[Screening and identifying of erythrocyte alloantibodies in patients with Thalassemia major referred to Ahvaz Shafa hospital]

Patients with thalassemia major are clinically dependent on red blood cell [RBC] transfusions. Performing multiple transfusions increase the risk of transfusion-related complications including blood-borne infections, iron overload and also RBC alloimmunization. This cross-sectional descriptive study was conducted on 70 thalassemia cases with regular blood transfusions. The serum samples were screened for the detection of the unexpected antibodies and the positive samples were subjected to antibody identification. Among 70 cases, 6 [8.6%] were identified as unexpected alloantibody; three cases as Anti-K, one as Anti-E and another one as Anti-D. Coincidence of Anti D and Anti-E was detected in one case. Eighteen patients [25.7%] were splenectomized. No significant correlation was seen between the presence of alloantibody and age, sex, the time of first transfusion and spleen condition. Considering that the most prevalent unexpected antibodies [8.6%] identified in this study were against the Kell and Rh system antigens, the evaluation of compatibility for antigens found can be recommended before the performing of transfusion. Therefore, this strategy may decrease the possibility of recipient immunization and production of the unexpected antibodies against donor RBCs

Screening and Identification of Unexpected Red Cell Antibodies by Simultaneous LISS/Coombs and NaCl/Enzyme Gel Methods

We evaluated the clinical usefulness of simultaneous LISS/Coombs and NaCl/Enzyme testing using the gel method for screening and identification of unexpected antibodies in 15,014 samples. When unexpected antibodies were detected by either screening test, those antibodies were identified using both the LISS/Coombs and the NaCl/Enzyme gel test. The positive screening rates of the LISS/Coombs, NaCl/Enzyme, and combined tests (excluding 25 autoantibody cases) were 0.48%, 1.29%, and 1.39%, respectively. Among the 57 samples positive by both screening methods, the antibodies in 19.3% could be identified only by the NaCl/Enzyme method. Among the 137 samples positive only by NaCl/Enzyme screening, 74.5% showed positive results in antibody identification only by the NaCl/Enzyme test, although 7.3% were also positive in the LISS/Coombs test. The NaCl/Enzyme method thus showed about threefold higher detection rates than the LISS/Coombs method, especially in screening for Rh antibodies, and higher exact identification rates and discriminatory power for identifying mixed antibodies. Addition of the NaCl/Enzyme method to routine laboratory procedures may detect and identify considerable numbers of significant antibodies that might be missed if only the LISS/Coombs method is used.

Varied distribution of RhD epitopes in the Indian population.

BACKGROUND: Inhabited by more than 4000 caste and tribal groups, India has an extremely heterogenous population. For thousands of years many tribal groups have practised endogamy and are practically genetically isolated. Traditionally, polyclonal anti-D reagent has been used for RhD typing; though monoclonal antibodies are increasingly being used. As a result, blood banks find it difficult to assign the RhD status to an increasing number of people. As monoclonal anti-D typing reagents may not detect all RhD antigen epitopes, we studied the RhD antigen epitope heterogeneity in different population groups in India. METHODS: Red cells of 5315 RhD-positive individuals belonging to different castes and tribes of India were tested with 30 different epitope-specific monoclonal anti-D antibodies. RESULTS: No single monoclonal antibody could detect all RhD-positive red cells detected by polyclonal antisera. The highest proportion of D antigen was detected by LHM 76/55 and BRAD-8 (98%) monoclonal antibodies. CONCLUSION: We need to determine the correct mix of monoclonal antibodies that will detect nearly all RhD antigens detected by polyclonal anti-D sera. Similarly, before accepting monoclonal anti-D for therapeutic use, it would be necessary to determine the appropriate ones for use in the Indian population.

