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At least 19 recordsLinked to original sources
PubMed2025

Long-read DNA sequencing resolves a rare case of alloimmune hemolysis mimicking autoimmune hemolysis.

BACKGROUND: Immune hemolytic anemia poses a significant challenge in transfusion medicine, as identification of underlying alloantibodies can be masked by warm and/or cold autoantibodies. This increases the risk of transfusing incompatible blood, which can precipitate or exacerbate hemolysis. Identifying alloantibodies in the presence of autoantibodies remains difficult with standard serologic and genotypic methods, often delaying accurate diagnosis and appropriate transfusion strategies. CASE REPORT: We describe a 63-year-old woman with autoimmune hemolytic anemia who suffered near-fatal hemolysis following transfusion. Despite extensive serologic and genotypic testing, the cause of her hemolytic transfusion reactions remained elusive. Given her clinical course and transfusion history, we hypothesized that her acute hemolytic transfusion reactions could be due to immune sensitization to a high-incidence RBC antigen. Research whole-genome long-read sequencing (LRS) revealed homozygosity for a rare KEL*02N.16 allele, consistent with a rare Ko phenotype, which was validated by Sanger sequencing. Retrospective serologic testing with Ko RBCs further confirmed alloimmunization within the Kell system. CONCLUSION: This case highlights the limitations of conventional serologic and genotypic methods in detecting rare blood group phenotypes, and emphasizes the diagnostic power of long-read sequencing in transfusion medicine. Early molecular testing in complex hemolytic cases can facilitate targeted transfusion strategies, reduce the risk of severe hemolysis, and improve patient outcomes. As sequencing technologies become more accessible, they have the potential to revolutionize blood group typing and alloimmunization risk assessment in clinical practice.

Humans↗
PubMed1976

Electrical hemolysis of human and bovine red blood cells.

The external electric field strength required for electrical hemolysis of human red blood cells depends sensitively on the composition of the external medium. In isotonic NaCl und KCl solutions the onset of electrical hemolysis is observed at 4 kV per cm and 50 per cent hemolysis at 6 kV per cm, whereas increasing concentrations of phosphate, sulphate, sucrose, inulin and EDTA shift the onset and the 50 per cent hemolysis-value to higher field strengths. The most pronounced effect is observed for inulin and EDTA. In the presence of these substances the threshold value of the electric field strength is shifted to 14 kV per cm. This is in contrast to the dielectric breakdown voltage of human red blood cells which is unaltered by these substances and was measured to be approximately 1 V corresponding in the electrolytical discharge chamber to an external electric field strength of 2 to 3 kV per cm. On the other hand, dielectric breakdown of bovine red blood cell membranes occurs in NaCl solution at 4 to 5 kV per cm and is coupled directly with hemoglobin release. The electrical hemolysis of cells of this species is unaffected by the above substances with exception of inulin. Inulin suppressed the electrical hemolysis up to 15 kV per cm. The data can be explained by the assumption that the reflection coefficients of the membranes of these two species to bivalent anions and uncharged molecules are field-dependent to a different extent. This explanation implies that electrical hemolysis is a secondary process of osmotic nature induced by the reversible permeability change of the membrane (dielectric breakdown) in response to an electric field. This view is supported by the observation that the mean volumes of ghost cells obtained by electrical hemolysis can be changed by changing the external phosphate concentration during hemolysis and resealing, or by subjecting the cells to a transient osmotic stress immediately after the electrical hemolysis step. An interesting finding is that the breakdown voltage, although constant throughout each normally distributed ghost size distribution, increases with increasing mean volume of the ghost populations.

Animals↗
PubMed1975

Phenomenon of hot-cold hemolysis: chelator-induced lysis of sphingomyelinase-treated erythrocytes.

