ABSTRACT
El rastreo de anticuerpos anti-eritrocitarios es una de las pruebas pretransfusionales más importantes en medicina transfusional por su aporte en la prevención de reacciones adversas luego de la administración de hemocomponentes. Sin embargo, no todos los bancos de sangre ecuatorianos han incluido esta prueba en sus protocolos de trabajo. Para demostrar su importancia se realizó el presente estudio cuyo propósito fue alertar al sistema nacional de salud sobre la existencia de aloinmunización en la población de donantes de sangre. Se estableció una prevalencia de anticuerpos anti-eritrocitarios del 0,27% y se identificó una mayor frecuencia en el género femenino. Los anticuerpos identificados estuvieron relacionados con los sistemas eritrocitarios Rh (RH), Kell (KEL), Duffy (FY) y Kidd (JK). Una de las limitaciones para la inclusión de esta prueba en los bancos de sangre y servicios de medicina transfusional es el elevado costo de los reactivos y la falta de paneles de células eritrocitarias de composición homocigota y heterocigota para la identificación de anticuerpos anti-eritrocitarios nativos, situación que constituye una oportunidad para que el Ministerio de Salud Pública del Ecuador promueva mejores estrategias para la importación de reactivos, reducción de costos y disponibilidad de paneles de células.
The screening of anti-erythrocyte antibodies is one of the most important pretransfusion tests in transfusion medicine because of its contribution to the prevention of adverse reactions after the administration of blood components, however not all blood banks in Ecuador have included this test in their work protocols. This study has the purpose to alert the national health system about the existence of alloimmunization in the blood donour population. A prevalence of anti-erythrocyte antibodies of 0.27% was established, with a higher frequency being found in the female gender. The identified antibodies are related to the erythrocyte systems Rh (RH), Kell (KEL), Duffy (FY) and Kidd (JK). One of the limitations for the inclusion of this test in blood banks and transfusion medicine services is the excessive cost of serological and gel methodology reagents, and the lack of homozygous and heterozygous erythrocyte cell panels for the identification of native anti-erythrocyte antibodies. That situation constitutes an opportunity for the Ministry of Public Health of Ecuador to promote better strategies for the imports of reagents, cost reduction and availability in the country.
O rastreamento de anticorpos anti-eritrocitários é um dos testes pré-transfusão mais importantes na medicina transfusional pela sua contribuição na prevenção de reações adversas após a administração de componentes sanguíneos. No entanto, nem todos os bancos de sangue do Equador tem incluído esse teste em seus protocolos de trabalho. Para demonstrar a sua importância, foi realizado o presente estudo que teve como objetivo alertar o sistema nacional de saúde sobre a existência de aloimunização na população de doadores de sangue. Foi estabelecida uma prevalência de anticorpos anti-eritrocitários de 0,27%, identificando maior frequência no sexo feminino. Os anticorpos identificados estiveram relacionados com os sistemas eritrocitários Rh (RH), Kell (KEL), Duffy (FY) e Kidd (JK). Uma das limitações para a inclusão destes testes em bancos de sangue e serviços de medicina da transfusão é o alto custo dos reagentes, além da falta de painéis de células eritrocitárias de composição homozigótica e heterozigótica para a identificação de anticorpos anti-eritrocitários nativos, situação que constitui uma oportunidade para que o Ministério da Saúde Pública do Equador promova melhores estratégias para a importação de reagentes, redução de custos e disponibilidade de painéis de células.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Young Adult , Blood Donors/statistics & numerical data , Antibodies/blood , Blood Transfusion , Epidemiology, Descriptive , Prevalence , Retrospective Studies , Ecuador , ErythrocytesABSTRACT
The Rhesus G antigen is present on all RBCs that are C+ and also on most D+ RBCs. Due to this co-distribution of G with either C or D antigen, it mimics a reactivity pattern of anti C + anti D on Indirect Antiglobulin Test (IAT), though the role of Anti G in causing Hemolytic Disease of Newborn (HDN) is controversial. The differentiation of anti D, anti C, and anti G is essential particularly in pregnant females. We hereby report a rare case of anti G with anti D and anti C in a pregnant woman with emphasis on approach to identify anti D+C+G and its implications.