A RhD Negative Patient Failed to Produce Detectable Anti-D after Transfusion of 35 Units of RhD Positive Red Blood Cells / 대한진단검사의학회지

In the present day, pretransfusion tests include ABO and RhD grouping, antibody screening, antibody identification, and cross matching. Although error rates for these tests have decreased compared to those in the past, clerical errors still occur. When exposed to RhD positive RBCs, a RhD negative person can produce anti-D that causes a severe hemolytic disease of the fetus and the newborn in addition to hemolytic transfusion reactions. Therefore, administration of RhD positive RBCs to a RhD negative person should be avoided. We experienced a RhD negative patient who had been misidentified as positive and transfused 35 units of RhD positive RBCs eight years ago, but did not have detectable anti-D in present. The red cells of the patient showed no agglutination with the anti-D reagent and a negative result in the standard weak D test. The multiplex PCR with sequence-specific priming revealed that the patient was RhD negative.

A Case of Severe Hemolytic Disease of the Newborn Due to Anti-Di(a) Antibody / 대한진단검사의학회지

Here we report a severe case of hemolytic anemia of the newborn with kernicterus caused by anti-Di(a) antibody. A full term male infant was transferred due to hyperbilirubinemia on the third day of life. Despite single phototherapy, the baby's total bilirubin had elevated to 30.1 mg/dL. After exchange transfusion, total bilirubin decreased to 11.45 mg/dL. The direct antiglobulin test on the infant's red cells was positive. The maternal and infant's sera showed a negative reaction in routine antibody detection tests, but were positive in Di(a) panel cells. The frequency of the Di(a) antigen among the Korean population is estimated to be 6.4-14.5%. Anti-Di(a) antibody could cause a hemolytic reaction against transfusion or hemolytic disease of the newborn. We suggest the need for reagent red blood cell panels to include Di(a) antigen positive cells in antibody identification test for Korean.

A case report of neonatal alloimmune thrombocytopenic purpura: the importance of correct diagnosis for future pregnancies

CONTEXTO: Púrpura trombocitopênica neonatal aloimune (PTNA) é uma doença neonatal caracterizada por aloimunização materna contra as plaquetas fetais, que apresentam antígenos herdados do pai. Podem ocorrer hemorragias cerebrais, levando à morte ou a anomalias neurológicas permanentes. RELATO DE CASO: Mulher saudável, de 30 anos, deu à luz, por parto cesariano na 36ª semana de gestação, seu primeiro filho. Com 10 horas de vida, o recém-nascido apresentou petéquias e contagem de 8 x 103 plaquetas/µl no sangue periférico; foi medicado com imunoglobulina e recebeu alta após 18 dias de internação, com 100 x 103 plaquetas/µl. A causa da trombocitopenia não foi elucidada na época. Um ano depois, a criança morreu de neuroblastoma. Como os pais desejavam outro filho, foram encaminhados para investigação da trombocitopenia. Genotipagem plaquetária e pesquisa de anticorpos antiplaquetários foram realizadas, mostrando total falta de concordância entre os sistemas HPA-1 do pai (HPA-1a1a) e da mãe (HPA-1b1b) e anticorpos anti-HPA-1a no soro da mãe. Concluímos que o primeiro bebê nasceu com PTNA. Por isso, na segunda gravidez, a mãe foi tratada com diversas infusões de imunoglobulina intravenosa. Foi realizado cuidadoso monitoramento por ultra-som, com resultados normais para mãe e feto durante a gravidez. O segundo bebê nasceu por cesárea às 39 semanas, apresentando 92 x 103 plaquetas/µl seis horas após o nascimento. As plaquetas do recém-nascido foram genotipadas como HPA-1a1b e o soro da mãe novamente mostrou anticorpos anti-HPA-1a. Não houve hemorragia. A terapia de infusão de imunoglobulina foi efetiva na prevenção da PTNA no segundo filho.

The relevance of crossmatch and HLA compatibility in liver transplantation

Encontra-se bem definido o papel dos aloanticorpos HLA no desencadeamento da rejeicao hiperaguda nos transplantes renais. Nos casos dos transplantes hepaticos, assim como nos transplantes cardiacos, permanece controverso o papel de anticorpos pre-formados na sobrevida do enxerto. Realizamos neste estudo extensa revisao da literatura medica recente publicada pelos grandes centros mundiais transplantadores de figado a respeito da importancia do crossmatch e da compatibilidade HLA nos resultados precoces e tardios do transplante de figado. Ainda longe da unanimidade, a compatibilidade imunologica HLA parece exercer influencias nos desempenhos precoce e tardio dos enxertos hepaticos, apesar do avanco dos imunossupressores. Entretanto a baixa incidencia de paciente transplantados com altos titulos de testes de crossmatch positivos, nao altera a sobrevida global das casuisticas analisadas, sendo controversa sua utilizacao como metodo de selecao frente aos custos de seu emprego, mas nao excluindo seu valor como auxiliar na orientacao da imunossupressao precoce e tardia destes pacientes

Crossmatching considerations in renal transplantation.

