Double-Filtration Plasmapheresis and High-Dose Intravenous Immunoglobulin Therapy in a Case of Anti-M Alloimmunization.

Hemolytic disease is a common cause of fetal morbidity and mortality. The anti-M blood cell alloantibodies are one of the most severe causes of fetal anemia and intrauterine death. Since no standard treatment method has been established for pregnant women, the management of this pathology is through conventional methods used for treating Rh blood-type alloimmunization. For the first time, we report a unique case wherein a pregnant woman who had intrauterine fetal death in two previous pregnancies with very low titers of anti-M antibodies had negative effects during very early pregnancy, which were successfully managed in her third pregnancy with a novel protocol. We aggressively managed the blood type (anti-M antibody) and blood platelet incompatibilities (anti-HPA-4b antibody) through combination therapy twice a week (46 cycles between 12 and 34 weeks) of double filtration plasmapheresis (DFPP) and high-dose γ-globulin (20-40 g/wk). An elective cesarean section was performed at 34 weeks, and a healthy neonate was born without detection of alloantibodies in the umbilical cord blood. Our report suggests that the combination of DFPP and intravenous immunoglobulin should be considered for the treatment of anti-M alloimmunization in pregnant women.

Living Donor Liver transplantation in an alloimmunised patient: Immunological challenges and Management in Indian Settings.

Liver transplantation (LT) is often associated with hematological abnormalities with immune or non-immune etiologies and require timely diagnosis and interventions. We report a case of a patient suffering from non-alcoholic steato-hepatitis (NASH) related end stage liver disease (ESLD) with multiple red cell antibodies who underwent LT surgery. In postoperative phase, she developed immune hemolysis as well as acute antibody mediated rejection (AMR) which was managed with therapeutic plasma exchange and IVIG. The case highlights the need to develop an algorithm for red cell and HLA antibody screening in high-risk patients for timely detection and management.

High-sensitivity detection of clinically significant red blood cell antibodies by the column agglutination technique.

BACKGROUND: The detection of clinically significant antibodies to red blood cell antigens is important for the selection of compatible blood for patients. The conventional test tube technique (CTT) is commonly used as the gold standard test, but manual testing and visual detection of hemagglutination may produce errors. A more recently developed method, the column agglutination technique (CAT), facilitates ease of testing. OBJECTIVES: To investigate the specificity and sensitivity of the CAT compared to the CTT for the screening of clinically significant antibodies from the Rh blood group. MATERIAL AND METHODS: Standard antibodies to the Rh blood group, anti-D, -C and -E, were used as examples of clinically significant antibodies in transfusion science. The antibodies were serially diluted by two-fold, then reacted with screening cells with different antigen expression. The hemagglutination reaction was investigated using both techniques, and the grades and scores of the reactions were used to analyze the sensitivity and specificity of the CTT and CAT. RESULTS: The CAT had a better sensitivity than the CTT. The lowest antibody dilution of 1:8192 could be detected using CAT, while a dilution of only 1:2048 could be detected with CTT. However, the CTT and CAT were equal in specificity. The 2 techniques specifically detected all antibodies to the screening cells. CONCLUSIONS: Both the CAT and CTT showed 100% specificity. However, the CAT exhibited more sensitivity than the CTT, and can be used in substitution of, or in parallel with, the CTT technique for red blood cell phenotyping, antibody screening, identification, and crossmatching.

The Frequency Unexpected Antibodies at Kyungpook National University Hospital / 대한수혈학회지

BACKGROUND: Unexpected antibody screening and identification tests are very important pre-transfusion tests for preventing transfusion reactions. Nowadays, the column agglutination test is widely used in Korea. The results of many studies that used this method showed the decreased frequency of nonsignificant cold antibodies and an increased frequency of warm antibodies when compared with other studies that used the tube test or the microplate test. This study was performed in order to determine the accurate frequency and distribution of unexpected alloantibody by using the column agglutination test. METHODS: We analyzed the results from 32,218 antibody screening tests with using LISS/Coombs cards and ID-DiaCell I and II for the transfusion candidates and patients with hemolytic anemia who were seen at Kyungpook National University Hospital during a recent eight-year period. RESULTS: According to the results of the antibody screening test, 188 samples (0.58%) out of all 32,218 samples, were shown to be positive. Unexpected alloantibodies were detected in 86 patients (0.27%) with using the antibody identification test. The antibodies that were detected most frequently were anti-E (29 samples), followed by anti-D (8 samples), anti-M (8 samples) and anti-c (7 samples). CONCLUSION: The frequency and distribution of unexpected antibodies at our hospital are similar with those obtained in other Korean studies. The detection rates of warm antibodies, including Rh antibodies, were high. The proportion of Rh antibodies in patients with a gestation history was significantly higher than that in the patients without a gestation history. This study shows once again that pregnancy affects the antibodies and this supports the relationship between pregnancy and antibody formation.