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Quraishy N, Sapatnekar S. Immunohematological testing and transfusion management of the prenatal patient. Adv Clin Chem 2023; 117:163-208. [PMID: 37973319 DOI: 10.1016/bs.acc.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
The primary indication for immunohematological testing in the prenatal patient is to detect and identify maternal red cell antibodies. If there are antibodies that are expected to hemolyze the fetus' red cells, their strength of reactivity must be tested, and the fetus' antigen status determined. After delivery, testing is performed to assess the extent of fetomaternal hemorrhage, as a large hemorrhage may require other therapeutic interventions. Another major role for immunohematological testing is to select blood components appropriately when intrauterine transfusion is required for fetal anemia resulting from maternal alloimmunization or some other cause. Supplementation with molecular methods has transformed the practice of immunohematology, particularly as it applies to typing for the D antigen of the Rh blood group system. Notwithstanding the advances in testing, close coordination and communication between the transfusion service and the obstetrics service are the foundation for ensuring the finest care for prenatal patients, and for new mothers and their infants. This review describes testing and transfusion practices for prenatal patients, using case presentations to highlight the management of selected immunohematological findings. It also includes a discussion of key patient management topics that are currently unresolved.
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Affiliation(s)
- NurJehan Quraishy
- Section of Transfusion Medicine, Department of Laboratory Medicine, Robert J. Tomsich Pathology & Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Suneeti Sapatnekar
- Section of Transfusion Medicine, Department of Laboratory Medicine, Robert J. Tomsich Pathology & Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, United States.
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2
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Cruz DT, Conrado MCV, Mendrone A, Dinardo CL. Application of Monocyte Monolayer Assay technique to predict hyperhemolysis in patients with sickle cell disease. Hematol Transfus Cell Ther 2023:S2531-1379(23)00157-8. [PMID: 37690979 DOI: 10.1016/j.htct.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 03/29/2023] [Accepted: 07/07/2023] [Indexed: 09/12/2023] Open
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Allhoff W, Weidner L, Lindlbauer N, Grüner L, Libisch M, Schistal E, Jungbauer C. Jk null alleles in two patients with anti-Jk3. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2021; 19:237-243. [PMID: 33539287 PMCID: PMC8092040 DOI: 10.2450/2021.0349-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 12/23/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND As of publication, a total of 41 null alleles have been acknowledged by the International Society of Blood Transfusion (ISBT) to cause the rare Jknull phenotype, but none have been discovered in Austria thus far. MATERIALS AND METHODS Two patients with anti-Jk3 were serologically identified by a positive antibody screening and typed as Jk(a-b-). The initial genotyping using an SSP-PCR method for the common 838A/G polymorphism indicated a JK*02/02, or JK*01/02 genotype, respectively. To find the disruptive mutations, Sanger sequencing was performed and results were compared to the reference sequence. The patient's antibodies were characterized with a monocyte monolayer assay (MMA) for their potential clinical significance. RESULTS Three novel null-mutations of the SLC14A1 gene were found in two patients. Patient 1 was homozygous for a 10bp deletion in exon 4 (c.157_166del on JK*02). Testing of her family members revealed Mendelian inheritance of the deletional allele. The other patient was compound heterozygous for two mutations: one allele carrying a single base deletion in exon 4 (c.267delC on JK*01) and the other a splice site mutation in intron 3 (c.152-1g>a on JK*02). The MMA results suggest high clinical significance of the anti-Jk3 in both patients. DISCUSSION The detected mutations led to Jknull phenotypes and are the first description of JKnull alleles in the Austrian population.
