun Chih
- School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Susan Finch
- PathWest, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Paul Ellery
- Curtin Medical School, Curtin University, Perth, Western Australia, Australia
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Blake D, Crews WS, Wortman S, Burnett-Greenup S, Walker L. Implementation of a molecular genotyping protocol for patients with warm autoantibodies. Transfusion 2023; 63:1739-1746. [PMID: 37381697 DOI: 10.1111/trf.17463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 05/30/2023] [Accepted: 06/10/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND Warm autoantibodies (WAAs) cause delays and additional expenses while determining suitable products when using a traditional protocol (TP). In 2013, Carter BloodCare Immunohematology Reference Laboratory (IRL) introduced a molecular protocol (MP) for patients with WAAs. STUDY DESIGN AND METHODS Retrospective review of records for samples referred to the IRL from November 2004 to September 2020, was performed. Referrals, alloantibody(ies), gender, and age were recorded. Additionally, the count of common clinically significant antigens needed for phenotypically matched red blood cells (RBCs) were recorded for patients in MP. To further analyze charges and time spent testing patients with WAAs, 300 patients were selected. RESULTS Analysis of average charges to the referring hospital and time spent testing in the IRL determined savings at two or more referrals. Overall, 219 of 300 (73%) of patients in the study met or exceeded the number of referrals. Further analysis shows that while the population of patients with WAA (n = 300) shared similar demographics, there was a statistically significant difference between the average time testing patients in TP (M = 264.18, SD = 15.06) and MP (M = 156.00, SD = 90.37), t(157) = 14.46, p < .001, 95% confidence interval [CI] (93.41-122.97). Additionally, the assumption that each patient received two RBCs per referral provided no statistically significant difference between average charges to the hospitals of patients in TP (M = 1222.58, SD = 165.69) and MP (M = 1269.78, SD = 433.52), t(192) = -1.25, p = .214, 95% CI (-121.95-27.54). CONCLUSION The MP has been effective in saving time spent testing patients with WAAs, which benefits referring hospitals, patients, and IRLs. Charges for prophylactic phenotypically matched blood were negligible and a MP would alleviate some of the current laboratory difficulties while providing safe products to patients.
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Affiliation(s)
- Dorothy Blake
- Reference and Transfusion, Carter BloodCare, Bedford, Texas, USA
| | - William S Crews
- Reference and Transfusion, Carter BloodCare, Bedford, Texas, USA
| | - Sandy Wortman
- Reference and Transfusion, Carter BloodCare, Bedford, Texas, USA
| | - Sarah Burnett-Greenup
- Clinical Laboratory Sciences, University of Texas Medical Branch, Galveston, Texas, USA
| | - LeeAnn Walker
- Clinical Laboratory Sciences, University of Texas Medical Branch, Galveston, Texas, USA
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4
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Jacobs JW, Booth GS, Allen ES, Adkins BD. Commentary: Case report: Daratumumab treatment in pre-transplant alloimmunization and severe hemolytic anemia. Front Immunol 2023; 14:1133382. [PMID: 36776872 PMCID: PMC9912978 DOI: 10.3389/fimmu.2023.1133382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 01/18/2023] [Indexed: 02/14/2023] Open
Affiliation(s)
- Jeremy W Jacobs
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Garrett S Booth
- Department of Pathology, Microbiology & Immunology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Elizabeth S Allen
- Department of Pathology, University of California San Diego, La Jolla, CA, United States
| | - Brian D Adkins
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, United States
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5
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Jacobs JW, Binns TC, Abels E, Iyer K, Figueroa Villalba CA, Verma A, Sostin N, Tormey CA. Alloimmunization following antigen-negative red blood cell transfusion. Transfusion 2023; 63:430-434. [PMID: 36458330 DOI: 10.1111/trf.17208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 11/13/2022] [Accepted: 11/13/2022] [Indexed: 12/05/2022]
Abstract
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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Affiliation(s)
- Jeremy W Jacobs
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Thomas C Binns
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Elizabeth Abels
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Krishna Iyer
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, Connecticut, USA.,Department of Pathology, Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Anuj Verma
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Nataliya Sostin
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Christopher A Tormey
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, Connecticut, USA
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Jeannet R, Descazeaud A, Daix T, Pauthier H, Pascal V, Hantz S, Cam SL, Francois B, Feuillard J, Lafarge X. De novo natural anti-M alloantibody emergence in severe Coronavirus Disease 2019. J Infect Public Health 2022; 15:1455-1458. [PMID: 36403401 PMCID: PMC9628129 DOI: 10.1016/j.jiph.2022.10.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 10/25/2022] [Accepted: 10/27/2022] [Indexed: 11/05/2022] Open
Abstract
The immune response is a key player in the course of SARS-CoV-2 infection, and is often seriously dysfunctional in severe Coronavirus Disease 2019. The hyperinflammatory status has been described to be accompanied by the appearance of autoantibodies. In a lethal COVID-19 infection, we observed the emergence of a de novo natural alloantibody which targeted the M antigen from the MNS blood group on red blood cells (RBC) without evidence of any cross-reaction with SARS-CoV-2 antigens. This IgM lambda alloantibody was unmutated and unswitched. Here, we describe for the first time the emergence of a bystander de novo natural alloantibody against RBCs in a severe COVID-19 patient, highlighting the extra-follicular humoral response reported in these cases.
