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Jacquot C, Pary PP, Babu V, Belay E, Mo YD, Webb JL, Luban NLC, Delaney M. Erythrocyte T-antigen activation in children: Patient characteristics and the hemolytic risk of transfusion. Pediatr Blood Cancer 2021; 68:e29082. [PMID: 33900685 DOI: 10.1002/pbc.29082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/19/2021] [Accepted: 04/09/2021] [Indexed: 11/12/2022]
Abstract
BACKGROUND T-antigen activation usually occurs upon red blood cell (RBC) membrane cryptantigen exposure due to bacterial enzymes. Although uncommon, the condition is probably underrecognized. There is concern about hemolysis after plasma and plasma-containing platelet transfusions due to naturally occurring anti-T antibody in healthy blood donors. However, experts have debated the extent and severity of clinical hemolysis due to anti-T. PROCEDURE We retrospectively identified patients who tested positive for polyagglutination with Arachis hypogea and Glycine max lectins from 2008 to 2019. The records of the patients were reviewed to determine clinical symptoms, laboratory evidence of hemolysis, need for transfusion, and clinical outcomes. RESULTS Ten patients were identified. At diagnosis, all were anemic and four had thrombocytopenia. Severe Streptococcus pneumoniae infection affected seven patients; one died. Seven of 10 patients (70%) had laboratory evidence of hemolysis. Peripheral blood smear findings in six patients included RBC agglutination and changes suggesting hemolysis (spherocytes and schistocytes), but three had unremarkable RBC morphology. Four patients required plasma or platelet transfusions; all survived to discharge. CONCLUSIONS T-antigen activation is a rare entity. Most patients diagnosed at our hospital had hemolytic anemia and severe pneumococcal infection. Hemoglobin decreased after plasma and platelet transfusions in all patients assessed, but these transfusions were necessary to support treatment. RBCs were given to maintain appropriate hemoglobin levels.
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Affiliation(s)
- Cyril Jacquot
- Divisions of Laboratory Medicine and Hematology, Center for Cancer and Blood Disorders, Sheikh Zayed Campus for Advanced Children's Medicine, Children's National Hospital, District of Columbia, Washington.,Departments of Pediatrics and Pathology, George Washington University School of Medicine and Health Sciences, District of Columbia, Washington
| | - Philippe P Pary
- Divisions of Laboratory Medicine and Hematology, Center for Cancer and Blood Disorders, Sheikh Zayed Campus for Advanced Children's Medicine, Children's National Hospital, District of Columbia, Washington.,Departments of Pediatrics and Pathology, George Washington University School of Medicine and Health Sciences, District of Columbia, Washington
| | - Varshini Babu
- Divisions of Laboratory Medicine and Hematology, Center for Cancer and Blood Disorders, Sheikh Zayed Campus for Advanced Children's Medicine, Children's National Hospital, District of Columbia, Washington
| | - Ezana Belay
- Divisions of Laboratory Medicine and Hematology, Center for Cancer and Blood Disorders, Sheikh Zayed Campus for Advanced Children's Medicine, Children's National Hospital, District of Columbia, Washington
| | - Yunchuan D Mo
- Divisions of Laboratory Medicine and Hematology, Center for Cancer and Blood Disorders, Sheikh Zayed Campus for Advanced Children's Medicine, Children's National Hospital, District of Columbia, Washington.,Departments of Pediatrics and Pathology, George Washington University School of Medicine and Health Sciences, District of Columbia, Washington
| | - Jennifer L Webb
- Divisions of Laboratory Medicine and Hematology, Center for Cancer and Blood Disorders, Sheikh Zayed Campus for Advanced Children's Medicine, Children's National Hospital, District of Columbia, Washington.,Departments of Pediatrics and Pathology, George Washington University School of Medicine and Health Sciences, District of Columbia, Washington
| | - Naomi L C Luban
- Divisions of Laboratory Medicine and Hematology, Center for Cancer and Blood Disorders, Sheikh Zayed Campus for Advanced Children's Medicine, Children's National Hospital, District of Columbia, Washington.,Departments of Pediatrics and Pathology, George Washington University School of Medicine and Health Sciences, District of Columbia, Washington
| | - Meghan Delaney
- Divisions of Laboratory Medicine and Hematology, Center for Cancer and Blood Disorders, Sheikh Zayed Campus for Advanced Children's Medicine, Children's National Hospital, District of Columbia, Washington.,Departments of Pediatrics and Pathology, George Washington University School of Medicine and Health Sciences, District of Columbia, Washington
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Alsaleem M. Intravenous Immune Globulin Uses in the Fetus and Neonate: A Review. Antibodies (Basel) 2020; 9:E60. [PMID: 33158209 PMCID: PMC7709108 DOI: 10.3390/antib9040060] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 10/07/2020] [Accepted: 11/02/2020] [Indexed: 02/07/2023] Open
Abstract
Intravenous immune globulin (IVIG) is made after processing plasma from healthy donors. It is composed mainly of pooled immunoglobulin and has clinical evidence-based applications in adult and pediatric populations. Recently, several clinical applications have been proposed for managing conditions in the neonatal population, such as hemolytic disease of the newborn, treatment, and prophylaxis for sepsis in high-risk neonates, enterovirus parvovirus and COVID-19 related neonatal infections, fetal and neonatal immune-induced thrombocytopenia, neonatal hemochromatosis, neonatal Kawasaki disease, and some types of immunodeficiency. The dosing, mechanism of action, effectiveness, side effects, and adverse reactions of IVIG have been relatively well studied in adults but are not well described in the neonatal population. This review aims to provide the most recent evidence and consensus guidelines about the use of IVIG in the fetus and neonate.