ABSTRACT
El desarrollo de la Medicina Transfusional y la Inmunohematología en el Instituto de Hematología e Inmunología en estas cinco décadas se ha caracterizado por logros relevantes como la introducción de métodos de mayor sensibilidad para optimizar el diagnóstico inmunohematológico, entre ellos los ensayos inmunoenzimáticos, la citometría de flujo y las técnicas de inmovilización de antígenos eritrocitarios y plaquetarios por anticuerpos moclonales específicos (MAIEA y MAIPA, respectivamente); la profundización en el estudio de las citopenias inmunes; la pesquisa de agentes infecciosos en donantes de sangre y pacientes politransfundidos; la producción y distribución de anticuerpos hemoclasificadores poli y monoclonales; la labor de referencia nacional del laboratorio de Inmunohematología; las contribuciones al Programa Nacional de sangre que incluyen la confección y distribución de guías clínicas para el uso de la sangre y de procederes para bancos de sangre y servicios de transfusiones; el desarrollo de métodos de aféresis terapéutica; el desarrollo de investigaciones multicéntricas en Medicina Transfusional; la obtención y procesamiento de células madre hematopoyéticas de médula ósea y sangre periférica para su empleo en trasplantes hematopoyéticos y terapia celular; la formación y actualización de profesionales y técnicos en Medicina Transfusional, tanto en Cuba como en otros países de Latinoamérica y la organización de talleres, eventos e intercambios nacionales e internacionales en estas ramas. Las proyecciones de trabajo se encaminan a introducir técnicas moleculares en Inmunohematología para lograr una mejor caracterización de los anticuerpos contra células sanguíneas, profundizar en el estudio de los anticuerpos contra leucocitos y plaquetas, contribuir al desarrollo de un programa nacional de hemovigilancia, crear un banco de células progenitoras de cordón umbilical para uso terapéutico e iniciar programas de maestrías y doctorados en Medicina Transfusional.
The development of Transfusion Medicine and Immunohematology at the Institute of Hematology and Immunology in these five decades has been characterized by relevant achievements such as the introduction of more sensitive methods to optimize the immunohematological diagnosis such as immunoenzymatic assays, flow cytometry and techniques of immobilization of erythrocyte and platelet antigens by specific monoclonal antibodies (MAIEA and MAIPA, respectively); deepening the study of immune cytopenias; screening for infectious agents in blood donors and polytransfused patients; the production and distribution of polyclonal and monoclonal hemoclastic antibodies, the national reference work of Immunohematology Laboratory; contributions to the National Blood Program such as the preparation and distribution of clinical guidelines for the use of blood and procedures for blood banks and transfusion services; the development of therapeutic apheresis methods; the development of multicentric investigations in Transfusional Medicine; the procurement and processing of hematopoietic stem cells from bone marrow and peripheral blood for use in hematopoietic transplantation and cell therapy; the training and updating of professionals and technicians in Transfusion Medicine, both in Cuba and in other countries of Latin America and the organization of workshops, events and national and international exchanges in these branches. The work projections are aimed at introducing molecular techniques in Immunohematology to achieve a better characterization of the antibodies against blood cells, to deep the study of the antibodies against leukocytes and platelets, to contribute to the development of a national haemovigilance program, to create a bank of umbilical cord progenitor cells for therapeutic use and initiate master's and doctoral programs in Transfusion Medicine.
Subject(s)
Humans , Transfusion Medicine/history , Transfusion Medicine/methods , HematologyABSTRACT
BACKGROUND: Although the risks of adverse pregnancy outcomes associated with anti-D antibodies are well-recognized, much less is known concerning alloimmunization with other red blood cell antibodies detected during routine maternal screening. To date, most reports of adverse pregnancy outcomes associated with non-anti-D antibodies have been from small case studies. The aim of this study was to examine the associations of maternal alloimmunization with specific red blood cell antibodies and the risks of preterm birth and stillbirth in the Swedish population. METHODS: All antibody screening, outcome and covariate data were obtained through linkages of Swedish national health and data registers. Follow-up in these population-based registers was available up to 31 December 2002. The final study sample consisted of 1,022,569 singleton births from 668,952 mothers during 1987-2002. RESULTS: In total, 1.3% of the 1,022,569 study pregnancies were alloimmunized. In adjusted logistic regression models, compared with having no antibodies, alloimmunization with anti-D, anti-E, anti-C and anti-c was associated with increased risk of both stillbirth and preterm birth. In addition, anti-Kell was associated with increased risk of preterm birth and anti-Lea with increased risk of stillbirth. Compared with firstborn children, risk of preterm birth associated with alloimmunization was greater in subsequent births CONCLUSIONS: In the largest study to date, alloimmunization with Rhesus, K- and -Lea red blood cell antibodies increased the risk of preterm birth and/or stillbirth. The association of anti-Lea with stillbirth was an unexpected finding. Further study of the consequences of non-anti-D alloimmunization is warranted.