Staphylococcus aureus produces a phospholipase C specific for sphingomyelin (beta-hemolysin). Erythrocytes with approximately 50% sphingomyelin in their membranes, e.g., from sheep, have been shown to have up to 60% of this phospholipid hydrolyzed by this enzyme at 37 C in isotonic buffered saline without hemolysis. Cooling of sphingomyelinase C-treated erythrocytes to 4 C causes complete lysis of the cells, a phenomenon known as hot-cold hemolysis. The addition of ethylenediaminetetraacetate (EDTA) to sheep erythrocytes preincubated with sphingomyelinase C was found to induce rapid hemolysis at 37 C. The treated cells became susceptible to chelator-induced hemolysis and to hot-cold hemolysis simultaneously, and the degree of lysis of both mechanisms increased equally with prolonged preincubation with sphingomyelinase C. Erythrocytes of species not readily susceptible to hot-cold hemolysis were equally insusceptible to chelator-induced lysis. Chelators of the EDTA series were the most effective, whereas chelators more specific for Ca2+, Zn2+, Fe2+, Cu2+, and Mg2+ were without effect. The rate of chelator-induced lysis was dependent on the preincubation period with beta-hemolysin and on the concentration of chelator added. The optimal concentration of EDTA was found to equal the amount of exogenously added Mg2+, a cation necessary for sphingomyelinase C activity. Hypotonicity increased the rate of chelator-induced hemolysis, whereas increasing the osmotic pressure to twice isotonic completely inhibited chelator-induced lysis. The data suggest that exogenously added and/or membrane-bound divalent cations are important for the stability of sphingomyelin-depleted membranes. The phenomenon of hot-cold hemolysis may be a consequence of the temperature dependence of divalent ion stabilization.

2,2'-Dipyridyl↗
PubMed1977

Preferential hemolysis of postnatal calf red cells induced by internal alkalinization.

Red blood cells from neonatal calves, but not from adult cows, rapidly hemolyze in buffered 300 mM solutions of a variety of nonelectrolytes and amino acids. Of these compounds, sucrose is chosen to elucidate the mechanism by which this preferential hemolysis takes place. As in other mammalian red cells, both calf and cow cells are found to be impermeable to sucrose and, in an isosmolar sucrose solution, to undergo volume shrinkage caused by the net loss of chloride ions with concomitant increase in intracellular pH. To test the potential role of intracellular pH change associated with chloride loss in promoting hemolysis, intracellular pH was altered by: (a) a direct addition of fixed acid or base to sucrose solution; (b) the removal of dissolved CO(2) from sucrose solution; and (c) the addition of cells to isotonic NaHCO(3) solution in the absence of sucrose. In all cases, only calf and not cow cells underwent hemolysis. Moreover, 4-acetamido-4'-isothiocyano-2,2'-stilbene disulfonic acid, a potent anion transport inhibitor, completely protected calf cells from hemolysis and caused a nearly total inhibition of both chloride loss and intracellular alkalinization. Furthermore, the hemolytic process is closely related to the integrity of a membrane protein, the band 3 protein, which can be cleaved to varying degrees by the combined treatment of pronase and lipase. Hemolysis is progressively inhibited as the band 3 protein undergoes proteolysis, until a total inhibition of hemolysis takes place when almost all of the band 3 protein is digested into smaller protein components with a mol wt of 65,000 and 35,000 daltons. These results suggest that the intracellular alkalinization process leading to a structural instability of the membrane band 3 protein is responsible for this calf cell hemolysis.

Animals↗
PubMed1976

Hemolysis of erythrocytes by primary pharmacologic agents, part 2: influence of the vehicle.

The hemolytic activity in vitro of chlorpromazine hydrochloride, chlordiazepoxide hydrochloride and brompheniramine maleate was examined using various intravenous solutions as the vehicle. Fresh human blood was employed in the investigation which used a colorimetric method for the determination of hemolysis. Prior to the examination of the hemolytic activity of each drug in the various vehicles, the vehicles themselves were examined for their ability to protect erythrocytes from hemolysis. Little to no hemolysis occurred in normal saline solution (the standard), dextrose 2.5% in normal saline, dextrose 5% in normal saline, dextrose 10% in normal saline, and lactated Ringer's injection. Low levels of hemolysis occurred in dextrose 5% in water, invert sugar 10% in water, and M/6 sodium lactate in water. High levels of hemolysis occurred when red blood cells were suspended in dextrose 2.5% in water. Invert sugar 10% in normal saline and fructose 10% in water caused red cell denaturation resulting in brown cells and hemolysate rather than the characteristic red color. This denaturation was attributed to the hydrogen ion concentration of these two solutions, both having pH values less than 4.0. Vehicles of dextrose in saline, dextrose in water, lactated Ringer's, and invert sugar in water reduced the level of drug-induced hemolysis for the drugs tested compared to that which occurred in normal saline solution. The reduction of hemolysis was greater as the tonicity of the vehicle used was increased. It was concluded that the pharmaceutical vehicles examined have an influence on the cellular effects of drugs which only affects the erythrocyte but which could potentially affect the drugs' distribution from the blood to the sites of their action.

