1
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Longacre M, Bendapudi PK. Fatal hemolytic disease of the newborn due to anti-B Isohemagglutinin: An unfamiliar presentation of a familiar disease. Transfusion 2024; 64:185-188. [PMID: 38069508 DOI: 10.1111/trf.17614] [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: 05/31/2023] [Revised: 09/18/2023] [Accepted: 11/08/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND Hemolytic disease of the newborn (HDN) occurs in approximately 1 out of 3000 live births. Severe presentations are atypical but must be recognized and treated rapidly to avoid life-threatening organ dysfunction. CASE PRESENTATION Here we report an unusual case of neonatal ABO HDN that illustrates the enormous inflammatory potential of maternal-fetal blood group mismatch. Following an uneventful delivery notable only for HDN caused by maternal anti-B IgG, our patient developed shock, DIC, and renal failure. Despite numerous interventions, she experienced a rapid clinical decline and died 10 days after birth. Treatment with whole blood exchange and a monoclonal antibody directed at complement component 5 (eculizumab) were attempted late in the disease course but were unsuccessful. Importantly, this patient had several known risk factors for severe ABO HDN, including the pentad of a group O mother with a group B neonate, high newborn red blood cell B antigen expression, presence maternal anti-B isohemagglutinin in high titer, presence of a maternal IgG anti-B isohemagglutinin, and African ancestry. CONCLUSION Clinicians should be aware of the potential for severe ABO HDN and consider earlier diagnostic workup and more aggressive therapy in patients with high-risk features.
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Affiliation(s)
- Mckenna Longacre
- Department of Anesthesia, Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Pavan K Bendapudi
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Hematology and Blood Transfusion Service, Massachusetts General Hospital, Boston, Massachusetts, USA
- Division of Hemostasis and Thrombosis, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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2
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Sakamoto T, Mizuta H, Niiro N, Amagai T. Retrospective Study to Reduce Blood Transfusion Waste in Remote Island Healthcare Settings. Adv Hematol 2023; 2023:5549655. [PMID: 38116392 PMCID: PMC10730247 DOI: 10.1155/2023/5549655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/15/2023] [Accepted: 11/25/2023] [Indexed: 12/21/2023] Open
Abstract
Background Tokunoshima is a remote island in the Amami Islands, 470 km southwest of the Kagoshima mainland. It has a population of 23,000 and consists of three towns: Tokunoshima, Isen, and Amagi. Three medical institutions on the island are responsible for blood transfusion medicine, but there is no blood stockpiling station on the island, and blood is stockpiled in each of the hospitals. Although Tokunoshima Tokushukai Hospital is responsible for 70% of transfusion medicine on Tokunoshima, it is difficult to maintain a sufficient amount of blood in stock considering disposal. Aim To determine whether changing the distribution of blood types in a hospital's stockpile would reduce the transfusion disposal rate. Methods This was a retrospective survey. By changing the in-house stock of blood products for transfusions delivered to our hospital over 10 years from January 2013 to December 2017 (preintervention) and from January 2018 to December 2022 (postintervention), we compared the cost-saving effects of these two intervention strategies on disposal rates and blood inventories, as well as the survival rates of case profiles requiring transfusion interventions in hospital-donated transfusion and ABO-incompatible transfusion between two periods. The hospital's stock of RBC had changes that storage of type (A, B, O, AB) RBC from (4, 4, 4, 2) units in the pre-interventon to (2, 2, 6, 0) units in the postintervention. Results The annual blood product waste rate decreased from 23.4% in the preintervention period to 17.9% in the post-intervention period. Conclusion By changing the blood products stockpiled for transfusion medicine in Tokunoshima, the transfusion disposal rate can be reduced.
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Affiliation(s)
- Takamitsu Sakamoto
- Fukuoka Tokushukai Medical Center, Department of General Medicine, Kasuga, Japan
- The Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | | | | | - Teruyoshi Amagai
- Faculty of Health Care Sciences, Department of Clinical Engineering, Jikei University of Health Care Sciences, Tokyo, Japan
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3
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Jajosky RP, Wu SC, Zheng L, Jajosky AN, Jajosky PG, Josephson CD, Hollenhorst MA, Sackstein R, Cummings RD, Arthur CM, Stowell SR. ABO blood group antigens and differential glycan expression: Perspective on the evolution of common human enzyme deficiencies. iScience 2023; 26:105798. [PMID: 36691627 PMCID: PMC9860303 DOI: 10.1016/j.isci.2022.105798] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Enzymes catalyze biochemical reactions and play critical roles in human health and disease. Enzyme variants and deficiencies can lead to variable expression of glycans, which can affect physiology, influence predilection for disease, and/or directly contribute to disease pathogenesis. Although certain well-characterized enzyme deficiencies result in overt disease, some of the most common enzyme deficiencies in humans form the basis of blood groups. These carbohydrate blood groups impact fundamental areas of clinical medicine, including the risk of infection and severity of infectious disease, bleeding risk, transfusion medicine, and tissue/organ transplantation. In this review, we examine the enzymes responsible for carbohydrate-based blood group antigen biosynthesis and their expression within the human population. We also consider the evolutionary selective pressures, e.g. malaria, that may account for the variation in carbohydrate structures and the implications of this biology for human disease.
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Affiliation(s)
- Ryan Philip Jajosky
- Joint Program in Transfusion Medicine, Brigham and Women’s Hospital, Harvard Medical School, 630E New Research Building, 77 Avenue Louis Pasteur, Boston, MA 02115, USA
- Biconcavity Inc, Lilburn, GA, USA
| | - Shang-Chuen Wu
- Joint Program in Transfusion Medicine, Brigham and Women’s Hospital, Harvard Medical School, 630E New Research Building, 77 Avenue Louis Pasteur, Boston, MA 02115, USA
| | - Leon Zheng
- Joint Program in Transfusion Medicine, Brigham and Women’s Hospital, Harvard Medical School, 630E New Research Building, 77 Avenue Louis Pasteur, Boston, MA 02115, USA
| | - Audrey N. Jajosky
- University of Rochester Medical Center, Department of Pathology and Laboratory Medicine, West Henrietta, NY, USA
| | | | - Cassandra D. Josephson
- Cancer and Blood Disorders Institute and Blood Bank/Transfusion Medicine Division, Johns Hopkins All Children’s Hospital, St. Petersburg, FL, USA
- Departments of Oncology and Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Marie A. Hollenhorst
- Department of Pathology and Department of Medicine, Stanford University, Stanford, CA, USA
| | - Robert Sackstein
- Translational Glycobiology Institute, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Richard D. Cummings
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Connie M. Arthur
- Joint Program in Transfusion Medicine, Brigham and Women’s Hospital, Harvard Medical School, 630E New Research Building, 77 Avenue Louis Pasteur, Boston, MA 02115, USA
| | - Sean R. Stowell
- Joint Program in Transfusion Medicine, Brigham and Women’s Hospital, Harvard Medical School, 630E New Research Building, 77 Avenue Louis Pasteur, Boston, MA 02115, USA
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4
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Uramatsu M, Maeda H, Mishima S, Takahashi M, Wada J, Amano K, Barach P, Miki T. Serious hazards of transfusion: evaluating the dangers of a wrong patient autologous salvaged blood in cardiac surgery. J Cardiothorac Surg 2022; 17:182. [PMID: 35974374 PMCID: PMC9382733 DOI: 10.1186/s13019-022-01931-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 08/09/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The past half century has seen the near eradication of transfusion-associated hazards. Intraoperative cell salvage while widely used still poses significant risks and hazards due to human error. We report on a case in which blood collected from a patient with lung cancer was mistakenly administered to a patient undergoing cardiac surgery who should have received his own collected blood. The initial investigation found that the cause of the patient harm was violations of procedures by hospital personnel. A detailed investigation revealed that not only violations were the cause, but also that the underlying causes included haphazard organizational policies, poor communication, workload and staffing deficiencies, human factors and cultural challenges. CASE PRESENTATION On August 14, 2019, a 72-year-old male was admitted to our hospital for angina pectoris and multivessel coronary artery disease. Cardiac surgery was performed using an autologous salvage blood collection system, and there were no major problems other than the prolonged operation time. During the night after the surgery, when the patient's blood pressure dropped, a nurse retrieved a blood bag from the ICU refrigerator that had been collected during the surgery and administered it at the physician's direction, but at this time neither the physician nor the nurse performed the required checking procedures. The blood administered was another patient's blood taken from another surgery the day before; an ABO mismatch transfusion occurred and the patient was diagnosed with DIC. The patient was discharged 65 days later after numerous interventions to support the patient. An accident investigation committee was convened to analyze the root causes and develop countermeasures to prevent a recurrence. CONCLUSION This adverse event occurred because the protocol for intraoperative blood salvage management was not clearly defined, and the procedure was different from the standard transfusion practices. We developed a new workflow based on a human factors grounded, systems-wide improvement strategy in which intraoperative blood collection would be administered before the patient leaves the operating room to completely prevent recurrence, instead of simply requiring front-line staff to do a double-check. Implementing strong systems processes can reduce the risk of errors, improve the reliability of the work processes and reduce the likelihood of patient harm occurring in the future.