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Affiliation(s)
- Robin Jeannet
- INSERM CIC 1435, CHU Dupuytren, and UMR CNRS 7276 INSERM 1262, Université de Limoges, Limoges, France.
| | - Alexandra Descazeaud
- Laboratoire d'Immunohématologie, Établissement Français du Sang Nouvelle-Aquitaine, Limoges, France.
| | - Thomas Daix
- INSERM CIC 1435 and Réanimation polyvalente, CHU Dupuytren, and INSERM UMR 1092, Université de Limoges, Limoges, France.
| | - Hélène Pauthier
- Laboratoire d'Immunohématologie, Établissement Français du Sang Nouvelle-Aquitaine, Limoges, France.
| | - Virginie Pascal
- UMR CNRS 7276, INSERM 1262, Université de Limoges, and Laboratoire d'Immunologie, CHU Dupuytren, Limoges, France.
| | - Sébastien Hantz
- UMR INSERM 1092, RESINFIT, Université de Limoges, and Centre National de Référence des Herpèsvirus and Service de Bactériologie, Virologie et Hygiène, CHU Dupuytren, Limoges, France.
| | - Sophie Le Cam
- Laboratoire de qualification biologique des dons, Établissement Français du Sang Centre-Pays de la Loire, Angers, France.
| | - Bruno Francois
- INSERM CIC 1435 and Réanimation polyvalente, CHU Dupuytren, and INSERM UMR 1092, Université de Limoges, Limoges, France.
| | - Jean Feuillard
- UMR CNRS 7276 / INSERM 1262 CRIBL and Laboratoire d'Hématologie, Faculté de Médecine and CHU Dupuytren, Limoges, France.
| | - Xavier Lafarge
- INSERM U1035 Biothérapie des Maladies Génétiques, Inflammatoires et Cancers, and Direction Médicale, Établissement Français du Sang Nouvelle-Aquitaine, Bordeaux, France.
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Sivakaanthan A, Hollands S, Powley T, Ismay S, Daly J. Routine donor red cell antibody screening: Considering the alternate strategy. Vox Sang 2022; 117:708-714. [PMID: 34962295 DOI: 10.1111/vox.13235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 12/02/2021] [Accepted: 12/09/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND OBJECTIVES Australian Red Cross Lifeblood (Lifeblood) performs red blood cell (RBC) antibody screening on every whole blood donation. An alternate strategy has been proposed whereby an antibody screen is performed on the first donation and only repeated following pregnancy, transfusion or a significant break between donations (>2 years). We assess the blood safety risks associated with removing antibody screening for every whole blood donation. MATERIALS AND METHODS A retrospective desktop analysis included all whole blood donations collected by Lifeblood between 01 May 2018 and 30 April 2019 to quantify the antibodies that would have been undetected with the alternate strategy. The strategy was further assessed using the Alliance of Blood Operators Risk-Based Decision-Making framework. RESULTS One hundred and seventy-one routine donors had antibodies for the first time, but reported no sensitizing event since their last donation. Forty-seven of these had antibodies of a clinically significant specificity and titre that have the potential to cause a haemolytic transfusion reaction (HTR). The calculated risk of undetected antibodies being transfused to an incompatible recipient is 1 in 82,200. CONCLUSION The estimated risk of HTRs with the alternate strategy results in an increased risk. While the alternate strategy is identified as the most cost-effective option within the Australian setting, this additional residual risk was not deemed to be acceptable. Blood services would need to determine whether the increase in residual risk stemming from implementation of such a strategy is tolerable.
