Correlation Analysis of Hemolytic Transfusion Reaction Induced by Low Titer Antibody / 中国实验血液学杂志

OBJECTIVE@#To establish the diagnostic process of low titer blood group antibody in the occurrence of adverse reactions of hemolytic transfusion.@*METHODS@#Acid elusion test, enzyme method and PEG method were used for antibody identification. Combined with the patient's clinical symptoms and relevant inspection indexes, the irregular antibodies leading to hemolysis were detected.@*RESULTS@#The patient's irregular antibody screening was positive, and it was determined that there was anti-Lea antibody in the serum. After the transfusion reaction, the low titer anti-E antibody was detected by enhanced test. The patient's Rh typing was Ccee, while the transfused red blood cells were ccEE. The new and old samples of the patient were matched with the transfused red blood cells by PEG method, and the major were incompatible. The evidence of hemolytic transfusion reaction was found.@*CONCLUSION@#Antibodies with low titer in serum are not easy to be detected, which often lead to severe hemolytic transfusion reaction.

The Correlation Analysis between the Titer of IgG Anti-A/B Erythrocyte Antibody In Vivo of the Neonate and the Severity of Hemolytic Disease of Newborn / 中国实验血液学杂志

OBJECTIVE@#To investigate the titer of IgG anti-A/B erythrocyte antibody in vivo of the neonate with hemolytic disease of newborn(HDN), and explore its clinical valua in evaluating the severity of HDN.@*METHODS@#300 neonates with HDN, 50 neonates with neonatal hyperbilirubinemiain and 50 healthy neonates were selected as research object and Microtubes Gel Test was used to detect the titer of IgG anti-A/B erythrocyte antibody in vivo. Their clinical data and their mothers' prenatal examination data were retrospectively analyzed. Three hemolysis tests (direct antiglobulin test, free antibody test and release test), irregular antibody screening, and the titer of IgG anti-A/B blood group antibody was determined by serological method. Red blood cells(RBC), hemoglobin(Hb), reticulocytes(Ret) and nucleated red cells were detected by hematology analyzer. Indirect bilirubin and albumin(Alb) were detected by biochemical analyzer. The relationship between the titer of IgG anti-A/B erythrocyte antibody in vivo and the severity of HDN was analyzed.@*RESULTS@#There were six serological diagnosis modes in the HDN group,the difference between modes was statistically significant (P<0.05). The antibody titer relationship between HDN neonates and pregnant women was positive correlation(r=0.8302). The highest antibody titer of release test and free antibody test were 1∶32 and 1∶2, and the difference was statistically significant（P<0.05）. RBC, Hb and Alb in HDN patients were lower than those in neonatal hyperbilirubinemia patients and healthy neonates (P<0.05), and were negatively relevant with antibody titer in vivo (r=-0.8016). Bilirubin content in HDN patients were higher than those in neonatal hyperbiliru binemia patients and healthy neonates group(P<0.05), and was positively relevant with antibody titer in vivo (r=0.8731). The hospital day in HDN patients was significantly relevant with the antibody titer in vivo (r=0.8547), but not with the age, sex, weight and ABO blood types (P>0.05).@*CONCLUSION@#The detection of antibody titer in HDN patients can be used to evaluate the antibody concentration in vivo, predict the ability of antibody to induce erythrocyte hemolysis, and help to judge the serenrity and prognosis of HDN.

Enfermedad hemolítica del feto y del recién nacido por aloanticuerpos contra el antígeno M / Hemolytic disease in fetuses and newborns due to antibodies against the M-antigen

Resumen | Hay pocos reportes de enfermedad hemolítica del feto y del recién nacido causada por aloanticuerpos contra el sistema de antígenos MNS, especialmente, porque los anticuerpos que se generan contra estos antígenos son del tipo IgM, los cuales tienen reactividad a temperaturas inferiores a los 37 °C, y, por lo tanto, no son de importancia clínica. A pesar de ello, se han reportado casos con presencia de anticuerpos anti-M de tipo IgG causantes de la enfermedad hemolítica del recién nacido e, incluso, casos de muerte intrauterina por incompatibilidad materno-fetal en el sistema MNS. El proceso hemolítico se asemeja al causado por los anticuerpos anti-Kell, con anemia progresiva por supresión hematopoyética que induce la destrucción de precursores hematopoyéticos en la médula ósea y ausencia de reticulocitos en la periferia. Se reporta el caso de una mujer con 38,5 semanas de gestación, que presentó discrepancia en la hemoclasificación directa y en la inversa. Como resultado, el recién nacido fue positivo en la prueba de Coombs directa sin que existiera incompatibilidad ABO con la madre. La correlación de estos resultados llevó a la detección de un anticuerpo anti-M en el suero materno. El diagnóstico definitivo fue posible gracias a la discrepancia en la hemoclasificación de la sangre materna. A pesar de que los anticuerpos anti-M usualmente no desempeñan un papel importante en la enfermedad hemolítica perinatal, este caso resalta la importancia de determinar la presencia de diferentes anticuerpos que pueden ser de vital interés a la hora de prevenir resultados graves asociados con dicha condición. Además, abre la puerta a nuevas recomendaciones relacionadas con la tamización y el tratamiento temprano de la hemólisis en los recién nacidos.