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Affiliation(s)
- Masashi Uramatsu
- Department of Quality and Patient Safety, Tokyo Medical University, 6-7-1 Nishi-shinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan. .,Section of Medical Safety Management, Tokyo Medical University Hospital, 6-7-1 Nishi-shinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.
| | - Hideyuki Maeda
- Department of Forensic Medicine, Graduate School of Medicine, Tokyo Medical University, 1-1-1 Shinjuku, Shinjuku-ku, Tokyo, 160-8402, Japan
| | - Shiro Mishima
- Department of Quality and Patient Safety, Tokyo Medical University, 6-7-1 Nishi-shinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.,Section of Medical Safety Management, Tokyo Medical University Hospital, 6-7-1 Nishi-shinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Megumi Takahashi
- Department of Quality and Patient Safety, Tokyo Medical University, 6-7-1 Nishi-shinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.,Section of Medical Safety Management, Tokyo Medical University Hospital, 6-7-1 Nishi-shinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Jun Wada
- Department of Quality and Patient Safety, Tokyo Medical University, 6-7-1 Nishi-shinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.,Section of Medical Safety Management, Tokyo Medical University Hospital, 6-7-1 Nishi-shinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Kagehiro Amano
- Department of Laboratory Medicine, Tokyo Medical University Hospital, 6-7-1 Nishi-shinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Paul Barach
- Thomas Jefferson University School of Medicine, Philadelphia, PA, USA.,University of Queensland School of Medicine, Brisbane, Australia.,Medical University of Graz, Graz, Austria
| | - Tamotsu Miki
- Department of Quality and Patient Safety, Tokyo Medical University, 6-7-1 Nishi-shinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
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5
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Deveci B, Saba R, Altunay H, Toptas T, Kublashvilli G, Karadogan I. Severe Acute Hemolytic Transfusion Reaction Treated with Ruxolitinib and Plasma Exchange. Transfus Med Hemother 2021; 48:250-253. [PMID: 34539320 DOI: 10.1159/000513056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 11/13/2020] [Indexed: 12/29/2022] Open
Abstract
Introduction Acute hemolytic transfusion reaction is a rare but extremely mortal condition. Even small quantities of ABO-incompatible erythrocytes, as much as 50 mL, can lead to fatality. Since there is no successful standard therapy, preventive measures are very important. In this case report, we presented a 29-year-old woman who was transfused with 2 units of AB Rh-positive instead of 0 Rh-positive red blood cells following a cesarean section. As far as we know, this is the first patient in the literature for whom ruxolitinib was used as a part of therapy. Case Report The patient was referred to our center 22 h after the ABO-mismatched transfusion. On admission, she had severe hemolysis, acute renal failure, and disseminated intravascular coagulation. Massive plasma exchange, hemodialysis, and pulse steroid therapy were commenced. The patient was refractory to first-line therapies. She was intubated on day 2 due to hypoxia, respiratory failure and changes in consciousness. Ruxolitinib, 2 × 10 mg/day, was started on day 3. The patient's clinical status improved on day 6. Ruxolitinib was withdrawn on day 15, and the patient was discharged without any complications or sequels on day 26. Conclusion Ruxolitinib may be life-saving in patients with ABO-incompatible transfusion reaction which follows a severe and catastrophic course.
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Affiliation(s)
- Burak Deveci
- Hematology and Stem Cell Transplantation Unit, Medstar Antalya Hospital, Antalya, Turkey
| | - Rabin Saba
- Infectious Disease Unit, Medstar Antalya Hospital, Antalya, Turkey
| | - Husnu Altunay
- Blood Bank and Transfusion Center, Medstar Antalya Hospital, Antalya, Turkey
| | - Tayfur Toptas
- Department of Hematology, Marmara Universitesi Tip Fakultesi, Istanbul, Turkey
| | | | - Ihsan Karadogan
- Hematology and Stem Cell Transplantation Unit, Medstar Antalya Hospital, Antalya, Turkey
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6
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"This is the wrong patient's blood!": Evaluating a Near-Miss Wrong Transfusion Event. AORN J 2021; 113:125-127. [PMID: 33377512 DOI: 10.1002/aorn.13279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 09/08/2020] [Indexed: 11/09/2022]
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7
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Koepsell S. Complications of Transfusion. Transfus Med 2021. [DOI: 10.1002/9781119599586.ch16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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8
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Matsuoka N, Watanabe H, Kurooka N, Kato S, Higashi C, Tanabe K, Kinomura M, Fujii N, Sada KE, Sugiyama H, Wada J. Acute Kidney Injury Caused by Evans Syndrome with Systemic Lupus Erythematosus and Systemic Sclerosis. Intern Med 2021; 60:1055-1060. [PMID: 33116016 PMCID: PMC8079912 DOI: 10.2169/internalmedicine.5976-20] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
A 65-year-old woman with systemic sclerosis and systemic lupus erythematosus developed acute kidney injury (AKI), Coombs-positive autoimmune hemolytic anemia and autoimmune thrombocytopenia; therefore, she was diagnosed with Evans syndrome (ES). Intravascular hemolysis was suggested as the cause of AKI based on the presence of acute tubular injury and trace hemosiderin deposits on the renal biopsy. The renal function, hemolytic anemia and thrombocytopenia were restored by an increased dose of glucocorticoids, hemodialysis, and plasma exchange. Although ES with severe hemolytic anemia is very rare, it is important to detect possible renal dysfunction when encountering patients with severe hemolysis.
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Affiliation(s)
- Natsumi Matsuoka
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
| | - Haruki Watanabe
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
| | - Naoko Kurooka
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
| | - Sumari Kato
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
| | - Chika Higashi
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
| | - Katsuyuki Tanabe
- Division of Hemodialysis and Apheresis, Okayama University Hospital, Japan
| | - Masaru Kinomura
- Division of Hemodialysis and Apheresis, Okayama University Hospital, Japan
| | - Nobuharu Fujii
- Department of Transfusion Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
| | - Ken-Ei Sada
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
| | - Hitoshi Sugiyama
- Department of Human Resource Development of Dialysis Therapy for Kidney Disease, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
| | - Jun Wada
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
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9
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Karafin MS, Becker JL, Berg M, DeSimone RA, Draper NL, Hudgins J, Metcalf RA, Pagano MB, Park YA, Rossmann SN, Schwartz J, Souers R, Thomas L, Uhl L, Ramsey GE. Heterogeneity in Approaches for Switching From Universal to Patient ABO Type-Specific Blood Components During Massive Hemorrhage: An International Survey and Review of the Literature. Arch Pathol Lab Med 2021; 145:1499-1504. [PMID: 33720316 DOI: 10.5858/arpa.2020-0374-cp] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2020] [Indexed: 11/06/2022]
Abstract
CONTEXT.— ABO mistransfusions are rare and potentially fatal events. Protocols are required by regulatory agencies to minimize this risk to patients, but how these are applied in the context of massive transfusion protocols (MTPs) is not specifically defined. OBJECTIVE.— To evaluate the approaches used by transfusion services for switching from universally compatible to patient ABO type-specific blood components during massive hemorrhage. DESIGN.— We added 1 supplemental multiple-choice question to address the study objective to the 2019 College of American Pathologists proficiency test J-survey (J-A 2019). We also reviewed the available literature regarding this topic. RESULTS.— A total of 881 laboratories responded to the supplemental question. Approximately 80% (704 of 881) report a policy for ABO-type switching during an MTP. Policies varied considerably between responding laboratories, but most (384 of 704, 55%) required 2 ABO types to match before switching from universal to recipient-specific blood components. Additional safety measures used in a minority of these protocols included reaction strength criteria (103 of 704, 15%), on-call medical director approval (41 0f 704, 5.8%), universal red cell unit number limits (12 of 704, 1.7%), or the presence of a mixed field (3 of 704, 0.4%). CONCLUSIONS.— This survey reveals that significant heterogeneity exists regarding the available approaches for ABO-type switching during an MTP. Specific expert guidance regarding this issue is very limited, and best practices have not yet been established or rigorously investigated.
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Affiliation(s)
- Matthew S Karafin
- From Versiti, Medical Sciences Institute, Milwaukee, Wisconsin (Karafin).,Karafin is currently located in the Department of Pathology at the University of North Carolina, Chapel Hill.,The Department of Pathology, Medical College of Wisconsin, Milwaukee (Karafin)
| | - Joanne L Becker
- The Department of Pathology, Roswell Park Comprehensive Cancer Center, Buffalo, New York (Becker)
| | - Mary Berg
- The Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora (Berg, Draper)
| | - Robert A DeSimone
- The Department of Pathology and Laboratory Medicine, Weill Cornell Medical Center, New York, New York (DeSimone)
| | - Nicole L Draper
- The Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora (Berg, Draper)
| | - Jay Hudgins
- The Department of Pathology, Los Angeles Children's Hospital, University of Southern California Medical Center, Los Angeles, California (Hudgins)
| | - Ryan A Metcalf
- ARUP Blood Services, University of Utah School of Medicine, Salt Lake City (Metcalf)
| | - Monica B Pagano
- The Department of Laboratory Medicine, University of Washington Medical Center, Seattle (Pagano)
| | - Yara A Park
- The Department of Pathology and Laboratory Medicine, University of North Carolina Hospitals, Chapel Hill (Park)
| | | | - Joseph Schwartz
- The Department of Pathology, Columbia University Medical Center, New York, New York (Schwartz)
| | - Rhona Souers
- Statistics (Souers) and PT - Technical & Administration (Thomas), College of American Pathologists, Northfield, Illinois
| | - Lamont Thomas
- Statistics (Souers) and PT - Technical & Administration (Thomas), College of American Pathologists, Northfield, Illinois
| | - Lynne Uhl
- The Department of Laboratory and Transfusion Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Uhl)
| | - Glenn E Ramsey
- The Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois (Ramsey)
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10
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What does acute kidney injury and dark red-brown urine that appear after bone marrow transplantation tell us: Answers. Pediatr Nephrol 2021; 36:67-70. [PMID: 32588226 DOI: 10.1007/s00467-020-04592-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 04/14/2020] [Accepted: 04/24/2020] [Indexed: 10/24/2022]
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11
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Adkins BD, Booth GS, Vasu S. Transfusion support for stem cell transplant recipients. Semin Hematol 2020; 57:51-56. [PMID: 32892843 DOI: 10.1053/j.seminhematol.2020.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 06/04/2020] [Accepted: 07/15/2020] [Indexed: 01/28/2023]
Abstract
Hematopoietic stem cell patients regularly require transfusion support. Indications for transfusion in this population are similar to other patients being treated with chemoradiation; however, special considerations must be made in regards to pretransfusion testing, ABO compatibility, product modifications, and anticipated challenges while patients undergo engraftment. Additionally, infusion of hematopoietic stem cells requires acute understanding of product collection, modification, and potential side effects. As these patients often require numerous platelet transfusions, platelet refractoriness may be encountered and practice options are discussed. We review current indications and guidelines for transfusion in hematopoietic stem cell patients and make recommendations for best practice based on current literature.