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Affiliation(s)
- Wolfgang Allhoff
- Austrian Red Cross, Blood Service for Vienna, Lower Austria and Burgenland, Vienna, Austria
| | - Lisa Weidner
- Austrian Red Cross, Blood Service for Vienna, Lower Austria and Burgenland, Vienna, Austria
| | - Nadja Lindlbauer
- Department of Transfusion Medicine, Paracelsus Medical University Hospital Salzburg, Salzburg, Austria
| | - Lydia Grüner
- Department of Transfusion Medicine, Paracelsus Medical University Hospital Salzburg, Salzburg, Austria
| | - Manuel Libisch
- Austrian Red Cross, Blood Service for Vienna, Lower Austria and Burgenland, Vienna, Austria
| | - Elisabeth Schistal
- Austrian Red Cross, Blood Service for Vienna, Lower Austria and Burgenland, Vienna, Austria
| | - Christof Jungbauer
- Austrian Red Cross, Blood Service for Vienna, Lower Austria and Burgenland, Vienna, Austria
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El-Sayed HAN, Abdollah MRA, Raafat SN, Ragab D. Monocyte monolayer assay in pre-transfusion testing: A magic key in transfusing patients with recurrent bad cross-match due to alloimmunization. J Immunol Methods 2021; 492:112968. [PMID: 33465386 DOI: 10.1016/j.jim.2021.112968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 01/06/2021] [Accepted: 01/12/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND The monocyte monolayer assay (MMA) is an in-vitro assay that can predict the outcome of blood transfusion of antigen positive units when serologically compatible blood is not available. MATERIALS AND METHODS Fifty-four patients testing positive by the antibody screening test using gel agglutination were further examined by the alloantibody identification panel to determine alloantibody specificity. After determining and categorizing the antibodies, patients' samples were examined using the MMA to determine the clinical significance of the detected alloantibodies. We also tested 2 seeding methods (24-well cell culture plates versus 8-well chamber-slides) and 3 visualization/staining techniques (unstained phase contrast, Leishman and Giemsa staining). RESULTS 35 out of the 54 cases (64.8%) had a monocyte index of >5% which is predictive of occurrence of hemolytic reaction after transfusion; 23 cases with antibodies known to be clinically significant [anti-C, anti-E, anti-c, anti-K, anti-Fy(a), anti Fy(b), anti-JK(b)], 2 with Anti-M specificity, 7 cases with autoantibodies and 3 cases with multiple antibodies. On the other hand, 19 out of the 54 (35.2%) cases included in the study showed a monocyte index of <5% which is predictive of absence of hemolytic reaction after transfusion. The 8-well chamber-slides were better than the 24-well culture plates, as the latter showed a lot of un-phagocytosed RBCs in the background. Also, Leishman staining was better than Giemsa staining with better and clearer differentiation between the RBCs, monocytes and phagocytic vacuoles. CONCLUSION MMA can be used as a surrogate cross-match test for the selection of blood units in cases where antigen-negative blood units are not available.
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Affiliation(s)
| | - Maha R A Abdollah
- Pharmacology and Biochemistry, Faculty of Pharmacy, The British University in Egypt (BUE), Egypt; The Center for Drug Research and Development (CDRD), Faculty of Pharmacy, The British University in Egypt (BUE), Egypt
| | - Shereen N Raafat
- Pharmacology, Faculty of Dentistry, The British University in Egypt (BUE), Egypt; Dentistry Research Center (DRC), Faculty of Dentistery, The British University in Egypt (BUE), Egypt
| | - Dina Ragab
- Clinical Pathology, Faculty of Medicine, Ain Shams University, Egypt.
