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Post-transfusion purpura associated with anti-Baka and anti-PIA2 platelet antibodies and delayed haemolytic transfusion reaction.

The occurrence of post-transfusion purpura (PTP) in a 16-year-old girl with sickle/beta-thalassaemia is described. Clinically this was a typical case of PTP, but it was unusual serologically. Anti-Baka and anti-PIA2 platelet-specific antibodies were identified and the patient's platelets were typed as homozygous PIA1-positive and Baka-negative. The patient also developed red-cell, granulocyte and lymphocytotoxic antibodies in response to the blood transfusion and had a delayed haemolytic transfusion reaction.

Adolescent↗

[Diagnosis of transfusion reactions].

The diagnosis of the haemolytic transfusion reaction in the immunhaematological and clinical-chemical laboratory is described. The origin of haemolysis and disseminated intravascular coagulation and the possibilities to diagnose these disorders are pointed out.

Blood Group Incompatibility↗

Delayed hemolytic transfusion reaction caused by anti-LebH antibody.

A major delayed hemolytic transfusion reaction produced by an antibody to Lewisb is reported. Delayed hemolysis following transfusion with Leb-positive red cells was not reported to the blood bank. Severe hemolysis recurred following a second transfusion with Leb-positive cells, but was avoided thereafter with Leb-negative red cells. This is the first reported case of a serious delayed hemolytic transfusion reaction caused by anti-Leb.

Aged↗

Biologic activity of RANTES in apheresis PLT concentrates and its involvement in nonhemolytic transfusion reactions.

BACKGROUND: RANTES, one of the PLT-derived biologic response modifiers, accumulates in PLT concentrates (PCs) during storage and may play a causative role in nonhemolytic transfusion reactions (NHTRs) after PC transfusion. STUDY DESIGN AND METHODS: To investigate the association of RANTES with NHTRs, the biologic activity of RANTES in the supernatant of stored PC at the intravascular concentration expected after PC transfusion was assessed by examining chemotaxis and histamine release in human basophils. In addition, the levels of RANTES in PCs involved in NHTRs were compared with those in PCs causing no transfusion reactions. RESULTS: The supernatant of PC diluted to contain 1 nM RANTES significantly increased the migration of and release of histamine from basophils. Neutralizing antibody to RANTES suppressed the PC-triggered migration, but not histamine release. The levels of RANTES in PCs involved in NHTRs after PC transfusion were comparable to those in PCs that did not cause any transfusion reactions. CONCLUSION: RANTES that accumulated in PCs during storage was biologically active in a basophil chemotaxis assay at the intravascular concentration expected after PC transfusion. However, the NHTRs after PC transfusion were not simply related to the RANTES level in PCs.

Basophils↗

[Platelet transfusion and allergic transfusion reactions: experiences at Lille Hospital over a four year period].

Among the immediate transfusion reactions caused by the utilization of blood products, those suggesting immuno-allergic mechanisms posed problems for frequency, gravity, laboratory diagnosis and safety. We report here the Lille Hospital's experience over a four-year period concerning these manifestations after platelet concentrate transfusion. Eight hundred and fifty-two immediate transfusion reactions have been declared, of which 230 were allergic, which appeared in 181 patients (27%). Among the most frequent clinical signs, rash was often described (158 cases: 68.7%); less frequent were respiratory problems such as dyspnea (34 cases: 14.8%) and hypotensive reactions (18 cases: 7.8%). Seven patients presented severe reactions (3%). Twenty percent of them presented multiple allergic reactions and in 43.2%, the recurrence was more serious than the initial problem in spite of preventive medication; the use of washed blood components was necessary. The age of platelet concentrates does not appear to play a part in provoking these events (67% of platelet concentrates had been collected within four days). These allergic transfusion reactions posed problems for those who prescribe medication, because they are frequent, sometimes serious, can recur and at present, the proposed medication prevention is not always efficient.

Adolescent↗

TRANSFUSION reaction.