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Affiliation(s)
- Brian D Adkins
- Department of Pathology, University of Virginia Health System, Charlottesville, VA, USA
| | - Garrett S Booth
- The Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sumithira Vasu
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA.
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12
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Samal P, Pradhan S, Das SS. Masquerading of mismatched blood transfusion by underlying autoimmune hemolytic anemia. Asian J Transfus Sci 2019; 13:142-144. [PMID: 31896924 PMCID: PMC6910039 DOI: 10.4103/ajts.ajts_154_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Accepted: 06/08/2018] [Indexed: 11/30/2022] Open
Abstract
Mismatched blood transfusion due to immunohematological discrepancy is relatively uncommon and in most instances occurs due to Type IV blood group discrepancy which is the discrepancies between forward and reverse groupings. Here, we present a case of a 15-year-old girl with preexisting autoimmune hemolytic anemia (AIHA) who inadvertently received 3 units of wrongly matched packed red blood cell (PRBC), followed by severe intravascular hemolysis. On detailed immunohematological investigation, the patient was found to be autoimmunized and diagnosed with “mixed AIHA” and the patient's blood group was confirmed as “A” positive. Three units of group-specific “best match” PRBC was transfused under close observation without any adverse effect. This highlights the importance of carrying out both forward and reverse blood groupings to avoid mismatched blood transfusion.
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Affiliation(s)
- Priyanka Samal
- Department of Clinical Hematology, IMS and SUM Hospital, Bhubaneswar, Odisha, India
| | - Sarita Pradhan
- Department of Pathology, Division of Hematology, IMS and SUM Hospital, Bhubaneswar, Odisha, India
| | - Sudipta Sekhar Das
- Department of Transfusion Medicine, Aapollo Gleneagles Hospital, Kolkata, West Bengal, India
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13
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Arthur CM, Chonat S, Fasano R, Yee MEM, Josephson CD, Roback JD, Stowell SR. Examining the Role of Complement in Predicting, Preventing, and Treating Hemolytic Transfusion Reactions. Transfus Med Rev 2019; 33:217-224. [PMID: 31679762 PMCID: PMC7147990 DOI: 10.1016/j.tmrv.2019.09.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 09/04/2019] [Accepted: 09/05/2019] [Indexed: 12/24/2022]
Abstract
Red blood cell (RBC) transfusion is a critical component of optimal management for a broad range of conditions. Regardless of the indication, pretransfusion testing is required to appropriately match RBC donors and recipients to provide immunologically compatible blood. Although this approach is effective in the vast majority of situations, occasionally, patients will inadvertently receive an incompatible RBC transfusion, which can result in a hemolytic transfusion reaction (HTR). In addition, patients with life-threatening anemia and a complex alloantibody profile, which precludes rapid procurement of compatible RBCs, may also receive incompatible RBCs, placing them at risk for an HTR. Despite the rarity of these clinical situations, when incompatible blood transfusion results in an HTR, the consequences can be devastating. In this review, we will explore the challenges associated with actively preventing and treating acute HTRs following incompatible RBC transfusion. In doing so, we will focus primarily on the role of complement, not only as a key player in HTRs, but also as a potential target for the prevention and treatment of HTRs.
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Affiliation(s)
- Connie M Arthur
- Aflac Cancer and Blood Disorders Center, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
| | - Satheesh Chonat
- Center for Transfusion Medicine and Cellular Therapies, Department of Laboratory Medicine and Pathology, Emory University School of Medicine, Atlanta, GA
| | - Ross Fasano
- Aflac Cancer and Blood Disorders Center, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA; Center for Transfusion Medicine and Cellular Therapies, Department of Laboratory Medicine and Pathology, Emory University School of Medicine, Atlanta, GA
| | - Marianne E M Yee
- Aflac Cancer and Blood Disorders Center, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA; Center for Transfusion Medicine and Cellular Therapies, Department of Laboratory Medicine and Pathology, Emory University School of Medicine, Atlanta, GA
| | - Cassandra D Josephson
- Aflac Cancer and Blood Disorders Center, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA; Center for Transfusion Medicine and Cellular Therapies, Department of Laboratory Medicine and Pathology, Emory University School of Medicine, Atlanta, GA
| | - John D Roback
- Center for Transfusion Medicine and Cellular Therapies, Department of Laboratory Medicine and Pathology, Emory University School of Medicine, Atlanta, GA
| | - Sean R Stowell
- Center for Transfusion Medicine and Cellular Therapies, Department of Laboratory Medicine and Pathology, Emory University School of Medicine, Atlanta, GA.
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14
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Glisch C, Jawa Z, Brener A, Carpenter E, Gottschall J, Treml A, Karafin MS. Evaluation of a two-sample process for prevention of ABO mistransfusions in a high volume academic hospital. BMJ Open Qual 2018; 7:e000270. [PMID: 30057954 PMCID: PMC6059318 DOI: 10.1136/bmjoq-2017-000270] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 06/05/2018] [Accepted: 06/19/2018] [Indexed: 11/17/2022] Open
Abstract
Background Acute haemolytic transfusion reactions due to ABO incompatible blood transfusion remain a leading cause of transfusion-associated morbidity and mortality in the USA. Erroneous patient identification and specimen labelling account for many errors that lead to ABO mistransfusions; these errors are largely preventable. Methods Our hospital requires a two-sample process of ABO/Rh typing prior to transfusion. Both samples must be drawn independently. To prevent simultaneous sample draw, our second sample tube has a unique pink top that is only available from the blood bank and can only be sent to the patient’s floor once the first sample arrives in the lab. We performed an audit of this process from 19 March to 30 July 2014 and 19 March to 30 July 2015. Results We reviewed type and crossmatch orders for 2702 new patients during the audit period and 824 patients (30.5%) required transfusion. All patients evaluated received compatible blood, and no mistransfusions were recorded using this method. Three per cent of testing was performed incorrectly, which safely defaulted to giving type O blood. Conclusions The two-sample protocol used by our institution can decrease the risk of mistransfusion. Our protocol was relatively inexpensive, safe, efficient and practical for adaptation by other hospitals.
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Affiliation(s)
- Chad Glisch
- Internal Medicine, Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Zeeshan Jawa
- Internal Medicine, Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Alina Brener
- Internal Medicine, Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Erica Carpenter
- Internal Medicine, Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Wisconsin Diagnostic Laboratories, Milwaukee, Wisconsin, USA
| | - Jerome Gottschall
- Internal Medicine, Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Medical Sciences Institute, Blood Center of Wisconsin, Milwaukee, Wisconsin, USA
| | - Angela Treml
- Internal Medicine, Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Medical Sciences Institute, Blood Center of Wisconsin, Milwaukee, Wisconsin, USA
| | - Matthew Scott Karafin
- Internal Medicine, Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Medical Sciences Institute, Blood Center of Wisconsin, Milwaukee, Wisconsin, USA
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15
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Gammon RR, Alvarez H, Benitez N. Rare blood donor needed. Transfusion 2018; 58:1890-1893. [PMID: 29664201 DOI: 10.1111/trf.14625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 03/03/2018] [Accepted: 03/03/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Here, we describe a 14-year-old male with leukocyte adhesion deficiency type 2 who was transferred to a university hospital with anemia (hemoglobin 6 g/dL) and multiple singular abscesses refractory to antimicrobials. CASE REPORT As leukocyte adhesion deficiency type 2 is associated with Bombay phenotype, the patient's red blood cells (RBCs) were tested with commercial anti-H lectin Ulex europaeus. An allogeneic adsorption with phenotype-matched cells was performed. RBCs negative for H antigen (Oh ) were tested with patient's plasma. The American Rare Donor Program was contacted to find granulocyte donors. The patient was Bombay phenotype (Oh ). All major clinically significant alloantibodies were excluded testing Oh cells and allogeneic adsorbed plasma. Two Bombay RBC units and five doses of granulocytes were requested from the blood center. Two frozen Bombay RBC units were obtained through another blood center. The American Rare Donor Program found one eligible granulocyte donor who lived 4 hours by car from the collection center. Because of this concern and other major logistic challenges, the blood center considered other options. These methods included gravity sedimentation and a cell separation system to isolate the RBCs from granulocytes. Unfortunately, neither one could be implemented. Auspiciously, the patient's condition improved and granulocytes were no longer needed. CONCLUSION To avoid the challenge of finding compatible granulocyte donors for patients with rare blood types and clinically significant antibodies, our blood center considered validating and implementing gravity separation to remove the incompatible RBCs from granulocyte collections.