Abstract | There are few case reports of hemolytic disease in fetuses and newborns (HDFN) caused by alloantibodies against the MNS blood group system. The reason for this dearth is that antibodies toward these antigens are usually IgM, which not only cannot cross the placental circulation but also react at temperatures below 37°C. They are, therefore, of minimal clinical importance. Nevertheless, cases have been reported in which the presence of anti-M IgG antibodies caused severe HDFN and even intrauterine death in the presence of maternal-fetal MNS incompatibility indicating that they could have a high clinical impact. The hemolytic pattern observed in these cases is similar to that caused by anti-Kell antibodies. Progressive anemia is mediated and developed through hematopoietic suppression inducing the destruction of bone marrow precursor cells with the resulting absence of reticulocytes in peripheral blood. This occurred in the case of a woman at 38.5 weeks of gestation who showed a discrepancy between direct and reverse blood type determination. A direct Coombs test was performed on the newborn's blood, which was positive in the absence of maternal-fetal ABO incompatibility. Further tests were performed and anti-M antibodies were found in the maternal serum screening. Our final diagnosis was largely due to discrepancy issues in maternal blood. Although anti-M antibodies do not usually play a significant role in HDFN, this case stresses the importance of identifying the presence of antibodies that can be crucial in preventing HDFN and lead to new recommendations for the screening and prompt treatment of hemolysis in newborns.

Investigation and Analysis of Non-ABO Hemolytic Disease of the Newborn / 中国实验血液学杂志

OBJECTIVE@#To study the serological detection characteristics and antibody specific distribution of hemolytic disease of the newborn (HDN) caused by irregular antibodies through retrospective case analysis.@*METHODS@#A total of 3 047 suspected cases of HDN were submitted by the Neonatal Department of our hospital from January 2014 to December 2019. Non ABO-HDN cases confirmed in our laboratory were taken as the research objects, while some cases of ABO-HDN were randomly selected as control. Disease-causing antibody specificity, serological detection characteristics, total bilirubin change trend and gender ratio of non ABO-HDN patients were explored.@*RESULTS@#Sixty-seven cases of non ABO-HDN were confirmed from the suspected cases of HDN, Among which 45 males and 22 females were detected with the positive rate 1.48% and 0.72%, respectively. The mothers of 65 cases had two or more pregnancies. The detected irregular antibodies were mainly involved with Rh system, MNS system, Kidd system and Lewis system, among which Rh system accounted for 88.07% of the total antibody detection rate. Compared with that of ABO-HDN patients, the total bilirubin of non ABO-HDN patients developed more rapidly with a higher peak and a longer duration (P<0.001). In terms of serological detection, the positive rate of non ABO-HDN direct antibody test was 97.01%, which was higher than 47.00% of ABO-HDN (P<0.001), and the agglutination strength was often ≥ 2+, but there were still weak positive or negative cases of direct antibody test.@*CONCLUSION@#Non ABO-HDN caused by irregular antibodies mostly occurs in fetuses whose mothers experience multiple pregnancies, and the number of males is more than females. The irregular antibodies detected are mainly attributed to Rh system. The peak value of bilirubin in non ABO-HDN patients is higher and lasts longer than that in ABO-HDN patients. Direct antiglobulin test may be used to roughly distinguish ABO-HDN from non ABO-HDN.

Transfusion Strategy for Rare Anti-LW Antibody Autoimmune Hemolytic Anemia Patients with Neonatal Hemolytic Disease / 中国实验血液学杂志

OBJECTIVE@#To analyze the causes of positive irregular antibody screening test and incompatibility of cross matching in one patient with autoimmune hemolytic anemia complicated with neonatal hemolytic disease, and to accurately identify the type of antibodies in patients, and to select a reasonable strategy for blood transfusion.@*METHODS@#One children was enrolled, blood group positive and reverse typing, Rh typing, direct anti-human globulin test, free test, dispersal test and cross matching test were carried out by test tube method and microcolumn gel card; irregular antibodies were identified by the reaction of DTT treatment and untreated panel cells with patients' plasma.@*RESULTS@#The blood group of the patient was RhD positive B and irregular antibody screening positive, while the blood group of the mother was RhD positive O and irregular anti-screening negative, the result showed that the anti-LW detected in the plasma of the patient was autoantibody and ABO neonatal hemolytic disease (ABO-HDN) was present. Both O type RhD positive washing RBCs and B type RhD negative RBCs were transfused effectively.@*CONCLUSION@#Irregular antibodies in patients are anti-LW antibodies, and transfusion of homotype RhD negative suspended erythrocytes after the exclusion of ABO-HDN shows a better effect.

