Acute hemolytic transfusion reaction caused by anti-M antibodies: a case report and literature review.

OBJECTIVE: We report a rare case of acute hemolytic reactions caused by immunoglobulin (Ig)M anti-M antibody and present a literature review. CASE REPORT: A 61-year-old male patient who underwent blood transfusion developed fever, chills, soy sauce-colored urine, and changes in laboratory test results, including persistently decreased hemoglobin levels, neutrophilia, elevated lactate dehydrogenase level, acute kidney injury, mild acute liver injury, and activation of the coagulation system, indicating acute hemolytic transfusion reaction (AHTR). Antibody screening and major crossmatching results indicated weak positive at 37°C for both posttransfusion and pretransfusion sample. Subsequent serological examinations indicated the presence of IgM anti-M antibodies in plasma but the direct antiglobulin and elution tests were negative. Antibody hemolytic activity assay confirmed AHTR caused by anti-M. The transfused red blood cells were MM and the patient is NN. These signs and symptoms disappeared rapidly and required no additional interventions before discharge. CONCLUSION: The accurate diagnosis of anti-M antibody-mediated acute hemolysis is essential for guiding treatment decisions.

Utility of hemoglobin electrophoresis to distinguish between severe delayed hemolytic transfusion reaction versus hyperhemolysis syndrome.

Delayed hemolytic transfusion reaction (DHTR) and hyperhemolysis syndrome (HHS) are both complications of red blood cell transfusions in patients with sickle cell disease.Clinically, both present with hemolysis and can be difficult to differentiate. Hemoglobin electrophoresis may aid in the diagnosis. Herein we describe a case in which a patient with hemoglobin SC disease presented with features of severe hemolysis several days after initiation of red blood cell exchange. Increase in reticulocyte count and complete absence of hemoglobin A on electrophoresis during this event supported the diagnosis of severe DHTR, indicating a rapid and selective destruction of the transfused red blood cells. Ability to interpret the hemoglobin electrophoresis can help clinicians distinguish between these two severe transfusion complications in patients living with sickle cell disease. It is important to identify the presence or absence of concomitant HHS, as patients with HHS tend to have a worse prognosis and there is a higher rate of recurrence of HHS with subsequent transfusions. Accurate diagnosis can lead to prompt management and decrease morbidity and mortality.

Hemolysin test as a tool to screen high-titer Group O platelet apheresis donors: A prospective study.

BACKGROUND: Minor ABO-incompatible apheresis platelet transfusion poses a risk of hemolytic transfusion reactions in non-Group O recipients when donor's plasma possesses unusual high titers for anti-A and anti-B. The aim was to determine whether the hemolysin test can be used as a screening tool to predict high-titer Group O platelet apheresis donors. METHODS: A prospective study, with Group O platelet donor's samples, was tested for hemolysin test and antibody titration test in parallel. Antibody titration was also performed on products suspended in platelet additive solution (PAS). Hemolysin test was assessed for diagnostic accuracy against antibody titration. Chi-square test and Mann-Whitney U-test were used to determine the relationship between the hemolysin test and antibody titration. RESULTS: Among 107 Group O platelet donations, median anti-A and anti-B titers in donors were 32 (8-128) and 32 (4-256), respectively. High titer (≥128) for ABO antibodies was seen in 18% of donations, whereas hemolysin test was positive in 69% of donations. Hemolysin test results differ significantly with antibody titration results (P = 0.03). Hemolysin test had higher sensitivity (89%) with a strong negative predictive value (94%). None of the products suspended in PAS had high-titer antibodies. CONCLUSION: Adopting hemolysin test as a screening tool may label a large number of units (69%) unsuitable for ABO-incompatible platelet transfusion. Alternatively identifying donors with high antibody titer or positive hemolysin test and selectively suspending their product in PAS may be a cost-effective approach and certainly prevent high-titer antibodies in the product.

Fenotipagem eritrocitária em doadores de sangue no HEMOPI - PI (Teresina - Picos) e no hemocentro regional do Crato - CE

Em razão da melhor expectativa de vida e do envelhecimento da população,consequentemente, a melhora dos avanços técnicos e diagnósticos na Medicina, aliados anovas modalidades terapêuticas para doenças, cresce no mundo inteiro a transfusão deconcentrados de hemácias, plaquetas e plasma fresco congelado. Assim, a fenotipagemeritrocitária, tanto em receptores quanto em doadores de sangue, tem como finalidade reduziro número de reações transfusionais, prevenindo o aparecimento de anticorpos de forma maistardia, principalmente naqueles receptores candidatos a politransfusão. Além disso, afenotipagem eritrocitária é essencial na confirmação dos aloanticorpos formados, além defacilitar a identificação de anticorpos que poderão ser constituídos no futuro. O estudo tevecomo objetivo analisar as frequências dos principais antígenos de grupos sanguíneospertencentes aos sistemas ABO, Rh, Duffy, Kidd, MNS, e o antígeno K do sistema Kell, bemcomo estudar a associação entre esses grupos e a distribuição quanto à procedência e o gruporacial autorreferido, por serem esses os principais sistemas envolvidos em reaçãotransfusional hemolítica e causarem a doença hemolítica perinatal em todo o mundo. Foramanalisadas 532 amostras de doadores de sangue do Hemocentro do Estado do Ceará, regionaldo Crato, e Hemocentro do Estado do Piauí (Teresina e Picos)...

Due to better life expectancy and the aging of population, consequently the improvement oftechnical advances and diagnostics in medicine, combined with new therapeutic modalitiesfor different diseases, it is growing worldwide the transfusion of packed red blood cells,platelets and fresh frozen plasma. So, the erythrocyte phenotyping as in receptors as in blooddonors aims to reduce the number of transfusion reactions, preventing the appearance ofantibodies in a later way, mainly in those receptors candidates to poly-transfusion. Besidesthis the erythrocyte phenotyping is essential for confirmation of formed alloantibodies aswell as facilitating the identification of antibodies that can be formed in the future. This studyaimed to analyze the frequencies of the main antibodies of blood groups belonging to thesystems ABO, Rh, Duffy, Kidd, MNS, and K antigen of Kell system and to study theassociation between these groups and the distribution concerning the origin and the racialgroup self-referred. Being these, the main systems involved in hemolytic disease worldwide.532 samples of blood donors of hemocenter of Ceará State, regional of Crato and hemocenterof Piaui State (Teresina and Picos)...