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Affiliation(s)
- Richard R Gammon
- Scientific Medical and Technical Administration, OneBlood, Inc, Orlando, Florida
| | - Harold Alvarez
- Scientific Medical and Technical Administration, OneBlood, Inc, Orlando, Florida
| | - Nancy Benitez
- Immunohematology Reference Laboratory, OneBlood, Inc, Orlando, Florida
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16
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Strauss R, Downie H, Wilson A, Mounchili A, Berry B, Cserti-Gazdewich C, Callum J. Sample collection and sample handling errors submitted to the transfusion error surveillance system, 2006 to 2015. Transfusion 2018; 58:1697-1707. [PMID: 29664144 DOI: 10.1111/trf.14608] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 01/02/2018] [Accepted: 02/14/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND In Canada, transfusion-related errors are voluntarily reported to a tracking system with the goal to systematically improve transfusion safety. This report provides an analysis of sample collection (SC) and sample handling (SH) errors from this national error-tracking system. STUDY DESIGN AND METHODS Errors from 2006 to 2015 from 23 participating sites were extracted. A survey was conducted to obtain information regarding institutional policies. Samples received in the blood bank were used to calculate rates. "Wrong blood in tube" (WBIT) errors are blood taken from wrong patient and labeled with intended patient's information, or blood taken from intended patient but labeled with another patient's information. RESULTS A total of 42,363 SC and 14,666 SH errors were reported. Predefined low-severity (low potential for harm) and high-severity errors (potential for fatal outcomes) increased from 2006 to 2015 (low SC, SH: 13-27, 3-12 per 1000; high SC, SH: 1.9-3.7, 0.5-2.0 per 1000). The WBIT rate decreased from 12 to 5.8 per 10,000 between 2006 and 2015 (p < 0.0001). The overall WBIT rate was 6.2 per 10,000, with variability by site (median, 0.3 per 10,000; range, 0-17 per 10,000). Sites with error detection mechanisms, such as regrouping second sample requirements, had lower error rates than sites that did not (SC, SH: 12, 1 per 1000 samples vs. 17, 3 per 1000 samples; p < 0.0001). CONCLUSION WBIT rates decreased significantly. Low-severity error rates are climbing likely due to increased ascertainment and reporting. Prevention studies are necessary to inform changes to blood transfusion standards to eliminate these errors.
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Affiliation(s)
| | - Helen Downie
- Department of Clinical Pathology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Ann Wilson
- Department of Hematology, McGill University Health Centre, Montreal, Québec, Canada
| | | | - Brian Berry
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Christine Cserti-Gazdewich
- Department of Laboratory Medicine, University Health Network, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Jeannie Callum
- Department of Clinical Pathology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
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17
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Stowell SR. Toward functional assays for assessing the significance of anti-ABO(H) alloantibodies. Transfusion 2018; 57:491-494. [PMID: 28297078 DOI: 10.1111/trf.14030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 12/29/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Sean R Stowell
- Center for Transfusion and Cellular Therapies, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA
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18
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Nickel RS, Qayed M, Worthington-White D, Stowell SR, Chiang KY. Infusion hemolysis after pediatric major ABO-mismatched bone marrow transplant: Comparison of two red blood cell depletion techniques. Pediatr Blood Cancer 2018; 65:10.1002/pbc.26883. [PMID: 29115715 PMCID: PMC5766410 DOI: 10.1002/pbc.26883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 09/20/2017] [Accepted: 10/12/2017] [Indexed: 11/11/2022]
Abstract
BACKGROUND During major ABO-mismatched bone marrow transplant (BMT), the infusion of incompatible red blood cells (RBCs) that are present in the bone marrow graft can cause adverse events from hemolysis. RBC depletion of the bone marrow graft can decrease this risk, but the optimal method to prevent hemolysis is unclear. PROCEDURE We conducted a retrospective cohort study of patients who underwent major ABO-mismatched BMT at a pediatric center and had RBC depletion with either hydroxyethyl starch (HES) sedimentation or Ficoll density gradient separation. Postinfusion hemoglobinuria and creatinine values were compared. RESULTS Between 2002 and 2016, 37 patients received HES-treated and 16 patients received Ficoll-treated major ABO-mismatched bone marrow grafts. The median residual volume of RBCs was significantly greater with HES-treated grafts (HES 21.0 ml vs. Ficoll 1.4 ml, P < 0.0001). Patients who received HES-treated grafts had a higher prevalence of postinfusion hemoglobinuria (HES 57% vs. Ficoll 6%, P = 0.0009), but renal impairment was rare. Considering only HES-treated grafts, the volume of RBCs was not associated with either postinfusion hemoglobinuria or a creatinine increase. CONCLUSIONS Ficoll density gradient separation achieves smaller RBC volumes and less postinfusion hemoglobinuria than HES sedimentation, but both can prevent significant hemolysis. Further studies are needed to determine the residual incompatible RBC volume threshold in major ABO-mismatched BMT.
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Affiliation(s)
- Robert Sheppard Nickel
- Division of Hematology, Children’s National Health System, Washington, DC 20310,Corresponding Author: , 111 Michigan Ave NW, Washington, DC 20010, Phone 202-476-3122, Fax 202-476-5685
| | - Muna Qayed
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Emory University, Atlanta, GA 30322
| | - Diana Worthington-White
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Emory University, Atlanta, GA 30322
| | - Sean R. Stowell
- Center for Transfusion and Cellular Therapy, Department of Pathology, Emory University, Atlanta, GA 30322
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19
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Namikawa A, Shibuya Y, Ouchi H, Takahashi H, Furuto Y. A case of ABO-incompatible blood transfusion treated by plasma exchange therapy and continuous hemodiafiltration. CEN Case Rep 2018; 7:114-120. [PMID: 29383577 PMCID: PMC5886938 DOI: 10.1007/s13730-018-0307-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 01/11/2018] [Indexed: 01/30/2023] Open
Abstract
ABO-incompatible blood transfusion is potentially a life-threatening event. A 74-year-old type O Rh-positive male was accidentally transfused with 280 mL type B Rh-positive red blood cells during open right hemicolectomy, causing ABO-incompatible blood transfusion. Immediately after the transfusion, the patient experienced a hypotension episode followed by acute hemolytic reaction, disseminated intravascular coagulation and acute kidney injury. Plasma exchange therapy was performed to remove anti-B antibody and free hemoglobin because they caused acute hemolytic reaction, disseminated intravascular coagulation, and acute kidney injury. Free hemoglobin levels decreased from 13 to 2 mg/dL for 2 h. Continuous hemodiafiltration was used to stabilize hemodynamics. The patient was successfully treated for acute hemolytic reaction, disseminated intravascular coagulation, and acute kidney injury. Plasma exchange therapy and continuous hemodiafiltration are likely to be effective treatments for ABO-incompatible blood transfusion, and further studies are required to assess this effectiveness in future.
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Affiliation(s)
- Akio Namikawa
- Department of Hypertension and Nephrology, NTT Medical Center Tokyo, 5-9-22 Higash-Gotanda, Shinagawa-ku, Tokyo, 141-8625, Japan.
| | - Yuko Shibuya
- Department of Hypertension and Nephrology, NTT Medical Center Tokyo, 5-9-22 Higash-Gotanda, Shinagawa-ku, Tokyo, 141-8625, Japan
| | - Haruki Ouchi
- Department of Hypertension and Nephrology, NTT Medical Center Tokyo, 5-9-22 Higash-Gotanda, Shinagawa-ku, Tokyo, 141-8625, Japan
| | - Hiroko Takahashi
- Department of Hypertension and Nephrology, NTT Medical Center Tokyo, 5-9-22 Higash-Gotanda, Shinagawa-ku, Tokyo, 141-8625, Japan
| | - Yoshitaka Furuto
- Department of Hypertension and Nephrology, NTT Medical Center Tokyo, 5-9-22 Higash-Gotanda, Shinagawa-ku, Tokyo, 141-8625, Japan
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20
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Abstract
Transfusion reactions are common occurrences, and clinicians who order or transfuse blood components need to be able to recognize adverse sequelae of transfusion. The differential diagnosis of any untoward clinical event should always consider adverse sequelae of transfusion, even when transfusion occurred weeks earlier. There is no pathognomonic sign or symptom that differentiates a transfusion reaction from other potential medical problems, so vigilance is required during and after transfusion when a patient presents with a change in clinical status. This review covers the presentation, mechanisms, and management of transfusion reactions that are commonly encountered, and those that can be life-threatening.
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Affiliation(s)
- William J Savage
- Transfusion Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Amory 260, Boston, MA 02115, USA.