The rare holley antibody associated with a severe hemolytic transfusion reaction: the importance of this antibody identification to find a compatible blood unit / Raro anticorpo associado à reação transfusional hemolítica grave: a importância de sua identificação para encontrar uma unidade sanguínea compatível

ABSTRACT The correct identification of erythrocyte antibodies is fundamental for the searching for compatible blood and haemolytic transfusion reactions prevention. Antibodies against antigens of high prevalence are difficult to identify because of the rarity of their occurrence and unavailability of negative red cells for confirmation. We report a case of 46-years-old woman, diagnosed with hemoglobinopathy, and who had symptomatic fall in hemoglobin levels (5.3g/dL) after blood transfusion suggestive of transfusion reaction. The patient's blood type was O RhD-positive. Irregular antibody screening was positive and demonstrated a panreaction against all erythrocytes tested, but this result was not reactive with dithiothreitol. Using negative red cells for antigens of high prevalence of our inventory we could identify in the serum of the same erythrocytes an anti-Holley antibody associated with anti-E. Molecular analysis confirmed that the patient was negative for E and Holley antigens. The crossmath with compatible units confirmed the results. Holley is a high prevalence antigen of the Dombrock blood system whose negative phenotype is extremely rare in all populations and is associated with hemolytic transfusion reactions. This is an antibody that is difficult to identify because laboratories need to have experience in solving complex cases, and have available a large stock of rare sera and erythrocytes, as well other tools such as enzymes, thiol reagents and molecular tests. The correct identification of a rare antibody is initial and mandatory for searching of compatible donors, and to guarantee a satisfactory transfusional support.

RESUMO A correta identificação dos anticorpos eritrocitários é fundamental na busca de sangue compatível e na prevenção das reações transfusionais hemolíticas. Anticorpos contra antígenos de alta prevalência são de difícil identificação, devido à raridade de sua ocorrência e à indisponibilidade de hemácias negativas para sua confirmação. Apresentamos aqui o caso de uma paciente do sexo feminino, 46 anos, com diagnóstico de hemoglobinopatia, que apresentou queda sintomática dos níveis de hemoglobina (5,3g/dL) após transfusão sanguínea, sugestiva de reação transfusional. O tipo sanguíneo da paciente era O RhD-positivo. A pesquisa de anticorpos irregulares foi positiva, demonstrando panreação contra todos os eritrócitos testados, mas não reativo ao ditiotreitol. Utilizando hemácias selecionadas negativas para antígenos de alta prevalência do nosso inventário, foi possível identificar no soro da mesma um anticorpo anti-Holley associado a um anti-E. A análise molecular confirmou que a paciente era negativa para os antígenos E e Holley, e as provas de compatibilidade com unidades fenotipadas confirmaram os resultados. Holley é um antígeno de alta prevalência do sistema sanguíneo Dombrock, cujo fenótipo negativo é extremamente raro em todas as populações e está associado a reações transfusionais hemolíticas. Trata-se de anticorpo de difícil identificação, pois os laboratórios precisam ter experiência na resolução de casos complexos, grande estoque de soros e eritrócitos raros, além de outras ferramentas, como enzimas, reagentes tiol e testes moleculares. A identificação correta de um anticorpo raro é inicial e obrigatória para a busca de doadores compatíveis, garantindo um suporte transfusional satisfatório.

Hiperbilirrubinemia severa en recién nacidos, factores de riesgo y secuelas neurológicas / Severe hyperbilirubinemia in newborns, risk factors and neurological outcomes