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Affiliation(s)
- Aarany Sivakaanthan
- Clinical Services and Research, Australian Red Cross Lifeblood, Melbourne, Victoria, Australia
| | - Sarah Hollands
- Manufacturing and Quality, Australian Red Cross Lifeblood, Melbourne, Victoria, Australia
| | - Tanya Powley
- Clinical Services and Research, Australian Red Cross Lifeblood, Melbourne, Victoria, Australia
| | - Sue Ismay
- Manufacturing and Quality, Australian Red Cross Lifeblood, Melbourne, Victoria, Australia
| | - James Daly
- Clinical Services and Research, Australian Red Cross Lifeblood, Melbourne, Victoria, Australia
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8
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Rankin A, Darbari D, Campbell A, Webb J, Mo YD, Jacquot C, Delaney M, Luban NLC, Nickel RS. Screening for new red blood cell alloantibodies after transfusion in patients with sickle cell disease. Transfusion 2021; 61:2255-2264. [PMID: 34002408 DOI: 10.1111/trf.16444] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 04/22/2021] [Accepted: 04/22/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Patients with sickle cell disease (SCD) are frequent recipients of red blood cell (RBC) transfusions and are at risk for RBC alloimmunization. RBC alloimmunization is diagnosed by identifying RBC alloantibodies as part of pre-transfusion testing, but this testing fails to detect alloantibodies that have evanesced. It may be beneficial to screen for new RBC alloantibody development after transfusion before possible antibody evanescence. STUDY DESIGN AND METHODS Our institution started a new initiative for episodically transfused patients with SCD to obtain at least one antibody screen 2-6 months after transfusion as part of their clinical care. A database was created to prospectively track all transfused patients for 1 year and their post-transfusion antibody screen results. Patients received prophylactically CEK-matched RBC units. RESULTS During the study year, 138 patients with SCD received a total of 242 RBC transfusions. Patients with a history of an RBC alloantibody (n = 13, 9.4%) had previously received more RBC units than non alloimmunized patients (median 11 vs. 2 RBC units, p = .0002). A total of 337 post-transfusion antibody screens were obtained in 127 patients (92.0%) with 110 patients (79.7%) having at least one antibody screen 2-6 months post-transfusion. With this prospective testing, two new RBC alloantibodies (anti-C and -M) were identified in two patients. CONCLUSION It is feasible to test for new RBC alloantibody development in most episodically transfused patients with SCD as part of their routine care. The yield of this screening appears low with CEK matching, but it could still provide important information for individual patients.
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Affiliation(s)
- Alexander Rankin
- Divisions of Hematology and Laboratory Medicine, Children's National Hospital, Washington, District of Columbia, USA.,Pediatric Hematology-Oncology, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Deepika Darbari
- Divisions of Hematology and Laboratory Medicine, Children's National Hospital, Washington, District of Columbia, USA.,Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Andrew Campbell
- Divisions of Hematology and Laboratory Medicine, Children's National Hospital, Washington, District of Columbia, USA.,Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Jennifer Webb
- Divisions of Hematology and Laboratory Medicine, Children's National Hospital, Washington, District of Columbia, USA.,Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Yunchuan Delores Mo
- Divisions of Hematology and Laboratory Medicine, Children's National Hospital, Washington, District of Columbia, USA.,Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Cyril Jacquot
- Divisions of Hematology and Laboratory Medicine, Children's National Hospital, Washington, District of Columbia, USA.,Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Meghan Delaney
- Divisions of Hematology and Laboratory Medicine, Children's National Hospital, Washington, District of Columbia, USA.,Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Naomi L C Luban
- Divisions of Hematology and Laboratory Medicine, Children's National Hospital, Washington, District of Columbia, USA.,Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Robert Sheppard Nickel
- Divisions of Hematology and Laboratory Medicine, Children's National Hospital, Washington, District of Columbia, USA.,Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
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9
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Pediatric Hemovigilance and Adverse Transfusion Reactions. Clin Lab Med 2020; 41:51-67. [PMID: 33494885 DOI: 10.1016/j.cll.2020.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Some types of transfusion reactions occur more frequently in the pediatric than the adult population. Allergic reactions are the most common, followed by nonhemolytic transfusion reactions; male children seem most susceptible to such reactions. Platelets are often implicated and pulmonary reactions are understudied in children. Clinical sequelae in neonates, such as bronchopulmonary dysplasia/chronic lung disease and intraventricular hemorrhage, have received increasing attention in relation to transfusion. There is a need to better understand the pathophysiology of transfusion reactions in neonatal and pediatric populations so preventive strategies can be undertaken. There is also a need for robust hemovigilance systems.