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21
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Mahjoub S, Baccouche H, Raissi A, Ben Hamed L, Ben Romdhane N. Hémovigilance à Tunis (hôpital La Rabta) : bilan 2007–2013. Transfus Clin Biol 2017; 24:15-22. [DOI: 10.1016/j.tracli.2015.12.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 12/30/2015] [Indexed: 12/20/2022]
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22
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Cunnion KM, Hair PS, Krishna NK, Sass MA, Enos CW, Whitley PH, Maes LY, Goldberg CL. Discriminating the hemolytic risk of blood type A plasmas using the complement hemolysis using human erythrocytes (CHUHE) assay. Transfusion 2016; 57:517-524. [DOI: 10.1111/trf.13948] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 10/06/2016] [Accepted: 10/12/2016] [Indexed: 12/25/2022]
Affiliation(s)
- Kenji M. Cunnion
- Department of Pediatrics; Eastern Virginia Medical School; Norfolk Virginia
- Children's Specialty Group; Norfolk Virginia
- Department of Pediatrics; Children's Hospital of the King's Daughters; Norfolk Virginia
| | - Pamela S. Hair
- Department of Pediatrics; Eastern Virginia Medical School; Norfolk Virginia
| | - Neel K. Krishna
- Department of Pediatrics; Eastern Virginia Medical School; Norfolk Virginia
- Department of Microbiology and Molecular Cell Biology; Eastern Virginia Medical School; Norfolk Virginia
| | - Megan A. Sass
- Department of Pediatrics; Eastern Virginia Medical School; Norfolk Virginia
| | - Clinton W. Enos
- Department of Pediatrics; Eastern Virginia Medical School; Norfolk Virginia
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23
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Complications of Transfusion. Transfus Med 2016. [DOI: 10.1002/9781119236504.ch14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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24
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Fully automated, clinical-grade bone marrow processing: a single-centre experience. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2016; 15:577-584. [PMID: 27723450 DOI: 10.2450/2016.0057-16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 07/19/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND Clinical grade processing of harvested bone marrow is required in various clinical situations, particularly in the management of ABO mismatching in allogeneic haematopoietic stem cell transplantation (HSCT) and in regenerative medicine. MATERIAL AND METHODS We report a single-centre experience using a fully automated, clinical grade, closed system (Sepax, Biosafe, Switzerland). From 2003 to 2015, 125 procedures were performed in our laboratory, including buffy-coat production for HSCT (n=58), regenerative medicine in an orthopaedic setting (n=54) and density-gradient separation in a trial for treatment of critical limb ischaemia (n=13). RESULTS Buffy coat separation resulted in a median volume reduction of 85% (range, 75-87%), providing satisfactory red blood cell depletion (69%, range 30-88%) and a median recovery of CD34 cells of 96% (range, 81-134%) in the setting of allogeneic HSCT. Significantly greater volume reduction (90%; range, 90-92%) and red blood cell depletion (88%; range, 80-93%) were achieved by the new SmartRedux software released for Sepax2, validated in the last eight allogeneic HSCT. The density gradient separation programme resulted in complete red blood cell depletion associated with high CD34 recovery (69%; range, 36-124%). No reactions related to the quality of the product were reported. Time to engraftment following allogeneic HSCT was in the normal range. No cases of microbiological contamination related to the manipulation were reported. DISCUSSION Clinical grade, automated bone marrow manipulation with Sepax was shown to be effective, giving operator-independent results and could be used for a broad range of clinical applications.
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25
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Staley EM, Schwartz J, Pham HP. An update on ABO incompatible hematopoietic progenitor cell transplantation. Transfus Apher Sci 2016; 54:337-44. [PMID: 27211814 DOI: 10.1016/j.transci.2016.05.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Hematopoietic progenitor cell (HPC) transplantation has long been established as the optimal treatment for many hematologic malignancies. In the setting of allogenic HLA matched HPC transplantation, greater than 50% of unrelated donors and 30% of related donors demonstrate some degree of ABO incompatibility (ABOi), which is classified in one of three ways: major, minor, or bidirectional. Major ABOi refers to the presence of recipient isoagglutinins against the donor's A and/or B antigen. Minor ABOi occurs when the HPC product contains the isoagglutinins targeting the recipient's A and/or B antigen. Bidirectional refers to the presence of both major and minor ABOi. Major adverse events associated with ABOi HPC transplantation includes acute and delayed hemolysis, pure red cell aplasia, and delayed engraftment. ABOi HPC transplantation poses a unique challenge to the clinical transplantation unit, the HPC processing lab, and the transfusion medicine service. Therefore, it is essential that these services actively communicate with one another to ensure patient safety. This review will attempt to globally address the challenges related to ABOi HPC transplantation, with an increased focus on aspects related to the laboratory and transfusion medicine services.
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Affiliation(s)
- Elizabeth M Staley
- Department of Pathology, Division of Laboratory Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Joseph Schwartz
- Department of Pathology and Cell Biology, Columbia University Medical Center and the New York-Presbyterian Hospital, New York, NY, USA
| | - Huy P Pham
- Department of Pathology, Division of Laboratory Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
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26
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Knowledge, attitudes and clinical practice of blood products prescribers in Niamey. Transfus Clin Biol 2016; 23:78-85. [DOI: 10.1016/j.tracli.2015.11.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 11/30/2015] [Indexed: 11/23/2022]
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27
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Cunnion KM, Hair PS, Krishna NK, Whitley PH, Goldberg CL, Fadeyi EA, Maes LY. Discriminating complement-mediated acute transfusion reaction for type O+ red blood cells transfused into a B+ recipient with the complement hemolysis using human erythrocytes (CHUHE) assay. Transfusion 2016; 56:1845-8. [DOI: 10.1111/trf.13592] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 01/25/2016] [Accepted: 02/23/2016] [Indexed: 12/23/2022]
Affiliation(s)
- Kenji M. Cunnion
- Department of Pediatrics; Eastern Virginia Medical School
- Children's Specialty Group
- Children's Hospital of the King's Daughters
- Department of Microbiology and Molecular Cell Biology; Eastern Virginia Medical School
| | - Pamela S. Hair
- Department of Pediatrics; Eastern Virginia Medical School
| | - Neel K. Krishna
- Department of Pediatrics; Eastern Virginia Medical School
- Department of Microbiology and Molecular Cell Biology; Eastern Virginia Medical School
| | | | | | - Emmanuel A. Fadeyi
- Department of Pathology; Wake Forest School of Medicine; Winston-Salem North Carolina
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28
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Balvers K, Saleh S, Zeerleder SS, Klinkspoor JH, Goslings JC, Juffermans NP. Are there any alternatives for transfusion of AB plasma as universal donor in an emergency release setting? Transfusion 2016; 56:1469-74. [DOI: 10.1111/trf.13527] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 01/03/2016] [Accepted: 01/05/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Kirsten Balvers
- Trauma Unit, Department of Surgery; Academic Medical Center; Amsterdam the Netherlands
- Department of Intensive Care Medicine; Academic Medical Center; Amsterdam the Netherlands
| | - Sarah Saleh
- Trauma Unit, Department of Surgery; Academic Medical Center; Amsterdam the Netherlands
- Department of Intensive Care Medicine; Academic Medical Center; Amsterdam the Netherlands
| | - Sacha S. Zeerleder
- Department of Hematology; Academic Medical Center; Amsterdam the Netherlands
- Department of Immunopathology; Sanquin Research; Academic Medical Center; Amsterdam the Netherlands
| | - J. Henriette Klinkspoor
- Laboratory for General Clinical Chemistry; Academic Medical Center; Amsterdam the Netherlands
| | - J. Carel Goslings
- Trauma Unit, Department of Surgery; Academic Medical Center; Amsterdam the Netherlands
| | - Nicole P. Juffermans
- Department of Intensive Care Medicine; Academic Medical Center; Amsterdam the Netherlands
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29
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Tekgündüz SA, Özbek N. ABO blood group mismatched hematopoietic stem cell transplantation. Transfus Apher Sci 2016; 54:24-9. [DOI: 10.1016/j.transci.2016.01.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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30
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Kopko PM. Transfusion Support for ABO-Incompatible Progenitor Cell Transplantation. Transfus Med Hemother 2016; 43:13-8. [PMID: 27022318 PMCID: PMC4797464 DOI: 10.1159/000441612] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 08/05/2015] [Indexed: 11/19/2022] Open
Abstract
ABO-incompatible transplants comprise up to 50% of allogeneic progenitor cell transplants. Major, minor and bidirectional ABO-incompatible transplants each have unique complications that can occur, including hemolysis at the time of progenitor cell infusion, hemolysis during donor engraftment, passenger lymphocyte syndrome, delayed red blood cell engraftment, and pure red cell aplasia. Appropriate transfusion support during the different phases of the allogeneic progenitor cell transplant process is an important part of ABO-incompatible transplantation.
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Affiliation(s)
- Patricia M. Kopko
- Department of Pathology, University of California, San Diego, CA, USA
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31
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Furumaki H, Fujihara H, Yamada C, Watanabe H, Shibata H, Kaneko M, Nagai S, Ishizuka K, Tsuzuki M, Adachi M, Takeshita A. Involvement of transfusion unit staff in the informed consent process. Transfus Apher Sci 2015; 54:150-7. [PMID: 26878975 DOI: 10.1016/j.transci.2015.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Revised: 12/02/2015] [Accepted: 12/18/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVES Obtaining informed consent (IC) for a blood transfusion is an absolute requirement. In this study, we compared the depth of understanding of blood transfusion among patients with or without an explanation by the transfusion unit staff and evaluated the usefulness of this intervention in obtaining IC. MATERIALS AND METHODS Expert staff from the transfusion unit started to provide patients with a basic explanation of blood transfusion (intervention group, n = 129). The efficacy of this strategy was assessed by comparison with explanation given by the primary doctors only (conventional group, n = 31). We performed a questionnaire survey to analyze the length of time spent providing information of blood transfusion and the depth of understanding of blood transfusion in the two groups. RESULTS The median time in providing information in the conventional and intervention groups was 6 and 20 minutes, respectively (P < 0.0001). Patients in the intervention group had a better understanding of several key points on blood transfusion than those in the conventional group. CONCLUSION Our results show that expert staff from the transfusion unit should be involved in obtaining IC for a blood transfusion. Patients who were provided information by transfusion unit staff were more likely to have a better understanding of the risks and benefits of transfusion.
