1/19. Use of recombinant human erythropoietin (EPO-alfa) in a mother alloimmunized to the Js(b) antigen.erythropoietin (EPO) is a glycoprotein hormone and the principal regulator of erythropoiesis in the fetus, newborn, and adult. EPO-alfa is erythropoietin manufactured by recombinant human dna technology (rhEPO). After counseling, a pregnant woman with anti-Js(b) in her serum was started on rhEPO (600 U/Kg, biweekly) to prevent anemia secondary to serial donations of her blood for fetal transfusions. After a total of 25 rhEPO infusions and autologous donation of 8 units of whole blood, maternal hemoglobin prior to the elective cesarean section at 37 weeks was 11.3 gm/dL. serum EPO concentration was determined in paired maternal and fetal blood samples, before ultrasound guided intravascular transfusions, in this alloimmunized Js(b)-negative and another Rh(D) alloimmunized pregnancy to determine possible correlations between maternal and fetal serum EPO. rhEPO prevented anemia in a patient who donated 8 units of blood from 18-37 weeks of pregnancy without inducing adverse biological effects such as hypertension or thrombotic complications in the placenta. Data presented in this study suggest that EPO does not cross the human placenta.- - - - - - - - - - ranking = 1keywords = sample (Clic here for more details about this article) |
2/19. Anti-Vel reactivity diminished by adsorption with rabbit RBC stroma.BACKGROUND: An anti-Vel, nearly missed in antibody identification studies, and the effect of a commercially available rabbit RBC stroma (rest, Immucor) adsorptions on eight anti-Vel sera are reported. Anti-Vel is an antibody to an antigen of high prevalence. CASE REPORT: A 48-year-old woman with chronic vaginal bleeding presented with a Hct of 14.7 percent. The transfusion service was not informed of her history of anti-Vel when she was transferred from another institution. Studies performed on an emergency request for transfusion were interpreted as a cold autoantibody as adsorption with a commercial source of rest eliminated the reactivity. Stored anti-Vel sera were tested by titration studies before and after adsorption with commercial rest. RESULTS: serum from the index case did not react after adsorption with rest at the transfusion service. Studies with the stored anti-Vel indicated antibody adsorption with four of four samples at immediate spin (IS) and room temperature (RT) phases, four of eight samples at 37 degrees C in albumin (ALB) phase, and four of eight samples at ALB-IgG-AGT phase. Variations in antibody reactivity were observed in the samples tested, but rest adsorption diminished antibody reactivity in most samples. All eight stored sera demonstrated some reactivity in at least one phase after adsorption with rest. CONCLUSION: Anti-Vel was completely or partially adsorbed by rest. Caution should be used when interpreting cold agglutinins with this method. The manufacturer warns that uncommon alloantibodies may be adsorbed.- - - - - - - - - - ranking = 5keywords = sample (Clic here for more details about this article) |
3/19. Severe immune haemolysis in a group A recipient of a group O red blood cell unit.Haemolysis caused by passive ABO antibodies is a rare transfusional complication. We report a case of severe haemolytic reaction in a 38-year-old man (blood group A) with lymphoma who had received one red blood cell (RBC) unit group O. After transfusion of 270 mL, the patient experienced fever, dyspnoea, chills and back pain. On the following morning he was icteric and pale. Haptoglobin was inferior to 5.8 mgdL(-1), haemoglobin was not increased and lactate dehydrogenase was elevated. Haemolysis was evident on observation of the patient's post-transfusion samples. The recipient's red cells developed a positive direct antiglobulin test and Lui elution showed anti-A coated the cells. Fresh donor serum had an anti-A titre of 1024, which was not reduced by treating the serum with dithiothreitol. Donor isoagglutinin screening has been determined by microplate automated analyser and showed titre higher than 100. physicians should be aware of the risk of haemolysis associated with ABO-passive antibodies. There is generally no agreement justifying the isoagglutinin investigation prior to transfusion. However, automated quantitative isoagglutinin determination could be part of the modern donor testing process, mainly in blood banks where identical ABO group units (platelets or phenotyped RBCs) are not available owing to limited supply.- - - - - - - - - - ranking = 1keywords = sample (Clic here for more details about this article) |
4/19. Characterisation of the anti-A antibody response following an ABO incompatible (A2 to O) kidney transplantation.Anti-A,B antibodies produced in a blood group OLe(a-b-) recipient receiving a kidney graft from a blood group A2Le(a-b ) donor have been analysed for their ability to bind to different glycosphingolipid antigens. Solid-phase RIA using pure glycosphingolipid antigens and a chromatogram binding assay using total nonacid glycosphingolipid fractions from erythrocytes of different human blood group phenotypes together with pure glycolipid antigens were used as assay systems. serum antibodies were shown to bind equally well to A (types 1, 2, 3 and 4) and B (types 1 and 2) antigenic structures but no binding to H antigens (types 1, 2 and 4) was detected. After adsorption of serum antibodies on A1 Le(a-b ) erythrocytes there was a residual anti-A antibody activity which could not be adsorbed by synthetic A-trisaccharides coupled to crystalline silica (Synsorb-A). These residual antibodies, which are not present in a pretransplant serum sample, had a specificity for the A antigen with type 1 core saccharide chain and the binding epitope obviously included both the N-acetylgalactosamine and the N-acetylglucosamine. The fucose residue was apparently not obligate for binding. The conformation of the sugar units involved in the binding epitope was determined.- - - - - - - - - - ranking = 1keywords = sample (Clic here for more details about this article) |
