Whole blood versus red cells and plasma for exchange transfusion in ABO haemolytic disease.

Records of 381 neonates who underwent exchange transfusion (ET) due to ABO haemolytic disease at the Division of Neonatology of Hacettepe University, Ankara, Turkey, between January 1977 and December 2003 were reviewed. Records were kept for the type of blood used in ET, the number of ETs for each infant, adverse event attributable to ET and bilirubin levels before, and 4 and 8 h after each ET. Of 381 infants, 300 were transfused with whole blood, whereas 81 infants were transfused with O red cells suspended in A or B plasma. The re-exchange rate was higher in the whole blood group, compared with the erythrocyte and plasma group. Use of erythrocyte and plasma provided 30% reduction in the number of ETs per patient. Eight hours after the first ET, mean bilirubin levels were 84% of the pre-exchange values in the whole blood group and 73% of the pre-exchange values in the erythrocyte and plasma group (P = 0.001). As the use of O group red cells re-suspended in AB plasma decreased the re-exchange risk compared with O group whole blood, we suggest the use of O red cells re-suspended in AB plasma for the ET in cases of ABO haemolytic disease.

Autoimmune hemolytic anemia with warm antibodies in children: retrospective analysis of 51 cases.

In this paper, research based on 51 children with a positive antiglobulin test is presented. Eighteen of the children had acute anemia and 33 had chronic anemia. Two clinical patterns were distinguished: an acute transient type and a prolonged chronic type. Corticosteroid therapy was effective in all acute cases but its results were variable in the chronic cases. The acute form was more frequent in young children, while chronic autoimmune hemolytic anemia (AIHA) occurred mainly among children at puberty. In the chronic form of the disease, it was sometimes necessary to add immunosuppressive drugs and in two cases to perform a splenectomy.

Rh blood group system in Turkey.

Because of the absence of original data concerning the Rh blood group system in Turkey, for the benefit of researchers interested in the human blood groups field, serological results obtained in Hacettepe University Hospitals' Blood Center between 1980 and 1996 have been evaluated for the first time in this paper. During the study, 581,606 people were evaluated for Rho (D) positivity and negativity. In addition, 5,600 people from different parts of Turkey were screened for the five major antigens (D, C, E, c, e) of the Rh blood group system and, according to the results, various gene frequencies and most likely genotypes were calculated. Results clearly show that the Rh blood group system in Turkey is completely, in line with that of the Caucasians.

Plasma exchange in refractory autoimmune anemia in a child with systemic vasculitis associated with homozygote beta thalassemia.

A four-year-old girl presenting with fever and purpuric lesions was diagnosed with systemic vasculitis based on her clinical and laboratory findings. She also had homozygote beta thalassemia. Oral steroids were administered and during the course of her treatment she developed necrotizing lesions on her extremities along with severe myalgia and an autoimmune refractory anemia. Autoantibodies against the Rh antigen causing a persistent hemolysis of her erythrocytes were detected in her serum. Since no improvement in her skin lesions and autoimmune hemolytic anemia was achieved with bolus methylprednisolone therapy and cyclophosphamide, plasma exchange was performed. After three sessions of plasma exchange, her immune complex and autoantibody levels gradually declined and a remission in her clinical and laboratory findings was achieved. We suggest the use of plasma exchange along with conventional therapy for similar cases with ongoing immunologic injury.

Chronic autoimmune hemolytic anemia in children: a report of four patients.

Four children, ages seven to ten years, with direct antiglobulin test (DAT)-positive chronic hemolytic anemia are presented. The patients were followed for 3 to 10 years. Autoantibody against red cell antigens was nonspecific IgG type in all of the patients. In one of the four patients, anemia was associated with splenomegaly and jaundice. In this patient, the third component of the complement was also detected on the red cell surface. In one patient, serum IgA deficiency and frequent pulmonary infections were associated with the disease. This patient developed rheumatoid arthritis five years after diagnosis of hemolytic anemia. The third patient initially had thrombocytopenia subsequently developed DAT-positive hemolytic anemia, vitiligo and alopecia without any evidence of serologic changes suggestive of collagen vascular disorders. In these three patients, partial response was obtained with steroid therapy. The fourth patient developed DAT-positive hemolytic anemia twice during the five year follow-up period. Anemia resolved completely with steroid therapy in two months during the first episode, and in five months in the second. Generalized and peripheral lymphadenopathies which developed at the time of the second hemolytic anemia episode have persisted for the last three years. Administration of cyclosporine in two of the four patients did not result in any amelioration of the symptoms.

A case of mumps associated with acute hemolytic crisis resulting in hemoglobinuria and acute renal failure.

A 13-year-old boy presented with acute hemolytic anemia a few days after mumps infection. The ensuing hemoglobinuria resulted in acute renal failure in this child, which was corrected with fluid and alkali therapy. We draw attention to this uncommon complication of mumps and the need for careful evaluation.

Acute hemolytic anemia caused by irregular rifampicin therapy.

Acute hemolytic anemia characterized by vomiting, diarrhea, vertigo, lumbar pain pallor and high fever due to an irregular and high dose of rifampicin is described in a 13-year-old girl during her treatment for tuberculosis. The presence of rifampicin-dependent antibodies was identified by special tests.