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Affiliation(s)
- Hiroaki Furumaki
- Transfusion and Cell Therapy, Hamamatsu University School of Medicine, Hamamatsu, 431-3192, Japan
| | - Harumi Fujihara
- Transfusion and Cell Therapy, Hamamatsu University School of Medicine, Hamamatsu, 431-3192, Japan
| | - Chiaki Yamada
- Transfusion and Cell Therapy, Hamamatsu University School of Medicine, Hamamatsu, 431-3192, Japan
| | - Hiroko Watanabe
- Transfusion and Cell Therapy, Hamamatsu University School of Medicine, Hamamatsu, 431-3192, Japan
| | - Hiroki Shibata
- Transfusion and Cell Therapy, Hamamatsu University School of Medicine, Hamamatsu, 431-3192, Japan
| | - Makoto Kaneko
- Transfusion and Cell Therapy, Hamamatsu University School of Medicine, Hamamatsu, 431-3192, Japan
| | - Seiya Nagai
- Transfusion and Cell Therapy, Hamamatsu University School of Medicine, Hamamatsu, 431-3192, Japan
| | - Keiko Ishizuka
- Transfusion and Cell Therapy, Hamamatsu University School of Medicine, Hamamatsu, 431-3192, Japan
| | - Mariko Tsuzuki
- Transfusion and Cell Therapy, Hamamatsu University School of Medicine, Hamamatsu, 431-3192, Japan
| | - Miwa Adachi
- Transfusion and Cell Therapy, Hamamatsu University School of Medicine, Hamamatsu, 431-3192, Japan
| | - Akihiro Takeshita
- Transfusion and Cell Therapy, Hamamatsu University School of Medicine, Hamamatsu, 431-3192, Japan.
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32
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Xu GP, Wu LF, Li JJ, Gao Q, Liu ZD, Kang QH, Hou YJ, Zhang LC, Hu XM, Li J, Zhang J. Performance Assessment of Internal Quality Control (IQC) Products in Blood Transfusion Compatibility Testing in China. PLoS One 2015; 10:e0141145. [PMID: 26488582 PMCID: PMC4619478 DOI: 10.1371/journal.pone.0141145] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Accepted: 10/04/2015] [Indexed: 11/23/2022] Open
Abstract
Internal quality control (IQC) is a critical component of laboratory quality management, and IQC products can determine the reliability of testing results. In China, given the fact that most blood transfusion compatibility laboratories do not employ IQC products or do so minimally, there is a lack of uniform and standardized IQC methods. To explore the reliability of IQC products and methods, we studied 697 results from IQC samples in our laboratory from 2012 to 2014. The results showed that the sensitivity and specificity of the IQCs in anti-B testing were 100% and 99.7%, respectively. The sensitivity and specificity of the IQCs in forward blood typing, anti-A testing, irregular antibody screening, and cross-matching were all 100%. The reliability analysis indicated that 97% of anti-B testing results were at a 99% confidence level, and 99.9% of forward blood typing, anti-A testing, irregular antibody screening, and cross-matching results were at a 99% confidence level. Therefore, our IQC products and methods are highly sensitive, specific, and reliable. Our study paves the way for the establishment of a uniform and standardized IQC method for pre-transfusion compatibility testing in China and other parts of the world.
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Affiliation(s)
- Gui-Ping Xu
- Transfusion Department, the Second Hospital Affiliated to Chongqing Medical University, Chongqing, China
| | - Li-Fang Wu
- The Department of Laboratory Medicine, the Second Hospital Affiliated to Chongqing Medical University, Chongqing, China
| | - Jing-Jing Li
- Transfusion Department, the Second Hospital Affiliated to Chongqing Medical University, Chongqing, China
| | - Qi Gao
- Transfusion Department, the Second Hospital Affiliated to Chongqing Medical University, Chongqing, China
| | - Zhi-Dong Liu
- Transfusion Department, the Second Hospital Affiliated to Chongqing Medical University, Chongqing, China
| | - Qiong-Hua Kang
- Transfusion Department, the Second Hospital Affiliated to Chongqing Medical University, Chongqing, China
| | - Yi-Jun Hou
- Transfusion Department, the Second Hospital Affiliated to Chongqing Medical University, Chongqing, China
| | - Luo-Chuan Zhang
- Transfusion Department, the Second Hospital Affiliated to Chongqing Medical University, Chongqing, China
| | - Xiao-Mei Hu
- Transfusion Department, the Second Hospital Affiliated to Chongqing Medical University, Chongqing, China
| | - Jie Li
- Transfusion Department, the Second Hospital Affiliated to Chongqing Medical University, Chongqing, China
| | - Juan Zhang
- Transfusion Department, the Second Hospital Affiliated to Chongqing Medical University, Chongqing, China
- * E-mail:
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Nickel RS, Waller EK, Qayed M, Chiang KY. Clinically significant adverse events after major ABO mismatch BMT. Bone Marrow Transplant 2015; 51:148-9. [PMID: 26437061 DOI: 10.1038/bmt.2015.230] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- R S Nickel
- Department of Pathology, Center for Transfusion and Cellular Therapy, Emory University, Atlanta, GA, USA.,Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University, Atlanta, GA, USA.,Division of Hematology, Children's National Health System, Washington, DC, USA
| | - E K Waller
- Department of Pathology, Center for Transfusion and Cellular Therapy, Emory University, Atlanta, GA, USA.,Division of Stem Cell Transplantation and Immunotherapy, Emory University, Atlanta, GA, USA
| | - M Qayed
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University, Atlanta, GA, USA
| | - K-Y Chiang
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University, Atlanta, GA, USA
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Flegel WA. Pathogenesis and mechanisms of antibody-mediated hemolysis. Transfusion 2015; 55 Suppl 2:S47-58. [PMID: 26174897 DOI: 10.1111/trf.13147] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 03/24/2015] [Accepted: 03/25/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND The clinical consequences of antibodies to red blood cells (RBCs) have been studied for a century. Most clinically relevant antibodies can be detected by sensitive in vitro assays. Several mechanisms of antibody-mediated hemolysis are well understood. Such hemolysis after transfusion is reliably avoided in a donor-recipient pair, if one individual is negative for the cognate antigen to which the other has the antibody. STUDY DESIGN AND RESULTS Mechanisms of antibody-mediated hemolysis were reviewed based on a presentation at the Strategies to Address Hemolytic Complications of Immune Globulin Infusions Workshop addressing intravenous immunoglobulin (IVIG) and ABO antibodies. The presented topics included the rates of intravascular and extravascular hemolysis; immunoglobulin (Ig)M and IgG isoagglutinins; auto- and alloantibodies; antibody specificity; A, B, A,B, and A1 antigens; A1 versus A2 phenotypes; monocytes-macrophages, other immune cells, and complement; monocyte monolayer assay; antibody-dependent cell-mediated cytotoxicity; and transfusion reactions due to ABO and other antibodies. CONCLUSION Several clinically relevant questions remained unresolved, and diagnostic tools were lacking to routinely and reliably predict the clinical consequences of RBC antibodies. Most hemolytic transfusion reactions associated with IVIG were due to ABO antibodies. Reducing the titers of such antibodies in IVIG may lower the frequency of this kind of adverse event. The only way to stop these events is to have no anti-A or anti-B in the IVIG products.
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Affiliation(s)
- Willy A Flegel
- Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, Maryland
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35
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Scott DE, Epstein JS. Safeguarding immune globulin recipients against hemolysis: what do we know and where do we go? Transfusion 2015; 55 Suppl 2:S122-6. [DOI: 10.1111/trf.13196] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Indexed: 01/22/2023]
Affiliation(s)
- Dorothy E. Scott
- Office of Blood Research and Review, Center for Biologics Evaluation and Research; US Food and Drug Administration; Silver Spring Maryland
| | - Jay S. Epstein
- Office of Blood Research and Review, Center for Biologics Evaluation and Research; US Food and Drug Administration; Silver Spring Maryland
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36
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Fujihara H, Yamada C, Furumaki H, Nagai S, Shibata H, Ishizuka K, Watanabe H, Kaneko M, Adachi M, Takeshita A. Evaluation of the in-hospital hemovigilance by introduction of the information technology-based system. Transfusion 2015; 55:2898-904. [PMID: 26173656 DOI: 10.1111/trf.13228] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 05/31/2015] [Accepted: 06/01/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Hemovigilance is an important aspect of transfusion medicine. However, the frequency of the adverse reactions often varies using different reporters. Recently, we have employed a new information technology (IT)-based in-hospital hemovigilance system. Here, we evaluated changes in practice after implementation of an IT-based reporting system. STUDY DESIGN AND METHODS We compared the rate of frequency and details of blood transfusion-related adverse reactions 3 years before and after introduction of the IT-based reporting system. Contents and severity of the adverse reactions were reported in a paper-based reporting system, but input by selecting items in an IT-based reporting system. The details of adverse reactions are immediately sent to the blood transfusion unit online. RESULTS After we introduced the IT-based reporting system, the reported rate of transfusion-related adverse reactions increased approximately 10-fold from 0.20% to 2.18% (p < 0.001), and frequencies of urticaria, pruritus, rash, fever (p < 0.001), hypertension (p = 0.001), tachycardia (p = 0.003), and nausea and vomiting (p = 0.010) increased significantly. Although there was no error report in the paper-based reporting, incorrect reports were observed in 90 cases (0.52%) in the IT-based reporting (p < 0.001). CONCLUSION The advantages of IT-based reporting were: 1) a significant increase in the frequency of adverse reaction reporting and 2) a significant decrease in underreporting, although the true frequency has yet to be clarified. The disadvantage of the IT-based reporting was an increased incidence of incorrect inputs, all of which was unnoticed by the reporters. Our results showed several important points in need of monitoring after introduction of an IT-based reporting system.