5/19. Transfusion-associated graft vs. host disease after donor-specific leukocyte transfusion before kidney transplantation.Transfusion-associated graft vs. host disease (TA-GVHD) is a well-known but rare complication that follows infusion of histo-incompatible lymphoid cells, often seen in individuals with impaired cellular immunity. However, we present here a case report of fatal TA-GVHD in a 'presumed' immunocompetent patient after transfusion of a freshly isolated buffycoat from a relative as part of our protocol to prepare the patient for living-related kidney transplantation. To confirm the diagnosis of TA-GVHD, a polymerase chain reaction was used to detect donor cells in various affected tissues. Furthermore, the immune reactivity of the patient against donor and vice versa was tested on samples taken before transfusion using limiting dilution assays. Our patient received a transfusion with blood from a donor who was homozygous at the human leukocyte antigen (HLA) class I loci. Despite incompatibility for HLA class II, infused donor T lymphocytes were not rejected and became engrafted. The patient did not have cytotoxic T lymphocytes to reject the donor cells. dna polymorphism studies on several organ biopsies confirmed the presence of infiltrating cells of donor origin. This report illustrates the possibility, in the general patient population, of developing TA-GVHD from whole blood transfusion. In the case of pre-transplant blood transfusion, the patient and donor have to be HLA-typed and special care should be taken in the situation of donor homozygosity for HLA class I, even in the presence of HLA class II incompatibility. Protocols in which donor-specific blood or bone marrow transfusions are given in an attempt to modulate the immune system should exclude these combinations.- - - - - - - - - - ranking = 1keywords = sample (Clic here for more details about this article) |
6/19. Case report: immune anti-D stimulated by transfusion of fresh frozen plasma.FFP has occasionally been reported to generate an immune response to RBC antigens (e.g., anti-D and anti-Fya). The Council of europe requires that each unit of FFP have less than 6 x 10(9)/L RBCs. However, there is considerable variation internationally in the method of production and the level and assessment of RBC contamination of FFP. This study reports the case of a 63-year-old group B, D- man who received multiple transfusions of D- blood products over a 4-month period. Seven months later the patient's antibody screen remained negative and he was transfused with seven units of D- RBCs and six units of FFP, four of which were D . Two months later anti-D, -E, and -K were detected in his plasma. Although the anti-E and anti-K could have resulted from transfusion of antigen-positive RBCs, the anti-D could have resulted only from transfusion of the D FFP. The D status of FFP is currently not considered when selecting products for transfusion even though the D antigen is highly immunogenic and the level of RBC contamination of FFP is not always known. This case highlights that transfusion of FFP is a stimulus for RBC antibodies and that when a patient has had a recent transfusion of FFP, consideration should be given to obtaining a sample for pretransfusion testing within 3 days before a scheduled RBC transfusion. In addition, the D status of FFP should be considered before administering FFP to premenopausal D- women.- - - - - - - - - - ranking = 1keywords = sample (Clic here for more details about this article) |
7/19. Delayed hemolytic transfusion reaction due to anti-Jk(a).BACKGROUND: Kidd antibodies are very heterogeneous and difficult to detect. They have been frequently implicated in delayed hemolytic transfusion reactions (DHTRs). CASE REPORT: A 64 year old female (6 pregnancies, 2 deliveries, 4 abortions) with none red cell (RBC) transfusions in the history was admitted to hospital due to pneumonia and severe anemia. On admittance hemoglobin (Hb) level was 63g/L and hematocrit (Ht) 0.21 L/L. The blood sample of the patient was sent to laboratory for serologic testing since RBC transfusions were required. Patient appeared to beO Rh(D) with negative both direct antiglobulin (DAT) and routine antibody screen (ID-DiaCell I II III-P). Three units of packed RBCs with negative crossmatch (tube method) were prepared. Patient received two units on Day 2 and one more on Day 3 without any discomfort. Hematological values after the third unit were: Hb 116g/L and Ht 0.37 L/L. On Day 6 she started to feel week, tired, with nausea and mild jaundice. Her Hb and Ht had dropped to 99 g/L