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Affiliation(s)
- Mahdi Alsaleem
- Pediatrics Department, Neonatology, Children’s Mercy Hospital, Kansas City, MO 64108, USA;
- Pediatrics Department, University of Kansas, Wichita, KS 67208, USA
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3
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Abstract
PURPOSE OF REVIEW As in adults and older children, anemia in newborn infants can be the result of erythropoietic failure, hemorrhage, or hemolysis. When hemolysis is the prime consideration, it can be challenging for physicians caring for neonates to choose from the wide variety of available diagnostic tests. This review describes the authors' opinions regarding rational, consistent, and cost-effective means of making an exact diagnosis of a neonatal hemolytic condition. RECENT FINDINGS Two recent advances in the diagnosis of neonatal nonimmune hemolytic disorders are highlighted in this review: introduction of flow cytometry-based Eosin-5-maleimide (EMA) uptake as a screening test to identify RBC membrane defects and next-generation sequencing (NGS)-based panels to uncover exact mutations causing hemolysis. SUMMARY The availability of newer tools such as EMA and NGS to diagnose specific hemolytic conditions, which might otherwise remain unknown, enables neonatal practitioners not only to identify the exact cause of hemolysis but also to discover novel mutations that can be implicated in the cause of neonatal hemolytic processes.
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Wan-Huen P, Bateman D, Shapiro DM, Parravicini E. Packed red blood cell transfusion is an independent risk factor for necrotizing enterocolitis in premature infants. J Perinatol 2013; 33:786-90. [PMID: 23702619 DOI: 10.1038/jp.2013.60] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Revised: 04/09/2013] [Accepted: 04/10/2013] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To determine whether a temporal association exists between antecedent packed red blood cell (PRBC) transfusions and necrotizing enterocolitis (NEC) in premature infants. STUDY DESIGN This case-control study included inborn infants from a single center who developed NEC during a 2-year period. For every NEC infant, two matched controls from the same period were chosen based on gestational age and birth weight. Transfusion-related NEC was defined as antecedent PRBC transfusion within 48 h prior to the onset of any symptoms attributable to NEC. Bivariate analyses were used to compare baseline characteristics of all infants. To determine the raw odds ratio for the presence of exposure (transfusion) versus outcome (NEC), the hospital course (ages 6 to 63 days) of all study infants was divided into 48-h epochs; occurrence of transfusion and NEC was noted within each epoch. Generalized estimating equations were used to estimate the adjusted odds for developing NEC within an epoch with and without antecedent transfusion, controlling chronological age within infant as well as for gestational age, gender, feeding status in prior 48-h epoch and indicators of disease severity. RESULT There were 3652 48-h epochs and 557 transfusions among 49 NEC infants and 97 controls; 17 infants had transfusion-related NEC, yielding a raw odds ratio of 3.01 (P<0.001). The adjusted odds ratios were 2.97 (P=0.003) for transfusion and 2.76 (P=0.05) for feeding status in the prior 48-h epoch. Infants who were being fed in the 48-h period prior to transfusion were more than eight times more likely to develop NEC than infants who were neither fed nor transfused. CONCLUSION Antecedent PRBC transfusion appears to be an independent risk factor for developing NEC during the subsequent 48-h period.