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Conrado MCAV, Fonseca GSVC, Dezan MR, Mendes FR, Hamasaki DT, Chinoca KZ, Fonseca GH, Gualandro SFM, Rocha V, Mendrone-Júnior A, Dinardo CL. Accelerated erythrocyte destruction mimicking post-transfusion hyperhaemolysis in the course of uncomplicated vaso-occlusive crisis associated with sickle cell disease. Transfus Med 2020; 30:522-524. [PMID: 32946153 DOI: 10.1111/tme.12717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 10/10/2019] [Accepted: 09/07/2020] [Indexed: 11/30/2022]
Affiliation(s)
| | - Guilherme S V C Fonseca
- Discipline of Hematology Transfusion and Cell Therapy, University of São Paulo School of Medicine (FMUSP), São Paulo, Brazil
| | - Marcia R Dezan
- Fundação Pró-Sangue Hemocentro de São Paulo, São Paulo, Brazil
| | - Fernanda R Mendes
- Discipline of Hematology Transfusion and Cell Therapy, University of São Paulo School of Medicine (FMUSP), São Paulo, Brazil
| | | | - Karen Z Chinoca
- Discipline of Hematology Transfusion and Cell Therapy, University of São Paulo School of Medicine (FMUSP), São Paulo, Brazil
| | - Guilherme H Fonseca
- Discipline of Hematology Transfusion and Cell Therapy, University of São Paulo School of Medicine (FMUSP), São Paulo, Brazil
| | - Sandra F M Gualandro
- Discipline of Hematology Transfusion and Cell Therapy, University of São Paulo School of Medicine (FMUSP), São Paulo, Brazil
| | - Vanderson Rocha
- Fundação Pró-Sangue Hemocentro de São Paulo, São Paulo, Brazil.,Discipline of Hematology Transfusion and Cell Therapy, University of São Paulo School of Medicine (FMUSP), São Paulo, Brazil.,Churchill Hospital, NHSBT, Oxford University, Oxford, UK
| | | | - Carla L Dinardo
- Fundação Pró-Sangue Hemocentro de São Paulo, São Paulo, Brazil
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Geisen C, North A, Becker L, Brixner V, von Goetz M, Corash L, Benjamin RJ, Mufti N, Seifried E. Prevalence of natural and acquired antibodies to amustaline/glutathione pathogen reduced red blood cells. Transfusion 2020; 60:2389-2398. [PMID: 32692456 DOI: 10.1111/trf.15965] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 05/25/2020] [Accepted: 06/11/2020] [Indexed: 01/14/2023]
Abstract
BACKGROUND The INTERCEPT™ Blood System for Red Blood Cells (RBCs) utilizes amustaline (S-303) and glutathione (GSH) to inactivate pathogens and leukocytes in transfused RBCs. Treatment-emergent low titer non-hemolytic antibodies to amustaline/GSH RBC were detected in clinical trials using a prior version of the process. The amustaline/GSH process was re-formulated to decrease S-303 RBC adduct formation. STUDY DESIGN AND METHODS A standard three-cell antibody screening panel was modified to include reagent red cells (RRC) with high (S-303H) or low (S-303L) S-303 adduct density as assessed by flow cytometry, representative of the original and current amustaline/GSH treatment processes, respectively. General hospital and RBC transfusion-dependent patients never exposed, and clinical trial subjects exposed to amustaline/GSH RBC were screened for antibodies to amustaline/GSH RBC using a standardized agglutination assay. RESULTS Twelve (0.1%) of 10,721 general hospital and 5 (0.5%) of 998 repeatedly-transfused patients not previously exposed to amustaline/GSH RBCs expressed natural, low titer (2-32) IgM and/or IgG (non-IgG1 or IgG3 isotype) antibodies with acridine (a structural element of amustaline) (n = 14) or non-acridine (n = 3) specificity. 11 of 17 sera reacted with S-303L panel RRCs. In clinical studies 81 thalassemia and 25 cardiac surgery patients were transfused with a total of 1085 amustaline/GSH RBCs and no natural or treatment-emergent S-303 antibodies were detected. CONCLUSION Standardized RRC screening panels are sensitive for the detection of natural and acquired S-303-specific antibodies. Natural low titer antibodies to amustaline/GSH RBC are present in 0.15% of naïve patients. The clinical relevance of these antibodies appears minimal but is under further investigation.
