Transfusion of incompatible blood to a patient with alloanti-Sc1

Sc1 is a high-prevalence blood group antigen that is part of the Scianna blood group system. The clinical significance of Scianna antibodies is not well understood because of their rarity; there are only a handful of cases in the literature. This scarcity of information can make it difficult to decide on the best course of action when transfusing a patient with alloantibodies to Scianna blood group antigens. We describe a case of an 85-year-old woman presenting with melena and a hemoglobin of 66 g/L. Upon request for crossmatched blood, a panreactive antibody was found, later elucidated to be alloanti-Sc1. Because of the urgent nature of the transfusion, the patient was transfused with 2 incompatible, presumed Sc1+, red blood cell units with no evidence of an acute or delayed transfusion reaction. This case has been shared with the International Society of Blood Transfusion Rare Donor Working Party, via their Outcome of Incompatible Transfusion form, and adds to the body of evidence on clinical significance of antibodies to the antigens of the Scianna blood group system.

Acute hemolytic transfusion reaction caused by anti-Yta

Many patients with anti-Yt^a receive multiple transfusions of Yt(a+) red blood cells (RBCs) with no ill effects. However, anti-Yt^a has been implicated in hemolytic transfusion reactions. Antibody identification typically determines specificity of antibodies and their clinical significance to justify blood requirements for antigen-negative blood when clinically significant antibodies are involved. Occasionally, specificity of antibody is of variable significance. Variability in clinical significance is a characteristic of anti-Yt^a that may affect the clinical management of such patients. This case reports the outcome of an incompatible transfusion in an 83-year-old female patient with anti-Yt^a, -D, -C, -Le^ab, and -HI who was admitted to the hospital for a severe urinary tract hemorrhage and fever. The patient was transfused with 1 crossmatch-incompatible group A, Yt(a+), D-, C-, E-, S- RBC unit in an emergency medical event. During that time, the patient exhibited chills, shivering, and tachycardia. Decreases in hemoglobin and hematocrit were noted. Laboratory parameters for hemolysis, such as total bilirubin, direct bilirubin, and lactate dehydrogenase, were increased. Based on clinical and laboratory evaluation, it was concluded that the patient had an acute hemolytic transfusion reaction caused by anti-Yt^a. The patient was successfully treated with antipyretics, antihistamines, and corticosteroids. Urinary tract hemorrhaging was stopped. Anemia was additionally improved with parenteral iron supplementation, and further transfusion was not required. Immunohematology 2021;37:13-17. Many patients with anti-Yt^a receive multiple transfusions of Yt(a+) red blood cells (RBCs) with no ill effects. However, anti-Yt^a has been implicated in hemolytic transfusion reactions. Antibody identification typically determines specificity of antibodies and their clinical significance to justify blood requirements for antigen-negative blood when clinically significant antibodies are involved. Occasionally, specificity of antibody is of variable significance. Variability in clinical significance is a characteristic of anti-Yt^a that may affect the clinical management of such patients. This case reports the outcome of an incompatible transfusion in an 83-year-old female patient with anti-Yt^a, -D, -C, -Le^ab, and -HI who was admitted to the hospital for a severe urinary tract hemorrhage and fever. The patient was transfused with 1 crossmatch-incompatible group A, Yt(a+), D–, C–, E–, S– RBC unit in an emergency medical event. During that time, the patient exhibited chills, shivering, and tachycardia. Decreases in hemoglobin and hematocrit were noted. Laboratory parameters for hemolysis, such as total bilirubin, direct bilirubin, and lactate dehydrogenase, were increased. Based on clinical and laboratory evaluation, it was concluded that the patient had an acute hemolytic transfusion reaction caused by anti-Yt^a. The patient was successfully treated with antipyretics, antihistamines, and corticosteroids. Urinary tract hemorrhaging was stopped. Anemia was additionally improved with parenteral iron supplementation, and further transfusion was not required. Immunohematology 2021;37:13–17.