Brompheniramine↗
PubMed1978

Intravascular hemolysis in the late course of aortic valve.

The degree of intravascular hemolysis was evaluated in 315 patients in the late course of aortic valve replacement. Starr-Edwards aortic ball valves of series 2300 caused significantly more hemolysis than did those of series 1200, as estimated from the serum lactate dehydrogenase levels. Smaller valves of series 2300 caused a higher degree of hemolysis than did the larger ones. Aortic disc valves induced a more moderate red cell destruction than did the ball valves, the Lillehei-Kaster significantly more than the Bjørk-Shiley prostheses. Crushing of red cells is thought to be a more important cause of hemolysis than shearing forces in turbulent blood. Hemolytic anemia represented a problem only in some patients with Starr-Edwards valve type 2300, although iron substitution was necessary also in some with other prostheses, since the hemoglobin-binding capacity of haptoglobin was exceeded in several patients. Valvular or paravalvular leakage was associated with stronger hemolysis in some patients, and should be suspected whenever the rate of red cell destruction increases. Longstanding intravascular hemolysis did not seriously affect renal function.

Anemia, Hemolytic↗
PubMed1978

Effect of hypervitaminosis A on hemolysis and lipid peroxidation in the rat.

Erythrocytes from rats fed large doses of Vitamin A alone, or large doses of vitamin A and vitamin E or diphenyl-p-phenylene diamine (DPPD) were studied for H2O2-induced hemolysis. The vitamin A-dosed rats were more susceptible than normal rats to H2O2-induced hemolysis. Hemolysis was not accompanied by lipid peroxidation. Nevertheless, the antioxidants vitamin E and DPPD inhibited hemolysis in erythrocytes from vitamin A-dosed rats. These antioxidants had the same inhibitory effect when they were included in the diet or added to erythrocyte suspensions in vitro. Erythrocytes from vitamin A-dosed rats with or without added vitamin E or DPPD were less susceptible than the erythrocytes from normal rats to osmotic challenge, showing that vitamin A was present in levels sufficient to alter the structure of the erythrocyte membrane. These studies show that oxidative hemolysis occurs when the erythrocyte membrane is modified. Furthermore, this oxidative hemolysis is unrelated to lipid peroxidation.

Animals↗
PubMed1976

A possible mechanism of ellipticine-induced hemolysis.

Ellipticine (E) [5,11-dimethyl-6H-pyrido-(4,3-b)-carbazole, NSC-71795] is an antineoplastic agent which is active against L1210 lymphocytic leukemia in mice. Preclinical toxicologic studies demonstrated hemolysis in dogs and monkeys following intravenous administration of 1.5 mg/kg. This finding prompted this investigation of the mechanism of hemolysis and a study of the various factors that might ameliorate this effect. Initial experiments demonstrated that human red blood cells were completely hemolyzed at an E concentration of 10(-3) M, while a concentration of 10(-4) M stabilized red blood cells against 150 mOsM NaCl. The extent of hemolysis correlated well with the surface activities, lipophilic properties and cellular uptake of E and some of its derivatives (7,10-dimethylellipticine, isoellipticine, 9-methoxyellipticine and 11-demethylellipticine). The greatest hemolysis occurred with 7,10-dimethylellipticine and the least with 11-demethylellipticine. The cellular uptake of E and its derivatives was linear over a wide concentration range and was not temperature-dependent. Hemolysis could be blocked by citrate, sodium ethylenediamine tetraacetate, oxytetracycline and [(+/-)-1,2-bis(3,5-dioxopiperazin-1-y1)propane]. The inhibition of E uptake by citrate appears to be a noncompetitive process and has a K1 of 1.9 X 10(-3) M. These data suggest that Ca++ might be involved in the hemolytic process and in the cellular uptake of E. The intravenous administration of ellipticine to rhesus monkey caused severe hemolysis which could be prevented by simultaneous injection of citrate.

Alkaloids↗
PubMed1979

Effects of low electrolyte media on salt loss and hemolysis of mammalian red blood cells.