INTRODUCCIÓN: La hiperbilirrubinemia es altamente prevalente en los recién nacidos, con riesgo de compromiso neurológico con bilirrubinemias mayor a 20-25 mg/dl. Esta progresión es prevenible con detección y tratamiento precoz. OBJETIVO: Describir incidencia y factores asociados en pacientes hospitalizados con hiperbilirrubinemia mayor de 20 mg/dl, y el seguimiento de casos sintomáticos durante hospitalización. PACIENTES Y MÉTODO: Estudio retrospectivo de pacientes con hiperbilirru- binemia severa, entre el 2013 y 2016. Se evaluaron factores de riesgo, estratificándose por nivel de bilirrubina, edad de ingreso y edad gestacional. Se compararon los datos con test exacto de Fisher, chi cuadrado y riesgo relativo (RR) en una base de excel, con un error alfa de un p<0.05. Los datos fueron obtenidos a través de la epicrisis electrónica y de la ficha de control a nivel secundarios. RESULTADOS: Durante el periodo, de 25.288 recién nacidos vivos (RNV), 593 se hospitalizaron por hiperbilirrubinemia mayor de 20 mg/dl, 1 por cada 42 RNV; y 59 con bilirrubinemia mayor a 25 mg/dl, 1 por cada 428 RNV. La hiperbilirrubinemia fue más frecuente en varones, con RR 1,22 (IC 95% 1,04-1,44) y en pretérminos tardíos, con un RR 2,39 (IC 95% 1,96-2,93) comparado con RN de término. En los ingresados con más de 4 días, el principal factor asociado fue la baja de peso excesiva, y en los primeros 3 días, la incompatibilidad de grupo clásico. Tres de 10 pacientes con encefalopatía aguda, persistieron con compromiso neurológico, lo que significa 11,8 por 100.000 nacidos vivos. CONCLUSIONES: Los principales factores de riesgo para desarrollar hiperbilirrubinemia severa fueron prematurez, baja de peso excesiva, incompatibilidad de grupo clásico y sexo masculino. Estos hallazgos permiten focalizar la atención en grupos de riesgo y disminuir la probabilidad de daño neurológico.

INTRODUCTION: Hyperbilirubinemia is highly prevalent in newborns, with risk of neurological invol vement with bilirubinemia higher than 20 to 25 mg/dl. This progression is preventable with early de tection and treatment. OBJECTIVE: To describe the incidence and associated factors in hospitalized pa tients with hyperbilirubinemia higher than 20 mg/dl, and the follow-up of symptomatic cases during hospitalization. OATIENTS Y METHOD: Retrospective study of patients with severe hyperbilirubine mia, between 2013 and 2016. Risk factors were evaluated, stratifying by bilirubin level, admission age, and gestational age. The data were compared with Fisher's exact test, chi-square test, and relative risk (RR) in an Excel database, with an alpha error of p <0.05. The data were obtained from the electronic discharge summary and the medical record of secondary level follow-up. RESULTS: During the studied period, out of 25,288 live newborns (NB), 593 were hospitalized due to hyperbilirubinemia higher than 20 mg/dl, one per each 42 live NB; and 59 with bilirubinemia higher than 25 mg/dl, one per each 428 live NB. Hyperbilirubinemia was more frequent in males, with RR 1.22 (95% CI 1.04-1.44), and in late preterm newborns, with RR 2.39 (95% CI 1.96-2.93) compared with term NB. In those admitted with more than four days, the main associated factor was excessive weight loss, whereas in the first three days was classic group incompatibility. Three of ten cases with acute encephalopathy persisted with neurological involvement, which means 11.8 per 100,000 live births. CONCLUSIONS: The main risk factors for developing severe hyperbilirubinemia were prematurity, excessive weight loss, classic group incompatibility, and male sex. These findings allow to focus attention on risk groups and decrease the probability of neurological damage.

Assessing the impact of ABO incompatibility on major allogeneic hematopoietic stem cell transplant outcomes: a prospective, single-center, cohort study

Abstract Background ABO blood group incompatibility between donor and recipient is associated with a number of immunohematological complications, but is not considered a major contraindication to allogeneic hematopoietic stem cell transplantation. However, available evidence from the literature seems to be conflicting as to the impact of incompatibility on overall survival, event-free survival, transplant-related mortality, graft-versus-host disease, and time to neutrophil and platelet engraftment. Methods This single-center, prospective, cohort study included patients with hematological malignancies who underwent a first allogeneic hematopoietic stem cell transplantation between 2008 and 2014. Patients receiving umbilical cord blood as the stem cell source were excluded from this analysis. The impact of ABO incompatibility was evaluated in respect to overall survival, event-free survival, transplant-related mortality, acute graft-versus-host disease and engraftment. Results A total of 130 patients were included of whom 78 (60%) were males. The median age at transplant was 36 (range: 2-65) years, 44 (33%) presented ABO incompatibility, 75 (58%) had acute leukemia, 111 (85%) had a related donor, 100 (77%) received peripheral blood hematopoietic stem cells as graft source and 99 (76%) underwent a myeloablative conditioning regimen. There was no statistically significant association between ABO incompatibility and overall survival, event-free survival, transplant-related mortality, grade II-IV acute graft-versus-host disease, neutrophil or platelet engraftment in multivariate analysis. Conclusion These results show that ABO incompatibility does not seem to influence these parameters in patients undergoing allogeneic hematopoietic stem cell transplantation.

