Experimental transfusion reactions and disseminated intravascular coagulation produced by incompatible plasma in monkeys

A case of ABO-incompatible blood transfusion treated by plasma exchange therapy and continuous hemodiafiltration

ABO-incompatible blood transfusion is potentially a life-threatening event. A 74-year-old type O Rh-positive male was accidentally transfused with 280 mL type B Rh-positive red blood cells during open right hemicolectomy, causing ABO-incompatible blood transfusion. Immediately after the transfusion, the patient experienced a hypotension episode followed by acute hemolytic reaction, disseminated intravascular coagulation and acute kidney injury. Plasma exchange therapy was performed to remove anti-B antibody and free hemoglobin because they caused acute hemolytic reaction, disseminated intravascular coagulation, and acute kidney injury. Free hemoglobin levels decreased from 13 to 2 mg/dL for 2 h. Continuous hemodiafiltration was used to stabilize hemodynamics. The patient was successfully treated for acute hemolytic reaction, disseminated intravascular coagulation, and acute kidney injury. Plasma exchange therapy and continuous hemodiafiltration are likely to be effective treatments for ABO-incompatible blood transfusion, and further studies are required to assess this effectiveness in future.

Risks of hemolysis due to anti-A and anti-B caused by the transfusion of blood or blood components containing ABO-incompatible plasma

BACKGROUND

The increasing use of fresh blood group O whole blood in acute trauma medicine makes it important to reevaluate the issue of hemolytic reactions related to the transfusion of ABO-incompatible plasma.

STUDY DESIGN AND METHODS

This review summarizes and evaluates published articles and case reports concerning hemolytic reactions in connection with the transfusion of group O whole blood or blood products to nongroup O recipients.

RESULTS

In 1945-1986, 15 nonmilitary publications reported hemolytic transfusion reactions with group O blood/blood products. All patients recovered except for two fatalities. Late in World War II and during the Korean and Vietnam wars and onward in Iraq and Afghanistan only "low anti-A, anti-B titer" group O whole blood has been used as universal blood. In spite of a large number of units transfused, there are no reports of hemolytic reactions. Twenty-five publications report hemolytic reactions after transfusion of group O platelets to nongroup O recipients. In all patients but one, the titer of the implicated A- or B-antibody was >100 (saline) or >400 (antiglobulin) and all cases with an infused volume of incompatible plasma <200 mL were related to anti-A or anti-B antiglobulin titers >1000.

CONCLUSION

In emergency lifesaving resuscitation, the risk of hemolytic transfusion reactions from transfusion of group O blood to nongroup O recipients constitutes risk that is outweighed by the benefits. A low titer of anti-A/B will minimize the risk for a hemolytic reaction, particularly if the screening is repeated after an immunization episode, e.g., blood transfusion, vaccination, or pregnancy.

Recurrent acute renal failure complicating IgG warm-type autoimmune intravascular haemolysis

A 44-year-old woman experienced recurrent episodes of massive intravascular haemolysis complicated by acute oliguric renal failure over a period of 22 years. The haemolysis was induced by IgG warm type autoantibody and complement and responded to corticosteroid therapy. The renal failure was treated effectively by dialysis. To our knowledge, such a life long occurrence of recurrent intravascular haemolysis induced by IgG warm type autoantibodies together with renal failure has not been reported before.

The effect of cyclo-oxygenase and thromboxane synthetase inhibitors on shock induced by injection of heterologous blood in cats

The injection of rabbit blood into cats causes hypotension, thrombocytopaenia, leukopaenia, a rise in central venous pressure and right ventricular and pulmonary artery pressures and a fall in circulating levels of fibrinogen. Death occurred rapidly after injection of the rabbit blood in 50% of control animals and was associated with respiratory distress. Measurement of plasma thromboxane B2 and 6-oxo PGF1 alpha levels in surviving controls demonstrated a marked elevation in the former with no significant change in the latter. Pretreatment with either the thromboxane synthetase inhibitor, 1-(cyclo octyl methyl) imidazole or aspirin prevented respiratory distress and death and reduced or prevented the elevations in cardiovascular pressures observed in control animals. Neither compound prevented thrombocytopaenia or leukopaenia but did attenuate the rise of thromboxane B2 following injection of rabbit blood. In addition, pretreatment with 1-(cyclo octyl methyl) imidazole resulted in an approximately five-fold increase in circulatory levels of 6-oxo PGF1 alpha five minutes after inducing the shock. We conclude that thromboxane A2 plays an important role in pulmonary (and other organs) dysfunction during the shock induced by injection of heterologous blood. In addition we have shown that inhibition of thromboxane synthetase in vivo under conditions where thromboxane A2 is produced leads to an increase in the synthesis of prostacyclin.

Activation of the alternate complement pathway by autologous red cell stroma

The present study demonstrates the ability of human autologous RBC stroma to activate the alternate complement pathway (C3-Activator system, properdin system), as evidenced by the generation of C3-Activator (C3A) from C3-Proactivator (C3PA) when RBC ghosts and sonicated ghosts are incubated with autologous serum. Intact RBC's, hemoglobin, and concentrated platelet stroma, on the other hand, are inactive in this regard. We postulate that this in vitro activity of RBC stroma may occur intravascularly when erythrocytes are damaged by immune or nonimmune mechanisms. The ensuing interaction of activated complement components with platelets leading to release of platelet factor three (PF-3) may constitute a mechanism for activation of the coagulation system during acute hemolytic episodes.