Cation loss and hemolysis of various mammalian red cells suspended in isotonic non-electrolyte media were investigated. Sucrose buffered with 10 mM Tris-Hepes, pH 7.4 was used as the non-permeable non-electrolyte. Mammals from which the red cells were derived include the human, guinea pig, rat, rabbit, newborn calf, newborn piglet and pig, all of which contain K as the predominant cation species (HK type) and the dog, cat, sheep and cow, all of which possess Na as the predominant cation species (LK type). Of HK cells, a rapid efflux of K takes place from humans, rats and guinea pigs. Of LK type cells, the dog and cat exhibit an augmented membrane permeability to Na. The governing factors which influence cation permeability are the change in pH, temperature, and ionic strength. In response to increase in pH, the red cells of humans, dogs and cats become more permeable to cations, whereas the red cells of rat and rabbit are unaffected. In response to increase in temperature, HK type cells exhibit augmented K efflux, while the Na loss from the dog and cat cells manifest a well-defined maximum at near 37 degrees C. In all cases, a small substitution of sucrose by an equal number of osmoles of salts results in a dramatic decrease in cation loss. By contrast, the red cells of the rabbit, newborn calf, adult cow, newborn piglet, adult pig and sheep display no discernible increase in ion-permeability under the conditions alluded to above. In some species including the newborn calf, dog, and cat, an extensive hemolysis occurs usually within an hour in isotonic buffered sucrose solution. The osmolarity of sucrose solution affects these cells differently in that as the osmolarity increases from 200--500 mM, hemolytic rates of the calf and dog reach a saturation near 300 mM sucrose, whereas the hemolytic rate of the cat decreases progressively. Common features pertaining to this hemolysis are (1) the intracellular alkalinization process; and (2) the diminution of the cell volume which take place prior to and onset of hemolysis. SITS, a potent anion transport inhibitor, completely protects the cells from hemolysis by inhibiting chloride flux and the concomitant rise in intracellular pH.

Animals↗
PubMed1976

Transitory postnatal hemolysis of calf red cells by amino acids.

Among the amino acids which can be solubilized to give a concentration of 300 mm at near physiological pH, histidine and proline caused a complete hemolysis of newborn calf but not of adult cow red cells within 20 to 30 minutes at 38 degrees C. While hydroxyproline, valine, and serine resulted in a partial lysis of calf cells, threonine, glutamine, and glycine were ineffective. In this communication, emphasis has been focused on the mode of the lytic process by histidine which was found to be affected by several governing parameters including the pH, temperature and the extracellular salts in the solution. Unlike human red cells suspended in isotonic histidine, both calf and cow cells lost little Na and K ions. In the presence of 300 mm histidine, both calf and cow cells displayed an instantaneous uptake of histidine amounting to 20 to 45 mumoles/ml RBC followed by a slow influx rate of 0.25 to 0.5 mumoles/ml RBC X min. The extent to which histidine entry was allowed by the cell was counterbalanced by Cl- efflux, resulting in little change in cell volume prior to hemolysis. Moreover, histidine-induced hemolysis can be prevented by 1 mm or lower PCMBS without a discernible effect on histidine influx suggesting a possible membrane lesion or damage at the outer surface of the cell. Hemolysis induced by histidine decreased substantially when a calf reached two months of age at which time the red cells containing the fetal hemoglobin are virtually depleted. The results of hemoglobin electrophoresis obtained during this postnatal period revealed that those cells resistant to histidine hemolysis almost invariably contain the adult type hemoglobin suggesting a selective, specific action of the amino acids on the fetal cells.

4-Chloromercuribenzenesulfonate↗
PubMed1977

Cold-induced hemolysis in a hypertonic milieu.

Suspension of human erythrocytes at 37 degrees C in an environment made hypertonic by increasing concentrations of sodium chloride and sucrose was followed by hemolysis when the temperature was lowered to 0 degrees C. Two distinct stages were involved in this hemolytic phenomenon, the first being incubation with hypertonic solute at some temperature above 20 degrees C with an increasing effect up to 45 degrees C, and the second stage consisting of lowering the temperature below 15 degrees C with increasing hemolysis down to 0 degrees C. The rate of cooling was not an important factor, but the presence of ions reduced the extent of cold-induced hemolysis in hypertonic sucrose. No significant release of membrane phospholipid and cholesterol accompanied this hemolysis. The solubilization of membrane protein components was investigated, with some differences appearing on sodium dodecyl sulfate polyacrylamide gel electrophoresis between hypertonic and isotonic supernatants. Spectrin could not be identified in solubilized form. Correlation of the temperatures of note in these studies with results from the literature on other biological effects of temperature-induced phase transitions in membrane lipids strongly points to the conclusion that such transitions are involved in the mechanism of cold-induced hypertonic hemolysis. It is postulated that the hypertonic milieu has resulted in membrane-protein alteration damage which prevents normal adaption to the new physical state of the membrane lipids during cooling.