Sistema de grupos sanguíneos AB em felídeos neotropicais e compatibilidade com gatos domésticos / AB blood group system in neotropical felids and compatibility with domestic cats

O principal sistema de grupos sanguíneos reconhecido para gatos é o AB. Os felinos apresentam anticorpos naturais contra o antígeno do tipo sanguíneo a que não pertencem, o que torna os testes de compatibilidade e as tipagens sanguíneas importantes na prevenção de reações transfusionais. O objetivo deste estudo foi realizar a tipagem sanguínea de oito gatos-mouriscos (Puma yagouaroundi), oito jaguatiricas (Leopardus pardalis), sete gatos-palheiros (Leopardus colocolo), sete gatos domésticos (Felis catus) da raça Persa e oito gatos domésticos sem raça definida (SRD), bem como realizar testes de compatibilidade entre os tipos sanguíneos iguais das diferentes espécies, para avaliar a possibilidade de transfusões interespecíficas. A técnica empregada para a tipagem foi a hemaglutinação em tubos de ensaio. A ocorrência do tipo sanguíneo tipo A foi de 100% entre as jaguatiricas, os gatos-palheiros e os gatos Persas e de 85,72% entre os gatos SRD. A ocorrência do tipo B foi de 100% nos gatos-mouriscos e de 14,28% nos gatos SRD. Considerando os testes de compatibilidade sanguínea, 87,5% (n=4) das jaguatiricas foram incompatíveis com os gatos domésticos, 100% (n= 6) dos gatos-palheiros foram compatíveis com os gatos domésticos e 100% (n= 4) dos gatos-mouriscos foram incompatíveis com os gatos domésticos do tipo B.(AU)

The blood group system recognized for cats is AB. Antibodies against other blood types occur naturally in cats, which makes the compatibility tests and blood typing important for preventing transfusion reactions. Wild felids need blood transfusions in cases of diseases and when run over on highways. The aim of this study was to perform blood typing of eight jaguarundies (Puma yagouaroundi), eight ocelots (Leopardus pardalis), seven pampas cats (Leopardus colocolo), seven domestic cats (Felis catus) of Persian breed and eight non-pedigree domestic cats (Felis catus), and test compatibility among the different species with the same blood types, to evaluate the possibility of performing interspecific blood transfusions. We conducted the study from August to December. We used haemagglutination in test tubes for typing. The occurrence of blood type A was 100% among ocelots, pampas cats and domestic cats of Persian breed, while non-pedigree domestic cats showed 85.72%. The occurrence of type B was 100% for jaguarundis and 14.28% for non-pedigree domestic cats. Regarding blood compatibility tests, 87.5% (n= 4) of the ocelots were incompatible with domestic cats; 100% (n=6) of the pampas cats were compatible with domestic cats, while 100% (n=4) of the jaguarundis were incompatible with type B domestic cats.(AU)

Effects of Neutralization by Soluble ABH Antigens Produced by Transplanted Kidneys From ABO-Incompatible Secretor Donors

BACKGROUND: Grafts survive despite blood group antigens on the transplant being continuously exposed to antibodies in the blood of recipients in ABO-incompatible kidney transplantation (ABOi KT), owing to the mechanism of accommodation. We analyzed the immunodynamics of soluble ABH antigens in allografts from secretor donors and the influence of such immunodynamics on accommodation and subsequent graft survival in ABOi KT. METHODS: The genotype of a known human β-galactoside α-1,2-fucosyltransferase gene (FUT2), which determines soluble ABH antigen secretor status, was established in 32 donors for ABOi KT at the Severance Hospital, from June 2010 to July 2015. Clinical outcomes of recipients, such as anti-A/B antibody titer change, renal function, and graft survival, were evaluated. RESULTS: Twenty-five donors were secretors (78.1%), and seven were nonsecretors (21.9%). The frequency of anti-A/B IgG or IgM antibody titer elevation or reduction post-transplantation was not significantly related to donor secretor status. However, IgM titer was rapidly reduced in recipients transplanted from nonsecretor donors (P=0.01), which could be explained by the lack of absorption effect of soluble antigens, enhancing the binding of antibodies to antigens in the allografts. Interestingly, soluble ABH antigens did not affect rejection-free graft survival, which may be due to the nature of β-galactoside α-1,2-fucosyltransferase. CONCLUSIONS: Soluble ABH antigens produced by transplanted kidneys from secretor donors played a role in inducing accommodation within three months of KT through neutralization; however, major graft outcomes were not affected.