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Blood Transfusion↗

Transfusion reactions.

Blood components are indicated in a wide variety of disease states. Although most transfusion therapies are administered uneventfully, there are a number of potential adverse transfusion reactions, some of which can assume serious dimensions. These reactions could occur during or even days after a transfusion. A brief description of the adverse effects of transfusion therapy has been outlined in this review. The etiopathogenesis, recognition and treatment of the adverse transfusion reactions have been highlighted. It is imperative that each transfusion of blood components has components be monitored carefully. Prompt recognition of an adverse event and early institution of remedial measures would help in decreasing transfusion related morbidity and mortality.

Blood Group Incompatibility↗

Extravascular hemolytic transfusion reactions due to anti-Yk(a)+Cs(a).

The literature lacks cases which document significant hemolytic transfusion reactions or which document successful transfusions of incompatible donor blood in patients who have anti-Yk(a), anti-Cs(a), or anti-Yk(a)+Cs(a). A patient who had multiple extravascular hemolytic transfusion reactions due to anti-Yk(a)+Cs(a) is herein reported. The initial reaction was on the basis of a secondary episodes involving incompatible donor units resulted in more rapid red cell destruction and finally oliguria.

Anemia, Hemolytic↗

Transfusion reactions in patients with cancer.

In general, the true incidence of transfusion reactions is difficult to determine with certainty. In patients with cancer, it becomes even more complex to define. During a four-year study period in which 100,177 units of red blood cell transfusions were given to 25,744 cancer patients, 245 episodes of transfusion reactions were reported. The incidence of overall reaction was 0.3% of all transfused units, which is significantly lower than other studies. Febrile nonhemolytic reactions and allergic urticarial reactions were the most frequently noted, constituting 51.3% and 36.7%, respectively, of total reactions. There were only 17 hemolytic reactions (four immediate and 13 delayed-type). The incidence of delayed hemolytic reactions in cancer patients is significantly lower than that reported for patients in non-oncology hospital settings. This could result from the inability of cancer patients to produce alloantibodies against blood group antigens as frequently and efficiently as can those with non-neoplastic conditions.

ABO Blood-Group System↗

[Haemolytic transfusion reaction of surgical patients due to incompatibility of Rh blood groups].

Haemolytic transfusion reactions occurred in 4 patients under plastic surgery due to incompatibility of Rh blood groups. The reaction in one of the patient occurred not only abrupt but severe and finally died of renal failure. Other three patients with delayed haemolytic reactions survived after treatment. Since more than 99.5% Chinese population is Rh positive, cross-matching on Rh blood groups is not a routine. The reactions develop usually different from typical ABO blood group haemolytic reactions and are not easy to make an early diagnose. If the surgical patients show profound anemia and haemorrhage following transfusion which could not be explained by bleeding and coagulation abnormalities, haemolytic transfusion reactions due to incompatibility of Rh blood groups might be considered.

Adult↗

Fatal delayed transfusion reaction in a sickle cell anemia patient with Serratia marcescens sepsis.

Patients with sickle cell anemia may require repeated red cell transfusion, putting them at risk for minor blood group alloimmunization and the development of delayed hemolytic transfusion reactions. Although Streptococcus pneumoniae is the most common cause of life-threatening infection in patients with sickle cell anemia, those who have been recently hospitalized are at risk for infection with resistant hospital-associated organisms, and blood transfusion may put the patient at risk of infection with transfusion-associated organisms such as Serratia marcescens and Yersinic enterocolitica. We recently cared for an adolescent with sickle cell anemia who presented to the emergency department with a severe, delayed hemolytic transfusion reaction and Serratia marcescens infection. The patient had been discharged from the hospital five days previously, and had been transfused and treated with antibiotics while hospitalized. In addition to demonstrating the potential severity of delayed hemolytic transfusion reactions, our case illustrates the importance of providing relatively broad-spectrum antibiotic coverage to patients with sickle cell anemia and possible infection who have recently been hospitalized.