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Affiliation(s)
- Christof Geisen
- Institute of Transfusion Medicine and Immunohaematology, German Red Cross Blood Transfusion Service Baden-Württemberg-Hessen gGmbH, Goethe University Hospital Frankfurt/Main, Frankfurt am Main, Germany
| | - Anne North
- Cerus Corporation, Concord, California, USA
| | - Lisa Becker
- Institute of Transfusion Medicine and Immunohaematology, German Red Cross Blood Transfusion Service Baden-Württemberg-Hessen gGmbH, Goethe University Hospital Frankfurt/Main, Frankfurt am Main, Germany
| | - Veronika Brixner
- Institute of Transfusion Medicine and Immunohaematology, German Red Cross Blood Transfusion Service Baden-Württemberg-Hessen gGmbH, Goethe University Hospital Frankfurt/Main, Frankfurt am Main, Germany
| | | | | | | | - Nina Mufti
- Cerus Corporation, Concord, California, USA
| | - Erhard Seifried
- Institute of Transfusion Medicine and Immunohaematology, German Red Cross Blood Transfusion Service Baden-Württemberg-Hessen gGmbH, Goethe University Hospital Frankfurt/Main, Frankfurt am Main, Germany
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Conrado MA, Leão Bonifácio S, Nogueira FM, Saraiva-Filho JCP, Dezan MR, Chinoca KZ, Gomes F, Fonseca GH, Gualandro SFM, Rocha V, Mendrone-Júnior A, Dinardo CL. Massive autoimmune hemolysis documented by monocyte monolayer assay in a multiply transfused patient using reticulocytes isolated by simple centrifugation in microhematocrit tubes. Transfusion 2018; 58:1578-1579. [PMID: 30133821 DOI: 10.1111/trf.14511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 11/16/2017] [Accepted: 12/13/2017] [Indexed: 11/30/2022]
Affiliation(s)
| | | | - Felipe M Nogueira
- Discipline of Hematology, University of São Paulo school of Medicine, Brazil
| | | | | | - Karen Z Chinoca
- Discipline of Hematology, University of São Paulo school of Medicine, Brazil
| | | | - Guilherme H Fonseca
- Discipline of Hematology, University of São Paulo school of Medicine, Brazil
| | | | - Vanderson Rocha
- Fundação Pró-Sangue, São Paulo, Brazil.,Discipline of Hematology, University of São Paulo school of Medicine, Brazil
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Conrado MCAV, D'Avila AN, Vieira JB, Bonifacio SL, Gomes FCA, Dezan MR, Oliveira VB, Ribeiro IH, Tucunduva LTCM, Mendrone-Júnior A, Rocha V, Dinardo CL. Defining the clinical relevance of red blood cell autoantibodies by Monocyte Monolayer Assay. J Clin Lab Anal 2017; 32. [PMID: 28568311 DOI: 10.1002/jcla.22274] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 05/06/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Monocyte Monolayer Assay (MMA) is an in vitro simulation of red blood cell (RBC) alloantibody behavior. It has been classically applied to predict the risks of post-transfusion hemolytic reactions when transfusing incompatible RBC units. Quantifying erythrophagocytosis by MMA may be an interesting option for situations where there is doubt whether a RBC autoantibody is mediating significant hemolysis. Here, we present three situations involving RBC autoantibodies in which the MMA was decisive for clarifying the diagnosis and choosing the best clinical treatment. CASE REPORT Case 1. Pregnant patient with severely anemic fetus exhibited warm autoantibody without signs of hemolysis. MMA revealed 30% of monocyte index (MI) highlighting that fetal hemolysis was caused by maternal autoantibody. Prednisone was prescribed with fetal clinical improvement. Cases 2 and 3. Two patients with the diagnosis of mixed auto-immune hemolytic anemia and poor response to corticosteroids were evaluated using MMA. The resulting MI was less than 10% in both cases, suggesting that the cold-agglutinin rather than the warm auto-IgG was responsible for overt hemolysis. Treatment with rituximab was begun, with good clinical response. CONCLUSION MMA can be used to evaluate the ability of RBC autoantibodies to mediate overt hemolysis. It can be especially useful to determine the role played by cold and warm auto-antibodies in mixed auto-immune hemolytic disease, helping to define the best treatment option.
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Affiliation(s)
| | | | | | | | | | - Marcia R Dezan
- Fundação Pró-Sangue Hemocentro de São Paulo, São Paulo, Brazil
| | | | | | | | | | - Vanderson Rocha
- Fundação Pró-Sangue Hemocentro de São Paulo, São Paulo, Brazil.,Discipline of Hematology, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Carla L Dinardo
- Fundação Pró-Sangue Hemocentro de São Paulo, São Paulo, Brazil
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