Study on Serological Blood Group Conversion in BM Empty Phase of ABO-incompatible Allogeneic Stem Cell Transplantation / 中国实验血液学杂志

<p><b>OBJECTIVE</b>To explore the regularity of serological conversion of blood group in BM empty phase of ABO-incompatible allogeneic stem cell transplantation so as to provide the basis for selecting the blood components in blood transfusion.</p><p><b>METHODS</b>Before hematpoietic stem cell transplantation (HSCT), the ABO and RhD blood groups of recipients and donors were identified by salt medium tube method and microcolumn gel method; after transplantation the changes of antigen intensity and antibody titer of ABO blood group in patients were periodically detected.</p><p><b>RESULTS</b>After blood group shift of 33 patients received ABO-incompatible allo-HSCT, the consistent rate of positive and regative types in major ABO incompatible group was 100%; the consistent rate of positive and negative types in minor ABO-incompatible group was 33%, no-consistent rate was 66.7%; the consistent rate of positive and negative types in bidirextional ABO incompatible group was 20%, the no-consistent rate was 80%.</p><p><b>CONCLUSION</b>After ABO-incompatible allo-HSCT, blood group antgen of patients shifts to the blood group of donors, there is a significant difference in the serological indicators between the minor and bidireetional ABO-incompatible patients and normal people.</p>

A Case of Hemolytic Transfusion Reaction Attributable to Anti-Jk(b) Abolished in the Enzyme Phase Reaction / 대한수혈학회지

We report a case of an intravascular hemolytic reaction attributable to anti-Jk(b) antibodies that were not detected using an enzyme phase antibody identification test. A 61-year-old male who had received two units of red blood cells was admitted to the emergency room because his urine was dark. LISS/Coombs gel column agglutination tests suggested the presence of anti-Jk(b) and anti-E antibodies. However, his serum was negative for the Jk(b) antigen when an enzyme phase test was performed. A positive reaction was evident, however, when EDTA-treated plasma was tested; this excluded any possible complement-mediated reaction. The patient was diagnosed with an intravascular hemolytic transfusion reaction, caused by anti-Jk(b), and was later discharged without specific complications after receiving antigen-negative blood transfusions.

Comparison of clinical outcomes between ABO-compatible and ABO-incompatible spousal donor kidney transplantation

BACKGROUND: Kidney transplantation (KT) is the treatment of choice for end-stage renal disease patients. The spouse is a major donor in living KT. Clinical outcomes of spousal donor KT are not inferior to those of living related donor KT. In this study, we compared clinical outcomes between ABO-compatible (ABOc) and ABO-incompatible (ABOi) spousal donor KTs. METHODS: Thirty-two cases of spousal donor KT performed from January 2011 to August 2013 were analyzed retrospectively. Twenty-one ABOc KTs and 11 ABOi KTs were performed. We investigated patient survival, graft survival, acute rejection, graft function, and complications. RESULTS: During follow-up, patient and graft survival rates were 100% in both groups. There were no significant differences in the incidence of delayed graft function, acute rejection, and the change in graft function between the 2 groups. Medical and surgical complications were not significantly different between the groups. CONCLUSION: The clinical outcomes of ABOc and ABOi spousal donor KTs were equivalent. In ABOi KT, an emotionally motivated spousal donor KT may be a good alternative to the problem of the absolute shortage of kidney donations.

Initial ABO Antibody Titer as a Variable for Estimating Number of Therapeutic Plasma Exchange prior to ABO Incompatible Kidney Transplantation / 대한수혈학회지

BACKGROUND: Therapeutic plasma exchange (TPE) for desensitization in ABO incompatible kidney transplantation (KT) has raised concerns regarding efficiency and safety. The purpose of this study was to determine the number of TPE prior to KT required to reach target titer for KT according to ABO blood groups. METHODS: The distribution of ABO antibody (Ab) titer of 117 patients was investigated. The relationship between initial ABO Ab and number of TPEs required to reach target titer to ≤1:8 prior to KT was evaluated retrospectively according to blood groups and ABO Ab classes. RESULTS: The initial IgG ABO Ab titers were the highest in blood O group recipients, and the average number±standard deviations (range) of TPEs performed prior to ABO incompatible KT was 3.0±1.1 (0~5) in blood group A, 3.7±1.5 (0~8) in blood group B, and 5.3±1.9 (2~13) in blood group O, respectively. The best correlation was observed in the linear relationship between initial ABO Ab titer and number of TPEs required (y=0.6829x+0.0523, R2=0.946, x=log2 initial ABO Ab titer, y=number of TPE required), regardless of the specific ABO blood group. CONCLUSION: The number of TPEs can be highly deduced from initial ABO Ab titer and our developed equation in desensitization programs would help increase the efficiency of TPE and patient safety.