Adolescent↗

Anti-Cob causing acute hemolytic transfusion reaction.

An example of anti-Cob which caused an acute hemolytic transfusion reaction is reported. Immunohematologic studies showed this antibody to be an IgG immunoglobulin that weakly bound complement and reacted in the antiglobulin phase of the crossmatch. The unit of whole blood implicated in the hemolytic transfusion reaction was from a donor who was phenotyped as Co(a+b+). The patient gave no history of previous transfusions; however, anti-E and anti-c were also present.

Acute Disease↗

Adverse transfusion reactions associated with a precipitating anti-C4 antibody of anti-Rodgers specificity.

A patient suffering from chronic hepatitis exhibited severe transfusion reactions after administration of fresh frozen plasma and a plasma fraction: PPSB (prothrombin complex concentrate). 1 month before these reactions, she received fresh frozen plasma during plasma exchange therapy. The patient's serum obtained 1 week and 6 months after the second reaction gave a precipitation arc against PPSB preparations when examined by double-diffusion technique in agarose gel. An antibody of IgG class present in these sera reacted with a purified preparation of the fourth complement component (C4). This was demonstrated by various experiments (protein A radioimmunoassay and passive hemagglutination) using purified C4 as antigen. The antibody had a limited specificity and reacted only with C4 of Rodgers specificity. Phenotype determination of the patient's C4 group showed that she was Chido positive and Rodgers negative. Her HLA group was A1, Aw30; B8,-; DR3,-. The patient had neither detectable anti-IgA nor other anti-immunoglobulin antibodies. She had not received blood or plasma transfusion before her hepatitis. The coexistence of a precipitating anti-C4 antibody and adverse transfusion reactions to plasma fractions containing large amounts of C4 indicates that in the absence of antibodies of other specificities, this antibody can be considered as the cause of the transfusion reaction.

Adult↗

Hematologic emergencies. Management of transfusion reactions and crises in sickle cell disease.

Two hematologic emergencies are reviewed in this article: transfusion reactions and crises in patients who have sickle cell disease. Transfusion reactions may be due to incompatibility, IgA deficiency, allergy or, rarely, bacterial contamination of the blood product. A major hemolytic reaction due to incompatibility may progress to hypotension and shock. To prevent this type of reaction, blood products should be given only when necessary and attention should be given to eliminating clerical errors, which are responsible for many hemolytic reactions. In patients with sickle cell disease, a painful crisis due to vascular occlusion is the most common emergency. Rehydration is essential, and narcotics may be needed to relieve pain. Aplastic crisis is managed by transfusion of packed red blood cells and supportive care. Sickle cell crisis may affect major organ systems. The acute chest syndrome can be complicated by pneumonia; rapid respiratory failure may occur if multiple lobes are involved. Splenic or hepatic sequestration requires aggressive rehydration and transfusion. In patients who have had stroke or subarachnoid hemorrhage, a long-term exchange transfusion program is needed to keep hemoglobin S levels below 30%.

Anemia, Sickle Cell↗

Intravascular hemolytic transfusion reaction due to anti-Vw+Mia with fatal outcome.

Because of the increasing use of type, screen and hold protocols and minimal surgical blood order protocols in transfusion services, a number of patients are receiving un-cross-matched blood in elective situations. There are many low-frequency red blood cell antigens which are lacking on reagent cells used for antibody screening procedures, and alloantibodies directed against these antigens are relatively common and occur in either natural or immune forms. A case of an intravascular hemolytic transfusion reaction resulting in death is reported. The patients had a naturally occurring anti-Vw+Mia and received 1 U of Vw+Mia-positive donor red cells. It is the 1st documented case of a hemolytic transfusion reaction due to this incompatibility. The potential threat of transfusion reactions due to low-frequency antigens must be recognized by the physicians who design type, screen and hold protocols and it has particular reference to the selection of possible recipients for whom the protocols are applied.

Antibody Specificity↗