Cold Temperature↗
PubMed1977

Hemolysis of human erythrocytes by transient electric field.

Exposure of human erythrocytes, under isotonic conditions, to a high voltage pulse of a few kV/cm leads to total hemolysis of the red cells. Experiments described herein demonstrate that the hemolysis is due to the effect of electric field. Neither the effect of current nor the extent of the rapid Joule-heating to the suspending medium shows a direct correlation with the observed hemolysis. Voltage pulsation of the erythrocyte suspension can induce a transmembrane potential across the cell membrane and, at a critical point, it either opens up or creates pores in the red cells. In isotonic saline the pores are small. They allow passage of potassium and sodium ions but not sucrose and hemoglobin molecules. The pores are larger in low ionic conditions and permit permeation of sucrose molecules, but under no circumstances can hemoglobin leak out as the direct result of the voltage pulse. Kinetic measurements indicate that the hemolysis of the red cells follows a stepwise mechanism: leakage of ions leads to an osmotic imbalance which in turn causes a colloidal hemolysis of the red cells. Other effects of the voltage pulsation are also discussed.

Adult↗
PubMed1977

Effects of lectins on the hemolysis of rabbit erythrocytes by straphylococcal alpha toxin.

When concanavalin A (1 microgram/ml) or wheat germ agglutinin (2 microgram/ml) was preincubated with a suspension of 2% rabbit erythrocytes for 5 min at 20 C, the binding [125I]-labeled staphylococcal alpha toxin to these erythrocytes was greatly inhibited and the hemolytic action of alpha toxin was decreased. The inhibitory effect of concanavalin A on hemolysis by alpha toxin was completely reversed in the presence of 0.1 M alpha-methyl-D-glucoside or alpha-methyl-D-mannoside. Phytohemagglutinin-P from Phaseolus vulgaris and soybean agglutinin inhibited hemolysis by the toxin at concentrations exceeding 20 microgram/ml. The effect of concanavalin A on alpha-toxin hemolysis was studied further to ascertain the nature of the inhibition. Double reciprocal plots were made of hemolysis against alpha toxin concentrations, and the data suggested that inhibition of the initial rate of the hemolysis by concanavalin A is competitive in nature. This was probably due to an interaction with the alpha toxin binding sites on the cell membrane surface.

Animals↗
PubMed1977

[Glycerol-induced hemolysis of mammalian erythrocytes and inhibition of the lysis by fructose (author's transl)].

The mechanisms of glycerol-induced hemolysis and inhibition of the lysis by fructose were studied. Energy of activation, entropy of activation, and free energy of activation for the hemolytic process were calculated from the data on temperature change in the rate of hemolysis. The values of the thermodynamic quantities thus obtained indicated that the temperature change in the rate of hemolysis is brought about mainly by that in the viscosity of liquid. The presence of fructose in the hemolytic systems caused a reduction in both energy of activation and entropy of activation while free energy of activation remained almost unchanged. Pretreatment of erythrocytes with glycerol gave rise to complete hemolysis of the cells in hypotonic as well as hypertonic saline solutions. Thus, it appears that glycerol releases a portion of the lipids of the cell membrane into the surrounding medium and dehydrates the membrane, thereby promoting hemolysis. Fructose was considered to prevent dehydration of the membrane by glycerol.

Animals↗
PubMed1979

Hemolysis with red cell covered surfaces.

Polypropylene (PP) disks activated by exposure to ammonia glow discharge were used as substrates for red cells deposited from saline suspensions. In some cases these cell-coated disks were further treated by glutaraldehyde to bind the cells more strongly. Each disk was used in a rotational blood-shearing device to induce hemolysis, which was compared with that induced by virgin PP. When the cell coating was uniform and dense from a single settling of cells, the glutaraldehyde-fixed surfaces were about 10% less hemolytic than PP. Non-fixed cells detached from outer regions of the disk and apparently contributed additional hemolysis in the process. Secondary layers of settled cells, both fixed and non-fixed, also proved to be more hemolytic than PP. Coatings of gamma-globulin reduced hemolysis relative to uncoated cell surfaces. The best performance was that of activated surfaces without cells, with hemolysis about 20% less than PP. Tests of cells hemolyzing during detachment in a saline medium suggested that hemolysis of whole blood involves a series of brief attachment/detachment events at the solid surface.

Ammonia↗