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Affiliation(s)
- P Wan-Huen
- Department of Pediatrics, Winthrop University Hospital, Mineola, NY, USA
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Mohamed A, Shah PS. Transfusion associated necrotizing enterocolitis: a meta-analysis of observational data. Pediatrics 2012; 129:529-40. [PMID: 22351894 DOI: 10.1542/peds.2011-2872] [Citation(s) in RCA: 182] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Several studies have reported the possibility of an association between recent exposure to transfusion and development of necrotizing enterocolitis (NEC). Our objective was to systematically review and meta-analyze the association between transfusion and NEC (TANEC), identify predictors of TANEC, and the assess impact of TANEC on outcomes. METHODS Medline, Embase, CINAHL, and bibliographies of identified articles were searched for studies assessing association with recent (within 48 hours) exposure to transfusion and NEC. Two reviewers independently collected data and assessed the quality of the studies for bias in sample selection, exposure assessment, confounders, analyses, outcome assessments, and attrition. Meta-analyses were performed by using random effect model, and odds ratio and 95% confidence interval were calculated. RESULTS Eleven retrospective case-control studies and 1 cohort study of moderate risk of bias were included. Ten case-control studies had NEC not associated with transfusion as control patients (unmatched). Recent exposure to transfusion was associated with NEC. Neonates who developed TANEC were younger by 1.5 weeks, were of 528 g lower birth weight, were more likely to have patent ductus arteriosus, and were more likely receiving ventilatory support. TANEC infants had higher risk of mortality. Two pre-post comparative studies of 20 patients reported reduction of TANEC after withholding feeds during transfusion. CONCLUSIONS Recent exposure to transfusion was associated with NEC in neonates. Neonates who developed TANEC were at overall higher risk of NEC. TANEC patients were at higher risk of mortality, but additional studies adjusting for confounders are needed.
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Affiliation(s)
- Adel Mohamed
- Department of Pediatrics, Mount Sinai Hospital, Toronto, Canada
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Wang LY, Chan YS, Chang FC, Wang CL, Lin M. Thomsen-Friedenreich activation in infants with necrotizing enterocolitis in Taiwan. Transfusion 2011; 51:1972-6. [DOI: 10.1111/j.1537-2995.2011.03106.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Boralessa H, Modi N, Cockburn H, Malde R, Edwards M, Roberts I, Letsky E. RBC T activation and hemolysis in a neonatal intensive care population: implications for transfusion practice. Transfusion 2002; 42:1428-34. [PMID: 12421215 DOI: 10.1046/j.1537-2995.2002.00237.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Reports of transfusion-associated hemolysis in infants with T-activated RBCs have led to the suggestion that infants should be screened and provided with low-titer anti-T blood components. T-activated RBCs react with the lectins Arachis hypogea and Glycine soja; variants of T (Th and Tx) and Tk also react with A. hypogea, but not G. soja. Although Tk is not a true variant of T, for the purposes of this study, all RBCs that are reactive with A. hypogea but are not reactive with G. soja are called "T variants." STUDY DESIGN AND METHODS A prospective study was carried out to examine T and T variant activation and transfusion-associated hemolysis in a neonatal intensive care population and to determine if antibodies to T and T variant are detectable in donor plasma. A total of 2041 samples from 375 infants were tested for T and T variant activation utilizing a lectin panel. Three hundred donor plasma samples were tested for antibodies to T and T variant. RESULTS Forty-eight of 375 infants (12.8%) had T- and T-variant-activated RBCs. Of these, 13 of 48 (27%) developed at least one episode of sepsis and 9 of 48 (19%) developed necrotizing enterocolitis (NEC) at some point during their inpatient stay. T activation was not always temporally associated with the onset of NEC or sepsis. The remaining 26 of 48 (54%) were healthy infants receiving convalescent care in the neonatal intensive care units and showed no evidence of either NEC or sepsis. Twelve (of 375) additional infants (3.2%) who developed NEC and 100 (27%) who developed sepsis showed no RBC T activation. Twenty-three of 48 (48%) infants with T-activated RBCs received standard blood components, but no transfusion-associated hemolysis occurred. Donor plasma samples contained T but not T variant antibodies. CONCLUSION T variant activation of RBCs occurs in healthy neonates as well as in infants with NEC and sepsis, but T activation appears rare. Transfusion- associated hemolysis was not seen. The provision of specially prepared blood components for infants with NEC is unnecessary.