During the year 1993-1994, 73 renal transplant cases have been screened for the presence of anti-HLA antibodies using the standard lymphocytotoxicity assay. Amongst the 9 related transplantations with 100% negative crossmatch 6 were successful. About 8.2% of the patients had a shift from positive to negative crossmatch. It was observed that an increased number of transfusions (ranging from 3 to 21) in males and females yielded negative crossmatches. In females, however, owing to various factors such as pregnancies, parity and infections, varied percentages were observed with different donors. The crossmatches in diabetics and hypertensive patients suggest no particular correlation and probably have no role in the outcome of the assay.

Asociación de marcadores eritrocitarios (ABO, MNSs, Rh, Lewis, P1) con recurrencias y anomalías anatómicas y funcionales en niños con infección del tracto urinario / Association of erythrocyt markers (ABO, MNSs, Rh, Lewis, P1) with recurrences and anatomical-functional abnormalities in children with urinary tract infection

Para contribuir a la identificación de niños con infección del tracto urinario con mayor riesgo de ubicación alta o baja, recurrencias y alteraciones radiológicas o ultrasonográficas (complicaciones) se estudiaron las asociaciones entre éstas y la distribución de marcadores eritrocitarios (ABO, MNSs, Rh, Lewis, P1) en 309 casos de infección urinaria. No se encontró asociación entre algún polimorfismo eritrocitario en particular con las mencionadas categorías, pero si entre el fenotipo P1 y la etiología Escherichia coli (OR=3,07; IC 95 porciento=1,13 a 8,6; p<0,02) y la ausencia de etiología no E. coli con el fenotipo B+(0/26) sin llegar a niveles de significación. Estos hallazgos sugieren que en niños con infección urinaria, estos fenotipos, por separado, probablemente tienen acciones independientes y aditivas

Assessment of severity of haemolytic disease of newborn by monocyte monolayer assay.

The present study was undertaken to estimate the predictive value of antibody titration, antibody quantitation and monocyte monolayer assay (MMA) in assessment of severity of haemolytic disease of the newborn (HDN). Serum samples from 45 alloimmunized mothers, with anti-D(23), anti-c(10), anti-K(6), anti-E(5) and anti-e(1) were taken for the study. The results obtained were compared and the efficiency of each technique in predicting the severity of HDN was assessed. Antibody quantitation and MMA (phagocytic index) correlated well with severity of HDN in mothers with anti-D antibodies. Antibody quantitation (anti-D) had a positive predictive value of 54.5 per cent and negative predictive value of 85.7 per cent while MMA had a positive predictive value of 75 per cent and a negative predictive value of 100 per cent. These findings suggest MMA to be a good negative predictor of HDN but not a good positive predictor of haemolytic disease of the newborn.

study of alloantibodies in children in relation to multiple blood transfusion

The study included 98 cases, 60 exposed to blood transfusion for more than 4 times, 20 exposed for 1-3 times and 18 did not expose to blood -transfusion. Besides clinical and laboratory examination needed for diagnosis of the studied cases, they were subjected to A B O and Rh blood grouping and alloantibody screening and typing. Out of the 80 children with blood transfusion, 9 cases were positive to alloantibody screening [11.25%] while none of the 18 children with no blood transfusion was positive. The rate of screening positivity was higher in cases of anemia [15.15%] than in either cases of malignancy [10%] or hemophilia [8%] and the proportionate distribution of positive cases was higher for anemia [55.56%] than for either malignancy or hemophilia [22.22% for each]. The rate of positivity was not much different in relation to the number of transfusions when it is 10, but rises in, cases receiving more than 10 blood transfusions. The proportionate distribution of alloantibody positive cases by A B O blood groups showed higher rate for blood group O [44.44%] than for other A B O blood groups. Regarding the types of alloantibodies, out of the 9 positive cases, 5 showed anti-k [55.56%], 2 showed anti-Js[D] [22.22%], one case showed anti-Lu[a] [11.11%] and one case showed anti-c [11.11%].Due to the relatively small number of alloantibody positive cases in the present series statistical significance of differences between the forementioned rates could not be documented