In vitro Quality Evaluation of Apheresis Platelets in Four Kinds of Platelet Additive Solutions / 대한수혈학회지

BACKGROUND: Platelets (PLTs) stored in platelet additive solution (PAS) presents potential benefits in clinical use by reducing the risk of several plasma-associated adverse transfusion reactions and more plasma may be recovered for fractionation. In this study, we compared in vitro characteristics of apheresis PLTs stored in CompoSol PS (Fenwal, Lake Zurich, IL, USA), InterSol (Fenwal, Lake Zurich, IL, USA), SSP+ (MacoPharma, Tourcoing, France), T-PAS+ (Terumo BCT, Lakewood, CO, USA), or plasma to evaluate the effectiveness of PAS. METHODS: PLTs were collected two times by apheresis from 12 healthy volunteers in a study comparing four kinds of PASs with 35% autologous plasma and 100% plasma-stored apheresis PLTs. The parameters of PLTs, including PLT counts, pH, PLT activation markers, blood gases, and metabolic variables were assessed up to 7-day. RESULTS: The results of in vitro assay including PLT concentration, mean PLT volume, pH, and blood gases for PLTs in four kinds of PASs were similar to those in 100% plasma PLTs. All units had Day 5 pH greater than 6.2. In vitro quality rating results, PLTs in T-PAS+ had a rating of 5, 4 for CompoSol PS, 2 for SSP+, 1 for InterSol, and 2 for plasma on Day 5. CONCLUSION: Partial replacement of plasma with CompoSol PS, SSP+, or T-PAS+ in PLTs showed better or equivalent quality and preservability of PLTs compared to PLTs in 100% plasma. The use of PAS for storage of PLTs in clinical practice may have an advantage as PAS-stored PLTs have a reduced volume of plasma.

Prophylactic strategies for acute hemolysis secondary to plasma-incompatible platelet transfusions: correlation between qualitative hemolysin test and isohemagglutinin titration

Brazilian legislation has recently suggested the use of the qualitative hemolysin test instead of isohemagglutinin titers as prophylaxis for acute hemolysis related to plasma-incompatible platelet transfusions. The efficacy of this test in preventing hemolytic reactions has never been evaluated while isohemagglutinin titers have been extensively studied. The main objective of this study was to evaluate the correlation between the results of these two tests. The impact of each type of prophylaxis on the platelet inventory management and the ability of the qualitative hemolysin test to prevent red cell sensitization after the transfusion of incompatible units were also studied.METHODS: A total of 246 donor blood samples were evaluated using both isohemagglutinin titers and the qualitative hemolysin test, and the results were statistically compared. Subsequently, 600 platelet units were tested using the hemolysin assay and the percentage of units unsuitable for transfusion was compared to historical data using isohemagglutinin titers (cut-off: 100). Moreover, ten patients who received units with minor ABO incompatibilities that were negative for hemolysis according to the qualitative hemolysin test were evaluated regarding the development of hemolysis and red cell sensitization (anti-A or anti-B).RESULTS: Isohemagglutinin titration and the results of qualitative hemolysin test did not correlate. The routine implementation of the qualitative hemolysin test significantly increased the percentage of platelet units found unsuitable for transfusions (15-65%; p-value <0.001)...

Impacts of ABO incompatibility on early outcome after single unit unrelated cord blood transplantation: a retrospective single center experience / 中华血液学杂志

<p><b>OBJECTIVE</b>To retrospectively study the impacts of ABO incompatibility on early outcome after single unit unrelated cord blood transplantation（UCBT）, such as cumulative incidence of engraftment, incidence of acute graft- versus- host disease （aGVHD） and 180- day transplant- related mortality（TRM）.</p><p><b>METHODS</b>208 patients underwent single unit UCBT from April 2008 to October 2014 were analyzed, included 99 ABO- identical, 60 minor, 38 major and 11 bidirectional ABO- incompatible recipients. All the patients received intensified myeloablative conditioning, and a combination of cyclosporine A and mycophenolate mofetil was given for GVHD prophylaxis.</p><p><b>RESULTS</b>Cumulative incidences of neutrophil engraftment, platelet recovery, erythroid lineage reconstitution, Ⅱ-Ⅳ aGVHD, Ⅲ-Ⅳ aGVHD and 180- day TRM showed no significant difference among the patients receiving ABOidentical, minor, major, and bidirectional UCBT（all P>0.05, respectively）. What's more, none of the patients developed pure red- cell aplasia（PRCA）after UCBT. Group A donor and a group O recipient patients didn't appeared to influence the clinical results when compared with others（all P>0.05, respectively）.</p><p><b>CONCLUSION</b>Patients receive ABO- incompatible UCBT may not develop PRCA. The presence of ABO- incompatibility did not influence the hematopoietic reconstitution, the incidence of aGVHD and 180-day TRM in this cohort. There is not support for the need to regard ABO-compatibility as an UCB-graft selection criterion.</p>