Management of the blood supply for a Jk(a-b-) patient with an anti-Jk3 in preparation for an urgent heart transplant: An illustrative example of a successful international cooperation

The Kidd blood group system currently comprises two polymorphic and antithetical antigens, Jk^a and Jk^b, and one high-prevalence antigen, Jk3. Jk_null individuals do not express any of the Kidd antigens, and are at risk of developing an anti-Jk3 which is known to be dangerous and responsible for acute or delayed hemolytic transfusion reaction. We report a case of an immunized Jk_null patient, who was scheduled to undergo a heart transplant. In order to organize his blood provision management, two conference calls were held between the clinical team and the different staff involved in this challenging blood supply. In light of the blood needs, the available resources, and the constraints, a mix of fresh and frozen units were used. As the supply from France was not sufficient, Finland and New Zealand provided the majority of the fresh units. We report here how this international supply chain was organized, including the difficulties that we encountered. Anticipation, communication and flexibility were essential in making this heart transplant possible without needing to transfuse incompatible units.

International society of blood transfusion working party on red cell immunogenetics and terminology: report of the Seoul and London meetings

The Working Party has met twice since the last report: in Seoul, South Korea 2014, and in London, UK 2015, both in association with the International Society of Blood Transfusion (ISBT) Congress. As in previous meetings, matters pertaining to blood group antigen nomenclature were discussed. Eleven new blood group antigens were added to seven blood group systems. This brings the current total of blood group antigens recognized by the ISBT to 346, of which 308 are clustered within 36 blood groups systems. The remaining 38 antigens are currently unassigned to a known blood group system.

Anti-Emm in a pregnant patient--case report

A 23-year-old primigravida of North African origin presented with a positive antibody screen at booking at 15 weeks of gestation. An antibody to a high-frequency antigen (HFA) of unknown identity was detected, which was reactive with the red blood cells of the father. This led to several challenges including antibody identification, clinical monitoring to detect signs of haemolytic disease of the foetus and newborn (HDFN) and compatible blood in case perinatal transfusion was needed. Anti-Emm was identified 2 months post-partum. This is the first published case which describes a pregnant patient with anti-Emm.

Medical misadventure = human tragedy

In May of 1997 a drug inadvertently injected intrathecally caused severe neurological damage and death to a child. This event rendered a family grief-stricken and numerous health care providers forever changed. As Paget (1988) says, "The sorrow of mistakes is sometimes very diffuse and sometimes very pointed. It is sometimes the sorrow of failed action and sometimes the sorrow of failed conduct. The sorrow of mistakes has been expressed as the too-lateness of human understanding as it lies along the continuum of time, and as a wish that it might have been different, both then and now" (p.149). The reports of this tragic event in the media horrified a mother in another province. The same error had led to the death of her child five years earlier. In fact, this error has taken place a number of times in North America in the preceding decade. However, we did not know of the previous tragedies nor had we fully understood how critical examination of some of our own earlier near misses could have made such a tragic mistake less likely to occur.

MDR1 pharmacogenetics: frequency of the C3435T mutation in exon 26 is significantly influenced by ethnicity

P-glycoprotein (PGP), the product of the multidrug resistance gene (MDR1), acts as an energy-dependent efflux pump that exports its substrates out of the cell. PGP expression is an important factor regulating absorption of a wide variety of medications. It has also been associated with intrinsic and acquired cross resistance to a number of structurally unrelated anticancer drugs. A single nucleotide polymorphism (SNP) in exon 26 of the MDR1 gene, C3435T, was recently correlated with PGP protein levels and substrate uptake. Individuals homozygous for the T allele have more than four-fold lower PGP expression compared with CC individuals. As overexpression of PGP has been associated with altered drug absorption, therapy-resistant malignancies, and lower concentrations of HIV-1 protease inhibitors, this SNP may provide a useful approach to individualize therapy. To facilitate clinical application throughout the world, 1280 subjects from 10 different ethnic groups were evaluated for this SNP using the polymerase chain reaction-restriction fragment length polymorphism assay and the genotype and allele frequency for each group were ascertained. Marked differences in genotype and allele frequency were apparent between the African populations and the Caucasian/Asian populations (P < 0.0001). The Ghanaian, Kenyan, African American and Sudanese populations studied had frequencies of 83%, 83%, 84% and 73%, respectively, for the C allele. The British Caucasian, Portuguese, South-west Asian, Chinese, Filipino and Saudi populations had lower frequencies of the C allele compared to the African group (48%, 43%, 34%, 53%, 59%, and 55%, respectively). The high frequency of the C allele in the African group implies overexpression of PGP and may have important therapeutic and prognostic implications for use of PGP dependent drugs in individuals of African origin.