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10
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Gupta GK, Balbuena-Merle R, Hendrickson JE, Tormey CA. Immunohematologic aspects of alloimmunization and alloantibody detection: A focus on pregnancy and hemolytic disease of the fetus and newborn. Transfus Apher Sci 2020; 59:102946. [PMID: 32962917 DOI: 10.1016/j.transci.2020.102946] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Alloimmunization to non-ABO, red blood cell (RBC) antigens remains one of the most clinically-relevant complexities faced by blood banking practitioners. In the setting of transfusion therapy, these antibodies raise risks for incompatibilities, while for pregnant patients they can mediate deadly forms of hemolytic disease of the fetus and newborn. As such, a thorough understanding of pathways that lead to alloimmunization, as well as the tools used by blood banks to detect alloantibodies, is critical to transfusion practice. In this review, in which alloimmunization in the setting of pregnancy will be emphasized, we will review: 1) the clinical impacts of RBC alloantibodies in the peri-partum period; 2) the current pathophysiologic mechanisms thought to influence non-ABO antigen alloimmunization; 3) the strengths and weaknesses of laboratory tools used in aiding alloimmunization detection; and 4) future directions of the transfusion community related to alloimmunization impacting pregnancy.
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Affiliation(s)
- Gaurav K Gupta
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT, United States
| | - Raisa Balbuena-Merle
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT, United States; Pathology & Laboratory Medicine Service, VA Connecticut Healthcare System, West Haven, CT, United States
| | - Jeanne E Hendrickson
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT, United States; Department of Pediatrics, Yale University School of Medicine, New Haven, CT, United States
| | - Christopher A Tormey
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT, United States.
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11
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Torres-Aguilar H, Sosa-Luis SA, Ríos-Ríos WDJ, Romero-Tlalolini MDLÁ, Aguilar-Ruiz SR. Silent red blood cell autoantibodies: Are they naturally occurring or an effect of tolerance loss for a subsequent autoimmune process? Autoimmunity 2020; 53:367-375. [PMID: 32815426 DOI: 10.1080/08916934.2020.1799989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Unexpected anti-red blood cell (RBC) alloantibodies are routinely investigated in immunohematology and blood banking since their existence in pregnant women may induce haemolytic disease of the foetus and newborn, and their presence in donors may induce haemolytic transfusion reactions or hyperacute rejection in solid organ transplantation. Unexpected anti-RBC alloantibodies may target antigens of the most blood types excluding the expected antibodies targeting the ABO antigens. Their incidence in humans was originally linked to alloimmunization events such as blood transfusions, transplants, or pregnancies. But later, many findings revealed their existence in pathogenic processes such as malignancies, infections, and autoimmune diseases; and usually (but not always) associated to autoimmune haemolytic anaemia (AIHA). Nevertheless, unexpected anti-RBC autoantibodies are also occasionally found in healthy individuals in the absence of AIHA and with no history of alloimmunization or the associated pathologic processes. Hence, they are generally known as non-clinically significant, are excluded for typification and called "silent red blood cell autoantibodies (SRBCAA)". This review highlights evidence related to genetic predisposition, molecular mimicry, immune dysregulation, and immune tolerance loss surrounding the existence of anti-RBC antibodies, describing the presence of SRBCAA as possible early witnesses of the development of autoimmune diseases.
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Affiliation(s)
- Honorio Torres-Aguilar
- Clinical Immunology Research Department of Biochemical Sciences Faculty, Universidad Autónoma "Benito Juárez" de Oaxaca, Oaxaca City, Mexico
| | - Sorely Adelina Sosa-Luis
- Department of Molecular Biomedicine, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional, Mexico City, Mexico
| | - William de Jesús Ríos-Ríos
- Clinical Immunology Research Department of Biochemical Sciences Faculty, Universidad Autónoma "Benito Juárez" de Oaxaca, Oaxaca City, Mexico
| | | | - Sergio Roberto Aguilar-Ruiz
- Molecular Immunology Research Department of Medicine and Surgery Faculty, Universidad Autónoma "Benito Juárez" de Oaxaca, Oaxaca City, Mexico
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