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Affiliation(s)
- J Ramasethu
- Department of Neonatology, The George Washington University School of Medicine and Health Sciences, Washington, DC 20010, USA
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Crookston KP, Reiner AP, Cooper LJ, Sacher RA, Blajchman MA, Heddle NM. RBC T activation and hemolysis: implications for pediatric transfusion management. Transfusion 2000; 40:801-12. [PMID: 10924607 DOI: 10.1046/j.1537-2995.2000.40070801.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- K P Crookston
- Department of Medicine, University of Washington, the Fred Hutchinson Cancer Research Center, and the Puget Sound Blood Center, Seattle, WA, USA.
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Osborn DA, Lui K, Pussell P, Jana AK, Desai AS, Cole M. T and Tk antigen activation in necrotising enterocolitis: manifestations, severity of illness, and effectiveness of testing. Arch Dis Child Fetal Neonatal Ed 1999; 80:F192-7. [PMID: 10212080 PMCID: PMC1720919 DOI: 10.1136/fn.80.3.f192] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIMS To determine if T or Tk antigen activation is associated with different and more severe manifestations of illness in infants with necrotising enterocolitis (NEC); and if a policy of testing infants with suspected sepsis or NEC for T and Tk antigen activation is effective. METHODS A case-control study of infants with confirmed NEC, born after the introduction of screening, was undertaken:17 activated infants were compared with 28 non-activated controls, matched for gestation and weight. A historical control study compared the outcome of infants before and after the introduction of testing. RESULTS Of 201 infants with confirmed NEC, 27 were T or Tk antigen activated-10 (9%) before and 17 (19%) after the introduction of testing. T or Tk antigen activated infants had a significantly higher mortality (35% vs 7%); more frequent (71% vs 21%) and severe haemolysis, hyperkalaemia, renal impairment, acidosis; and they received more colloid for resuscitation. While only known activated infants in both time periods were managed with the use of low titre T antibody blood products, there was a significant increase in mortality (odds ratios 2.6; 95% CI 1.2, 5.6) and incidence of surgery (OR 2.7; 1.5, 4.9) after the introduction of testing. The increased mortality (OR 2.6; 0.8, 5.2) and incidence of surgery (OR 1.8; 0.9, 3.7) were no longer significant after adjustment for several perinatal risk factors. CONCLUSIONS In a retrospective case-control study, routine testing of at risk infants increased the detection rate of T and Tk antigen activation. The use of low titre T plasma products in these patients did not reduce mortality compared with historical controls. A randomised controlled trial of testing in at risk infants, or of the use of low titre T plasma products in babies with NEC and T activation, is warranted.
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MESH Headings
- Antigens, Tumor-Associated, Carbohydrate/immunology
- Case-Control Studies
- Enterocolitis, Necrotizing/immunology
- Enterocolitis, Necrotizing/mortality
- Female
- Humans
- Infant, Newborn
- Infant, Premature
- Infant, Premature, Diseases/immunology
- Infant, Premature, Diseases/mortality
- Isoantigens
- Male
- Retrospective Studies
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Affiliation(s)
- D A Osborn
- Department of Neonatology, Westmead Hospital, Westmead, Australia
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Martin-Vega C. Blood Transfusion in Premature or Young Infants with Polyagglutination and Activation of the T Antigen. Vox Sang 1999. [DOI: 10.1046/j.1423-0410.1999.76201287.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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12
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Zupanska B. Blood Transfusion in Premature or Young Infants with Polyagglutination and Activation of the T Antigen. Vox Sang 1999. [DOI: 10.1046/j.1423-0410.1999.76201285.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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13
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Luban NL. Blood Transfusion in Premature or Young Infants with Polyagglutination and Activation of the T Antigen. Vox Sang 1999. [DOI: 10.1046/j.1423-0410.1999.76201283.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Rodwell R, Lavercombe P, Taylor KM, Freney R, Haffenden M, Liew YW, Jayaswal U. Diagnosis of cryptantigen exposure and polyagglutinability: management of transfusion therapy in a patient with sepsis and colitis. Anaesth Intensive Care 1995; 23:208-11. [PMID: 7793597 DOI: 10.1177/0310057x9502300217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- R Rodwell
- Haematology Division, Mater Misericordiae Hospital, South Brisbane, Qld
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Rodwell R, Tudehope DI. Screening for cryptantigen exposure and polyagglutination in neonates with suspected necrotizing enterocolitis. J Paediatr Child Health 1993; 29:16-8. [PMID: 8461172 DOI: 10.1111/j.1440-1754.1993.tb00430.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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