Nursing Students' Error and Recovery in Transfusion Simulation for Safety Competency / 기본간호학회지

PURPOSE: The purpose of this study was to identify the types of errors that occurred and were recovered in a simulated transfusion scenario by nursing students. METHODS: Twenty-eight teams of a total of 89 nursing students participated in a transfusion simulation using a high fidelity simulator. Data were collected by observing rule based errors and built in errors recovered according to the framework of Eindhoven model. Reflective journaling was used to identify perceived safety-threatening errors and commitment to improvement. Data were analyzed using descriptive statistics. RESULTS: All teams committed the rule based errors in the scenario. The most common errors occurred in the coordination category related to communication with physician. Most of students perceived the transfusion reaction as a safety-threatening error. CONCLUSION: The findings indicate that students lack patient safety competence. The simulation training to decrease errors and improve safe practice provides nursing students with an effective strategy to develop patient safety competence.

A Case of Washed Platelet Transfusion in a Patient with History of Recurrent Transfusion Reaction / 대한수혈학회지

Anaphylactic transfusion reaction is caused by deficiency of certain protein(s) in the recipient. We report on the experience of platelet count recovery using washed platelets for transfusion in a patient who developed an anaphylactic transfusion reaction. A 50-year old male diagnosed with angioimmunoblastic T-cell lymphoma was treated with chemotherapy followed by autologous hematopoietic stem cell transplantation. Immediately after starting transfusion of apheresis platelets, he began sweating and complained of visual impairment, chest discomfort, and abdominal pain. Both systolic and diastolic blood pressures and oxygen saturation monitored by pulse oximetry were decreased. Platelet transfusion was discontinued immediately and hydrocortisone was administered, and the symptoms and signs were resolved within two hours. Laboratory test using post-transfusion blood showed no apparent evidence of hemolysis. Platelet washing procedure using normal saline three times was newly set to prevent anaphylactic reaction in the patient. Transfusions of washed platelets were performed 20 times for 60 days, and the patient showed no anaphylactic reaction during this period. He showed no evidence of immunoglobulin A, haptoglobin, C3, or C4 deficiencies. We confirmed that washed platelet transfusion is highly effective for prevention of anaphylactic transfusion reaction.

Performance Evaluation of Unexpected Antibody Screening Test Including Di(a) Cell Using 3% Surgiscreen Sub-Code D in Korean Multi-Transfused Patients / 대한수혈학회지

BACKGROUND: The Dia antigen has been found to have a relatively higher incidence among Korean populations. However, the current popular antibody screening panels contain no Dia positive cells. To prevent hemolytic transfusion reaction, screening for unexpected antibody plus screening for Dia positive cells should be performed. In this study, we evaluate the performance of the 3% Surgiscreen Sub-code D (Ortho-Clinical Diagnostics, USA) manufactured as a 3-cell panel including Dia cell versus the ID-DiaCell I-II (DiaMed, Switzerland) as a 2-cell panel plus ID-DiaCell Dia+ (DiaMed, Switzerland) in screening for irregular red blood cell alloantibodies. METHODS: From December 13, 2013 to April 24, 2014, we tested the 3% Surgiscreen by the AutoVue Innova system and the ID-DiaCell in parallel to evaluate reagent sensitivity in detecting irregular antibodies in multi-transfused patients' plasma or serum. Identification of unexpected antibody tests was performed for positive screening results. RESULTS: Antibody-positive rates were 4.2% (79/1885) and 4.6% (87/1885) for antibody screening with the 3% Surgiscreen and the ID-DiaCell, respectively. Among the 1885 samples, 1875 (99.5%) showed concordant results between the 2 methods, while 10 results differed. From the 10 discrepancies, 1 result was positive only on the 3% Surgiscreen. The prevalence of anti-Dia antibody was 10.1% and 9.2% in the 3% Surgiscreen and the ID-DiaCell, respectively. CONCLUSION: The 3% Surgiscreen manufactured as 3-cell showed a high concordance rate ompared to standard methods. The prevalence of anti-Dia showed no difference between the 2 reagents.