ABSTRACT
【Objective】 To study the changes in serum immunoglobulin levels in children with thalassemia who undergo repeated blood transfusions and explore their correlation with delayed hemolytic transfusion reactions(DHTR). 【Methods】 Serum samples from children with thalassemia who received blood transfusion treatment from June 2022 to April 2023 (observation group) and healthy children who underwent physical examination (control group) in our hospital were collected. The levels of serum immunoglobulins (IgG subtype, IgM, IgA, IgE and IgD) were detected using flow cytometry CBA multi-factor quantitative detection technology, and the differences between the two groups were compared. The children were divided into 4 groups according to different transfusion numbers: ≤10 numbers, 11-30 numbers, 31-50 numbers and >50 numbers, and the differences between different blood transfusion numbers and serum immunoglobulin levels in each group were compared using one-way analysis of variance (ANOVA). Children with thalassemia with DHTR were in the hemolysis group, and children with thalassemia who did not experience DHTR were in the non-hemolysis group. The changes in serum immunoglobulins (IgG subtypes, IgM, IgA, IgE and IgD) between the two groups were compared to explore the correlation between serum immunoglobulins in thalassemia children with repeated transfusion and DHTR. 【Results】 The levels of IgG1, IgG3, IgG4 and IgA in the observation group were significantly higher than those in the control group, with the increase of(2.07±2.12), (0.67±2.03), (0.30±0.37)and(6.04±11.40)mg/mL, respectively, while the level of IgD in observation group was significantly lower than that in the control group, with a decrease of(0.03±0.01)mg/mL, P0.05). IgG1 and IgG4 both significantly increased with the number of blood transfusions.The IgG1 in the 4 groups increased sequentially as(0.30±0.62), (0.41±0.51)and(3.60±3.48)mg/mL, and IgG4 increased sequentially as (0.12±0.13), (0.22±0.07) and (0.21±0.38)mg/mL. IgG2, IgM and IgD showed a significant decrease, with IgG 2, IgM, and IgD in four groups decreased as(0.91±1.50), (0.14±0.10)and(0.05±0.05)mg/mL, respectively, showing significant differences with the number of blood transfusions(P0.05). IgG1, IgG3 and IgG4 in the hemolysis group were significantly higher than those in the non-hemolysis group, with an increase of (4.44±3.41), (0.73±1.26)and(0.52±0.40), respectively(P0.05). 【Conclusion】 The serum immunoglobulin levels of children with thalassemia who undergo repeated blood transfusions are abnormal. There are differences in correlation between the number of blood transfusions and serum immunoglobulin levels among children with thalassemia who undergo repeated blood transfusions. The relevant serum immunoglobulins for DHTR in children with thalassemia who undergo repeated blood transfusions are IgG1, IgG3 and IgG4.
ABSTRACT
Delayed hemolytic transfusion reaction is difficult to prevent using an unexpected antibody test performed prior to transfusion, and unlike acute hemolytic transfusion reaction, it occurs a few days after blood transfusion. Hence, determining the reason for delayed hemolytic transfusion reaction may be a tim-consuming task for clinicians Here, we report our experience of two cases of delayed hemolytic transfusion reaction as a result of the unexpected antibody production to Rh blood group antigens after transfusion. The first patient with a history of transfusion during admission was identified as having anti-E and anti-C antibodies according to the antibody identification test at the time of re-admission. The second patient who had chronic blood transfusion due to cancer treatment was found to have anti-C antibody. Both patients received transfusion of Rh antigen-compatible RBC units only after unexpected antibody development. However, like both cases, patients receiving continuous blood transfusion should be considered for a routine Rh phenotype test.
Subject(s)
Humans , Antibodies , Antibody Formation , Blood Group Antigens , Blood Transfusion , Phenotype , Transfusion ReactionABSTRACT
Delayed hemolytic transfusion reaction occurs when the transfused red cells possess an antigen to which the patient has been previously sensitized. Red cells are destructed by an antibody not detected by compatibility testiing some time after the transfusion. Anti-E(rh") is the Rh antibody that found second most commonly after anti-D in Korea, but very seldom causes hemolytic disease. Recently we experienced a case of delayed hemolytic transfusion reaction due to anti-E(rh") in a 37-year-old woman. Three days after the transfusion, she showed a fall in hematocrit and elevation of indirect bilirubin and LDH accompanied by a positive indirect antiglobulin test. Anti-E(rh") was identified in the patient's serum by antibody screening and identification test.