and 0.33 L/L respectively, with tendency of dropping further (Day 7: Hb 83 g/L, Ht 0.26 L/L). Total serum bilirubin was 58.9 umol/L (normal range 20.5 umol/L) and direct fraction was 14.9 umol/L (normal range 7 umol/L). DTHR was suspected. Antibody identification performed by ID-DiaMed Gel Techique (GT) showed the presence of anti-Jk(a) with dosage phenomenon. All three previously transfused units were typed Jk(a) and the patient s RBCs were Jk(a-b ). She received two units of Jk(a) negative packed RBCs and was well enough to be discharged on Day 14. CONCLUSION: It is important to monitor clinical effect of transfusion regularly and to provide good team work between specialists of transfusion medicine and related medical staff. The policy of transfusion practice is to keep pretransfusion sample for three weeks and to perform cross-match tests on the samples no older then 24h and 48h respectively.- - - - - - - - - - ranking = 3keywords = sample (Clic here for more details about this article) |
8/19. Use of the gel test to follow up chimerism in ABO mismatched bone marrow transplantation patient: a case report.OBJECTIVE: The authors report here our experience using the gel test to follow up chimerism in a 5 year old girl with beta thalassemia/hemoglobin e disease (beta thal/HbE), post allogeneic bone marrow transplantation with Hb E trait HLA identical sibling donor. They were ABO blood group major mismatched donor-recipient pairs (donor and recipient blood group are B and O, respectively). MATERIAL AND METHOD: Pre and post transplanted EDTA blood samples from the girl with beta thalassemia/ hemoglobin e were tested for ABO, Rh and direct antiglobulin test (DAT) using the A-B-AB-D-ctl/ AHG card and the titer of anti-A and anti-B were tested by the conventional tube technique. The sex chromosome study and hemoglobin typing were also examined. RESULTS: In this technique, mixed field agglutination is clearly identified from positive and negative results. The authors detected peripheral recovery, mixed O/B population after transplantation on day 26 with positive DAT. The DAT was negative on day 67 after transplantation and the recipient blood group was completely changed to B on day 123. In addition, Hb typing was changed to Hb E trait with Hb F less than 5 % on day 37. The engraftment of neutrophils, more than 5x10(9)/L, was detected on day 14 and platelet count was more than 20x10(9)/L on day 28. On day 90, the patient was transfusion-independent with the mean Hb level at 11.4 g/dL (10.4-13.1). The sex chromosome and hemoglobin typing were changed to the donor on day 300. CONCLUSION: The gel test is an alternative method which is simple and helpful in detecting mixed red blood cell populations, particularly in the ABO or other blood group mismatched bone marrow transplantation.- - - - - - - - - - ranking = 1keywords = sample (Clic here for more details about this article) |
9/19. Transfusion errors in the Thai anesthesia Incidents Study (THAI Study): three cases.Of 163,403 recorded cases of anesthesia in the Thai anesthesia Incidents Study (THAI Study), transfusion errors occurred thrice. Case #1: a 68-year-old male, blood group A, undergoing hepatectomy, received two units of PRC and four units of FFP (all units were group A), but two of the FFP units were given to the wrong patient because the caregiver did not check the patient-identification on all of the blood bags. Case #2: a 42-year-old female, blood group A, undergoing emergency exploratory laparotomy, received 250 mL of group B-blood. skin rashes, a clue for diagnosis of transfusion error were observed in the postoperative period. The error occurred because the caregiver did not check the patient-identification before starting the transfusion. Case #3: a 42-year-old female, blood group O, undergoing hysterectomy, received 430 mL of group AB-blood. More blood was requested in the ICU and it was discovered that the new bag was group O instead of AB. Mislabeling of the blood sample at the first blood request accounted for the error even though blood group O was recorded on the patient's OPD chart. The first two patients developed minor adverse reactions (grade 1) whereas the third developed a severe reaction (grade 3). All of the patients responded well to treatments. Accordingly, the system for preventing transfusion errors has been improved at both hospitals.- - - - - - - - - - ranking = 1keywords = sample (Clic here for more details about this article) |
10/19. ABO incompatible blood transfusion.Four cases of ABO incompatible blood transfusion are presented which occurred over a 3-year period and resulted in marked clinical variation. In each instance the error leading to the transfusion resulted from the incorrect identification of either the patient, the crossmatch sample or the donations. These cases not only highlight the problems in the clinical recognition of ABO incompatibility but indicate a need to shift emphasis from refining crossmatch methodology to the strict following of standard established protocols for transfusion. It is of paramount importance to guarantee the failsafe identification of blood specimens, donations and recipient to minimize the possibility of accidents due to human error.- - - - - - - - - - ranking = 1keywords = sample (Clic here for more details about this article) |
| | Next -> |