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Affiliation(s)
- Harumi Fujihara
- Transfusion and Cell Therapy, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Chiaki Yamada
- Transfusion and Cell Therapy, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hiroaki Furumaki
- Transfusion and Cell Therapy, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Seiya Nagai
- Transfusion and Cell Therapy, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hiroki Shibata
- Transfusion and Cell Therapy, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Keiko Ishizuka
- Transfusion and Cell Therapy, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hiroko Watanabe
- Transfusion and Cell Therapy, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Makoto Kaneko
- Transfusion and Cell Therapy, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Miwa Adachi
- Transfusion and Cell Therapy, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Akihiro Takeshita
- Transfusion and Cell Therapy, Hamamatsu University School of Medicine, Hamamatsu, Japan
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Villa CH, Pan DC, Zaitsev S, Cines DB, Siegel DL, Muzykantov VR. Delivery of drugs bound to erythrocytes: new avenues for an old intravascular carrier. Ther Deliv 2015; 6:795-826. [PMID: 26228773 PMCID: PMC4712023 DOI: 10.4155/tde.15.34] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
For several decades, researchers have used erythrocytes for drug delivery of a wide variety of therapeutics in order to improve their pharmacokinetics, biodistribution, controlled release and pharmacodynamics. Approaches include encapsulation of drugs within erythrocytes, as well as coupling of drugs onto the red cell surface. This review focuses on the latter approach, and examines the delivery of red blood cell (RBC)-surface-bound anti-inflammatory, anti-thrombotic and anti-microbial agents, as well as RBC carriage of nanoparticles. Herein, we discuss the progress that has been made in surface loading approaches, and address in depth the issues relevant to surface loading of RBC, including intrinsic features of erythrocyte membranes, immune considerations, potential surface targets and techniques for the production of affinity ligands.
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Affiliation(s)
- Carlos H Villa
- Department of Pathology & Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Daniel C Pan
- Department of Systems Pharmacology & Translational Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Sergei Zaitsev
- Department of Systems Pharmacology & Translational Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Douglas B Cines
- Department of Pathology & Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Donald L Siegel
- Department of Pathology & Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Vladimir R Muzykantov
- Department of Systems Pharmacology & Translational Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
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39
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Castillo N, García-Cadenas I, García O, Barba P, Diaz-Heredia C, Martino R, Azqueta C, Ferrà C, Canals C, Elorza I, Olivé T, Badell I, Sierra J, Duarte R, Valcárcel D, Querol S. Few and nonsevere adverse infusion events using an automated method for diluting and washing before unrelated single cord blood transplantation. Biol Blood Marrow Transplant 2014; 21:682-7. [PMID: 25545727 DOI: 10.1016/j.bbmt.2014.12.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 12/15/2014] [Indexed: 12/30/2022]
Abstract
Graft dilution and DMSO washing before cord blood (CB) administration using an automated system may offer low incidence of adverse infusion events (AIE), ensuring reproducible cell yields. Hence, we analyzed the incidences and significance of immediate AIE, cellular yield, and engraftment after single CB infusion. One hundred and fifty-seven patients (median age, 20 years; range, 1 to 60) received a single CB unit for treatment of hematologic and nonhematologic malignancies with myeloablative conditioning after graft dilution and washing. The median total nucleated cell (TNC) doses was 3.4 × 10(7)/kg (range, 2 to 26) and the median post-thaw recovery was 84% (range, 45 to 178). The cumulative incidence of neutrophil engraftment at 50 days was 84% (95% confidence interval [CI], 83 to 93). A total of 118 immediate AIE were observed in fifty-two (33%) patients. All reported AIE were transient, graded from 1 to 2 by Common Terminology Adverse Events version 4. The most frequent toxicity was cardiovascular but without any life-threatening reaction. Infused TNC, recipient's weight, and rate of infusion per kilogram were risk factors associated with cardiovascular AIE in multivariate analysis (odds ratio [OR], 1.2 (95% CI, 1.1 to 1.4); P < .001; OR, .94 (95% CI, .9 to .97); P < .001; and OR, 1.5 (95% CI, 1.2 to 1.8); P < .001; respectively). In summary, use of an automated method for graft washing before CB administration showed low incidence of AIE without compromising cell yields and engraftment. Infused TNC dose, recipient's weight, and rate of infusion per kilogram were risk factors associated with infusion reactions.
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Affiliation(s)
- Nerea Castillo
- Adult Hematology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
| | - Irene García-Cadenas
- Hospital Universitari de la Santa Creu i Sant Pau, IIB Sant Pau and Jose Carreras Research Institutes, Barcelona, Spain
| | - Olga García
- Adult Hematology Department, Institut Català d'Oncologia-Badalona, Barcelona, Spain
| | - Pere Barba
- Adult Hematology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | - Rodrigo Martino
- Hospital Universitari de la Santa Creu i Sant Pau, IIB Sant Pau and Jose Carreras Research Institutes, Barcelona, Spain
| | - Carmen Azqueta
- Cell Therapy Laboratory, Banc de Sang i Teixits, Barcelona, Spain
| | - Christelle Ferrà
- Adult Hematology Department, Institut Català d'Oncologia-Badalona, Barcelona, Spain
| | - Carme Canals
- Cell Therapy Laboratory, Banc de Sang i Teixits, Barcelona, Spain
| | - Izaskun Elorza
- Adult Hematology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Teresa Olivé
- Adult Hematology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Isabel Badell
- Hospital Universitari de la Santa Creu i Sant Pau, IIB Sant Pau and Jose Carreras Research Institutes, Barcelona, Spain
| | - Jorge Sierra
- Hospital Universitari de la Santa Creu i Sant Pau, IIB Sant Pau and Jose Carreras Research Institutes, Barcelona, Spain
| | - Rafael Duarte
- Adult Hematology Department, Institut Català d'Oncologia-Hospitalet, Barcelona, Spain
| | - David Valcárcel
- Adult Hematology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Sergio Querol
- Cell Therapy Laboratory, Banc de Sang i Teixits, Barcelona, Spain
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Sharp JA, Whitley PH, Cunnion KM, Krishna NK. Peptide inhibitor of complement c1, a novel suppressor of classical pathway activation: mechanistic studies and clinical potential. Front Immunol 2014; 5:406. [PMID: 25202312 PMCID: PMC4141160 DOI: 10.3389/fimmu.2014.00406] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 08/08/2014] [Indexed: 11/20/2022] Open
Abstract
The classical pathway of complement plays multiple physiological roles including modulating immunological effectors initiated by adaptive immune responses and an essential homeostatic role in the clearance of damaged self-antigens. However, dysregulated classical pathway activation is associated with antibody-initiated, inflammatory diseases processes like cold agglutinin disease, acute intravascular hemolytic transfusion reaction (AIHTR), and acute/hyperacute transplantation rejection. To date, only one putative classical pathway inhibitor, C1 esterase inhibitor (C1-INH), is currently commercially available and its only approved indication is for replacement treatment in hereditary angioedema, which is predominantly a kinin pathway disease. Given the variety of disease conditions in which the classical pathway is implicated, development of therapeutics that specifically inhibits complement initiation represents a major unmet medical need. Our laboratory has identified a peptide that specifically inhibits the classical and lectin pathways of complement. In vitro studies have demonstrated that these peptide inhibitors of complement C1 (PIC1) bind to the collagen-like region of the initiator molecule of the classical pathway, C1q. PIC1 binding to C1q blocks activation of the associated serine proteases (C1s–C1r–C1r–C1s) and subsequent downstream complement activation. Rational design optimization of PIC1 has resulted in the generation of a highly potent derivative of 15 amino acids. PIC1 inhibits classical pathway mediated complement activation in ABO incompatibility in vitro and inhibiting classical pathway activation in vivo in rats. This review will focus on the pre-clinical development of PIC1 and discuss its potential as a therapeutic in antibody-mediated classical pathway disease, specifically AIHTR.
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Affiliation(s)
- Julia A Sharp
- Department of Microbiology and Molecular Cell Biology, Eastern Virginia Medical School , Norfolk, VA , USA
| | | | - Kenji M Cunnion
- Department of Microbiology and Molecular Cell Biology, Eastern Virginia Medical School , Norfolk, VA , USA ; Department of Pediatrics, Eastern Virginia Medical School , Norfolk, VA , USA ; Children's Specialty Group, Division of Infectious Diseases , Norfolk, VA , USA
| | - Neel K Krishna
- Department of Microbiology and Molecular Cell Biology, Eastern Virginia Medical School , Norfolk, VA , USA ; Department of Pediatrics, Eastern Virginia Medical School , Norfolk, VA , USA
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Akel S, Regan D, Wall D, Petz L, McCullough J. Current thawing and infusion practice of cryopreserved cord blood: the impact on graft quality, recipient safety, and transplantation outcomes. Transfusion 2014; 54:2997-3009. [PMID: 24894338 DOI: 10.1111/trf.12719] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Revised: 03/13/2014] [Accepted: 03/24/2014] [Indexed: 12/11/2022]
Abstract
Methods of handling, thawing, and infusion of cord blood (CB) products vary substantially among thaw/transplant centers (TCs). This review 1) compares currently available CB product types and thaw methods recommended by CB banks (CBBs), 2) discusses causes of inconsistency in thaw method application at TCs, 3) advises elements to consider in thaw method approval or selection at the TC, 4) provides a procedural template for the traditional thaw methods, and 5) suggests acceptable time from product thaw to infusion and other considerations for safe infusion. It also compares postinfusion adverse reaction and engraftment data as functions of thaw methods. Remarks and suggestions made throughout this review are: 1) not intended to supersede manufacturer's instructions but meant to support the standardization of preparative procedures recommended by CBBs and 2) intended to help TCs to investigate relevant quality issues and handle challenges, especially when the TC is unable to follow recommendations due to foreseeable technical, quality, and/or clinical factors.