Aloinmunización feto-materna: estudio comparativo de tres técnicas para su detección / Fetus-maternal aloinmunization: comparative study of three techniques used for ditection

En el Servicio se utilizan tres técnicas para la detección de anticuerpos irregulares en pacientes embarazadas, RH negativas presuntamente no sensibilizadas. Se estudiaron 395 pacientes a las cuales se les efectuó investigación de anticuerpos irregulares con panel glovulara detector de tres tubos (R2R2, R1R1 y rr), utilizando tres técnicas: albúmina-Coombs, LISS-Coombs y glóbulos rojos bromelinados. Se detectó un 12,4% de anticuerpos identificados como anti-D. Es importante destacar que en tres oportunidades la reacción fue positiva primero en vomelina y luego en albúmina-Coombs y LISS-Coombs durante el segumiento de las pacientes. Además, se detectaron otros tipos de anticuerpos distintos al anti-D. Asociando la detección de anti-D con los otros anticuerpos se obtuvieron un 4,3% en medio albúmina, un 4,5% con glóbulos rojos en LISS y 12,9% con glóbulos rojos bromelinados. En la combinación de albúmina y LISS se detectó un 6,3%, en albúmina y bromelina 14,9% y en albúmina-bromelina-LISS un 19,2%. En nuestra casuística la técnica con bromelina ha demostrado ser más sensible en la detección de anticuerpos, fundamentalmente para anti-D. No obstante, para obtener una mayor eficacia en la detección de anticuerpos debemos combinar al menos tres técnicas

Trasplante renal ABO incompatible de dador vivo relacionado / ABO incompatible renal transplantation of related living donor

Se presenta un caso, que se suma a recientes y escasos ejemplos comunicados en la literatura extranjera, de un transplante exitoso de un dador de grupo sanguíneo B a un receptor de grupo sanguíneo 0. Se efectuó una preparación previa con esplenectomía, plasmaferesis, corticoides, ciclosporina y globulina antilinfocitaria que, de acuerdo a comunicaciones recientes serían factores determinantes del éxito del trasplante. En casos excepcionales, el trasplante entre grupos ABO incompatibles no debe ser siempre contra-indicado

Efeito talidomida sobre os níveis séricos de imunoglobulinas IgM e IgA, fator reumatóide e isohemaglutinina anti-A e Anti-B em pacientes com lepra lepromatosa: estudo duplo-cego / Effect of thalidomide on serum levels of imnunoglobulins IgM and IgA, rheumatoid factor and isohemagglutinis anti-A and anti-B in patients with lepromatosus leprosy: a double blind study

Um estudo duplo-cego foi conduzido em pacientes portadores de lepra lepromatosa estável, para avaliar a resposta a administraçäo de talidomida 100 mg por dia, por 18 dias, dos níveis séricos de IgM e IgA e dos títulos de fator reumatóide e isohemaglutininas anti-A e anti-B. Nenhum efeito significativo foi detectado ao fim deste período

Anti-P1, allohemagglutinins associated with Clonorchis sinensis and opisthorchis viverrini infections in patients from Southeast Asia.

An automated assay of anti-P1 allohemagglutinins has been carried out on sera of 61 individuals from Southeast Asia : 28 with clonorchiasis, 18 with opisthorchiasis and 15 control subjects. Anti-P1 activity was detected in 61% of the opisthorchiasis sera, 57% of the clonorchiasis sera and in 26.6% of the control subjects. Their concentration, in the sera, was low in control subjects and exceptionally high in clonorchiasis and opisthorchiasis (up to 13 and 22 times the maximum concentration of the control subjects, respectively). In all cases the anti-P1 antibodies were of IgM class. The results suggested that Clonorchis and Opisthorchis were responsible for immunization of the patients, with P1 alloantigen.