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Affiliation(s)
- Salem Akel
- St Louis Cord Blood Bank/Cellular Therapy Laboratory, SSM Cardinal Glennon Children Medical Center, St Louis, Missouri, Canada
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42
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Abstract
Hemolytic transfusion reactions (HTRs) due to incompatible red blood cell (RBC) transfusions are a leading cause of transfusion associated death. Although many transfused incompatible RBCs are cleared, some remain in circulation despite the presence of RBC-specific antibodies, potentially due to "antigen modulation." With a goal of better understanding incompatible RBC clearance, we generated a murine model with RBC-specific expression of a clinically significant human antigen (KEL2) known to be involved in antigen modulation as well as in HTRs. Wild-type (WT) recipients transfused with transgenic KEL2 RBCs generated anti-KEL glycoprotein alloantibodies, which fixed complement, led to intravascular hemolysis, and resulted in decreased levels of KEL2 antigen detectable on cells remaining in circulation. Antigen modulation did not appear to solely reflect removal of RBCs with higher antigen expression, because cells continued to display antigen modulation in the absence of significant clearance. Recipients genetically lacking complement exhibited lesser degrees of incompatible RBC clearance and antigen modulation in comparison with WT or FcγR knock-out (KO) animals, suggesting a role for complement in RBC clearance. In summary, this HTR model may serve as a platform to test strategies to downmodulate antigen and inhibit incompatible RBC clearance, thus potentially mitigating transfusion dangers.
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Makulska S, Jakiela S, Garstecki P. A micro-rheological method for determination of blood type. LAB ON A CHIP 2013; 13:2796-2801. [PMID: 23669864 DOI: 10.1039/c3lc40790j] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The measurement of time and distance can be used for determining agglutination in small (nL) samples of liquid. We demonstrate the use of this new scheme of detection in typing and subtyping blood in a simple microfluidic system that monitors the speed of flow of microdroplets. The system (i) accepts small samples of liquids deposited directly onto the chip, (ii) forms droplets on demand from these samples, (iii) merges the droplets, and (iv) measures their speed in a microchannel. A sequence of measurements on different combinations of blood and antibodies can thus be used to determine blood type with the estimated probability of mistyping being less than 1 in a million tests. In addition, in the agglutinated samples, red blood cells concentrate at the rear of the droplets yielding an additional vista for detection and suggesting a possible mechanism for separations.
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Affiliation(s)
- Sylwia Makulska
- Institute of Physical Chemistry, Polish Academy of Sciences, Kasprzaka, 44/52, 01-224 Warsaw, Poland
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44
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Delaney M, Ballen KK. Umbilical cord blood transplantation: review of factors affecting the hospitalized patient. J Intensive Care Med 2013; 30:13-22. [PMID: 23753249 DOI: 10.1177/0885066613488730] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The use of umbilical cord blood (UCB) as a stem cell donor source has dramatically increased over the last 2 decades. Patients undergoing UCB transplantation share medical management issues with patients receiving a hematopoietic stem cell transplantion using adult donor sources (peripheral blood stem cells or bone marrow stem cells) and may also have more complex medical issues that appear to be related to delayed immune recovery from UCB-derived stem cells. The interface with critical care providers is likely to occur in the transplant and posttransplant setting. Patients may experience UCB infusion reactions that range from mild to rarely severe. Following transplant, patients are transfusion dependent for long periods due to the prolonged engraftment of UCB cells. They are at high risk of infection, particularly viral. Once engrafted, UCB transplant patients have a lower rate of graft versus host disease compared to other donor sources. Some of the other complications that are seen in patients undergoing UCB transplant are posttransplant lymphoproliferative disease, diffuse alveolar hemorrhage, and posterior reversible encephalopathy will also be discussed.
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Affiliation(s)
- Meghan Delaney
- Puget Sound Blood Center, Seattle, WA, USA Department of Laboratory Medicine, University of Washington, Seattle, WA, USA
| | - Karen K Ballen
- Hematology/Oncology Division, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
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45
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Zimring JC, Spitalnik SL. On the appropriate use and interpretation of animal models in transfusion medicine research. Transfusion 2013; 53:2334-9. [PMID: 23441757 DOI: 10.1111/trf.12131] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Revised: 12/02/2012] [Accepted: 12/04/2012] [Indexed: 01/20/2023]
Affiliation(s)
- James C Zimring
- Puget Sound Blood Center Research Institute, Seattle, Washington; Laboratory of Transfusion Biology, Department of Pathology and Cell Biology, Columbia University Medical Center, New York Presbyterian Hospital, New York, New York
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46
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Initiation and regulation of complement during hemolytic transfusion reactions. Clin Dev Immunol 2012; 2012:307093. [PMID: 23118779 PMCID: PMC3479954 DOI: 10.1155/2012/307093] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2012] [Accepted: 09/07/2012] [Indexed: 11/19/2022]
Abstract
Hemolytic transfusion reactions represent one of the most common causes of transfusion-related mortality. Although many factors influence hemolytic transfusion reactions, complement activation represents one of the most common features associated with fatality. In this paper we will focus on the role of complement in initiating and regulating hemolytic transfusion reactions and will discuss potential strategies aimed at mitigating or favorably modulating complement during incompatible red blood cell transfusions.
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47
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Liepkalns JS, Cadwell CM, Stowell SR, Hod EA, Spitalnik SL, Zimring JC. Resistance of a subset of red blood cells to clearance by antibodies in a mouse model of incompatible transfusion. Transfusion 2012; 53:1319-27. [PMID: 23033973 DOI: 10.1111/j.1537-2995.2012.03910.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Revised: 08/10/2012] [Accepted: 08/15/2012] [Indexed: 11/26/2022]
Abstract
BACKGROUND Alloimmunization to antigens on transfused red blood cells (RBCs) represents a major barrier to chronic transfusion. In extreme cases of multiple alloimmunization, clinicians may be faced with the decision of transfusing incompatible RBCs or risking death from lack of transfusion. The disastrous results of hemolytic transfusion reactions are well understood, and major pathways of clearance have been described. However, well described but poorly understood is the survival of a subset of incompatible donor RBCs during hemolysis, despite antibody binding. STUDY DESIGN AND METHODS We utilize a tractable murine model of incompatible transfusion in which RBCs from transgenic donor mice expressing human glycophorin A (hGPA) are transfused into recipients passively immunized with anti-hGPA. RESULTS As in humans, the majority of RBCs are cleared but a subset of incompatible donor RBCs persist in circulation, despite being bound by antibodies. Data contained herein reject the hypothesis that lack of clearance is due to insufficient antibody or overwhelming of phagocytic machinery; rather, we establish that surviving RBCs represent a distinct population resistant to clearance. CONCLUSIONS These studies demonstrate that surviving RBCs during incompatible transfusion can represent a population that is resistant to clearance.
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Affiliation(s)
- Justine S Liepkalns
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia, USA
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Mauriello CT, Pallera HK, Sharp JA, Woltmann JL, Qian S, Hair PS, van der Pol P, van Kooten C, Thielens NM, Lattanzio FA, Cunnion KM, Krishna NK. A novel peptide inhibitor of classical and lectin complement activation including ABO incompatibility. Mol Immunol 2012; 53:132-9. [PMID: 22906481 DOI: 10.1016/j.molimm.2012.07.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Revised: 07/24/2012] [Accepted: 07/30/2012] [Indexed: 12/24/2022]
Abstract
Previous experiments from our laboratories have identified peptides derived from the human astrovirus coat protein (CP) that bind C1q and mannose binding lectin (MBL) inhibiting activation of the classical and lectin pathways of complement, respectively. The purpose of this study was to evaluate the function of these coat protein peptides (CPPs) in an in vitro model of complement-mediated disease (ABO incompatibility), preliminarily assess their in vivo complement suppression profile and develop more highly potent derivatives of these molecules. E23A, a 30 amino acid CPP derivative previously demonstrated to inhibit classical pathway activation was able to dose-dependently inhibit lysis of AB erythrocytes treated with mismatched human O serum. Additionally, when injected into rats, E23A inhibited the animals' serum from lysing antibody-sensitized erythrocytes, providing preliminary in vivo functional evidence that this CPP can cross the species barrier to inhibit serum complement activity in rodents. A rational drug design approach was implemented to identify more potent CPP derivatives, resulting in the identification and characterization of a 15 residue peptide (polar assortant (PA)), which demonstrated both superior inhibition of classical complement pathway activation and robust binding to C1q collagen-like tails. PA also inhibited ABO incompatibility in vitro and demonstrated in vivo complement suppression up to 24h post-injection. CPP's ability to inhibit ABO incompatibility in vitro, proof of concept in vivo inhibitory activity in rats and the development of the highly potent PA derivative set the stage for preclinical testing of this molecule in small animal models of complement-mediated disease.
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Affiliation(s)
- Clifford T Mauriello
- Department of Pediatrics, Eastern Virginia Medical School, 855 West Brambleton Avenue, Norfolk, VA 23510, United States
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Menis M, Izurieta HS, Anderson SA, Kropp G, Holness L, Gibbs J, Erten T, Worrall CM, MaCurdy TE, Kelman JA, Ball R. Outpatient transfusions and occurrence of serious noninfectious transfusion-related complications among US elderly, 2007-2008: utility of large administrative databases in blood safety research. Transfusion 2012; 52:1968-76. [DOI: 10.1111/j.1537-2995.2011.03535.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Carnahan RM, Kee VR. A systematic review of validated methods for identifying transfusion-related ABO incompatibility reactions using administrative and claims data. Pharmacoepidemiol Drug Saf 2012; 21 Suppl 1:230-5. [DOI: 10.1002/pds.2325] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Ryan M. Carnahan
- The University of Iowa College of Public Health; Department of Epidemiology; Iowa City IA USA
| | - Vicki R. Kee
- The University of Iowa College of Pharmacy; Division of Drug Information Service, Iowa Drug Information Service; Iowa City IA USA
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