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Yamada C, Ono T, Ino K, Nemoto N, Shinba T, Furumaki H, Shibata H, Ishizuka K, Yamada N, Matsuura H, Izuhara Y, Fujihara H, Minamiguchi H. The development and evanescence of red blood cell antibodies after transfusion: A multi-institutional prospective study in Japan. Transfusion 2024. [PMID: 39288000 DOI: 10.1111/trf.18009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 08/27/2024] [Accepted: 08/28/2024] [Indexed: 09/19/2024]
Abstract
BACKGROUND Despite several reports on red blood cell (RBC) alloimmunization, the actual prevalence and factors contributing to RBC alloimmunization in transfused patients remain poorly investigated. We examined the association between clinical factors and the development and evanescence of RBC antibodies after transfusion. STUDY DESIGN AND METHODS Each participating institution performed antibody screens before and after RBC transfusion. A survey including patient characteristics, results of antibody screen and identification, antibody screen methods, total amount of RBC transfused, and adverse reactions, was conducted. RESULTS Between October 2018 and March 2023, 1194 patients were registered at five institutions. Overall, 958 patients underwent at least one follow-up RBC antibody screen after transfusion, revealing new antibody development in 44 (4.6%). Anti-E was identified in 25 patients, anti-Jka in 5, and anti-c in 4. The number of RBC units transfused was significantly associated with antibody development after transfusion (p < .001). Among 55 patients in whom antibodies were identified after transfusion, including historical antibodies, antibodies evanesced in 18 (33%); anti-E in 7, anti-Jka in 4, and anti-Lea in 2. Evanescent antibodies were identified more frequently by saline and/or enzyme methods than persistent antibodies (p = .012). DISCUSSION The number of RBC units transfused can impact antibody development, and antibodies identified only by saline and/or enzyme methods, deemed clinically insignificant, are likely to have a high evanescence rate. Antibody screen should be carefully performed, especially in those receiving a large number of RBC units. Confirming previous antibody screen results should be performed to prevent omitting evanesced antibodies regardless of clinical relevance.
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Affiliation(s)
- Chiaki Yamada
- Transfusion and Cell Therapy, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Takaaki Ono
- Transfusion and Cell Therapy, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Kaede Ino
- Transfusion and Cell Therapy, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Naoki Nemoto
- Transfusion and Cell Therapy, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Takahito Shinba
- Transfusion and Cell Therapy, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hiroaki Furumaki
- Transfusion and Cell Therapy, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hiroki Shibata
- Transfusion and Cell Therapy, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Keiko Ishizuka
- Transfusion and Cell Therapy, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Naotomo Yamada
- Department of Transfusion Medicine, Saga University, Saga, Japan
| | - Hideaki Matsuura
- Department of Blood Transfusion, Fujita Health University, Toyoake, Japan
| | - Yumiko Izuhara
- Division of Transfusion Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Harumi Fujihara
- Transfusion Medicine & Cell Therapy, Kochi University, Kochi, Japan
| | - Hitoshi Minamiguchi
- Blood Transfusion and Cell Therapy Center, Shiga University of Medical Science, Otsu, Japan
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Ni H, Sun X, Cong H. Analysis of Specificity and Distribution Characteristics of Red Blood Cell Irregular Antibodies. Lab Med 2023; 54:507-511. [PMID: 36810696 DOI: 10.1093/labmed/lmac160] [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: 02/24/2023] Open
Abstract
OBJECTIVE The presence of red blood cell (RBC) irregular antibodies can severely jeopardize mother and child and bring trouble to the treatment of anemia. The aim of this study was to analyze the specificity of RBC irregular antibody in inpatients. METHODS An analysis was performed on samples from patients with RBC irregular antibodies. Antibody screening positive samples were analyzed. RESULTS Among the 778 cases of irregular antibody positive samples, 214 were from males and 564 from females. History of blood transfusion accounted for 13.1% of the total. Of the women, 96.8% had a pregnancy. A total of 131 antibodies were identified. The antibodies included 68 Rh systematic antibodies, 6 MNS systematic antibodies, 6 Lewis systematic antibodies, 2 Kidd systematic antibodies, 10 autoantibodies, and 39 antibodies of uncertain specificity. CONCLUSION Patients with blood transfusion or pregnancy history are prone to produce RBC irregular antibodies.
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Affiliation(s)
- Hui Ni
- Department of Blood Transfusion, Affiliated Hospital of Nantong University, Nantong, China
| | - Xiaoye Sun
- Department of Blood Transfusion, Affiliated Hospital of Nantong University, Nantong, China
| | - Hui Cong
- Department of Blood Transfusion, Affiliated Hospital of Nantong University, Nantong, China
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Tamai Y, Ohto H, Takahashi H, Kitazawa J. Transfusion-Related Alloimmunization to Red Blood Cell Antigens in Japanese Pediatric Recipients. Transfus Med Rev 2020; 35:29-36. [PMID: 33012576 DOI: 10.1016/j.tmrv.2020.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 08/24/2020] [Accepted: 09/01/2020] [Indexed: 11/30/2022]
Abstract
Red blood cell (RBC) transfusion to neonates is thought to rarely provoke an immune response. Neonatal testing guidelines suggest that antibody screening is not necessary when the mother has no antibodies. Alternatively, maternal blood samples can be used for antibody screening and cross-matching. However, the guidelines are based on small-scale studies of white-dominant populations. Furthermore, transfusion-related alloimmunization is less well established among children and adolescents as a whole among Japanese and East Asians. To elucidate the incidence of transfusion-related alloimmunization among neonates, children, and adolescents, and whether current guidelines are applicable to Japanese populations, a nationwide retrospective multicenter cohort survey was conducted in 50 tertiary-care hospitals in Japan. Between 2001 and 2015 inclusive, recipients of at least 1 allogeneic RBC transfusion were categorized into groups A-F according to their age at the time of transfusion: (A) neonates <1 month; (B) infants 1 to <12 months; (C) children 1 to <5 years; (D) prepubescents 5 to <10 years; (E) young pubescents 10 to <15 years; and (F) adolescents/young adults 15 to <20 years. Excluding maternally derived antibodies and naturally occurring, cold-reactive, and/or nonspecific antibodies, 69 (0.61%) of 11350 RBC recipients <20 years old formed at least 1 clinically significant alloantibody. The alloimmunization rate differed significantly (P < .0001) by age: none (0%) of 3407 in group A; 11 (0.46%) of 2410 in group B; 18 (0.76%) of 2361 in group C; 9 (0.80%) of 1119 in group D; 12 (1.15%) of 1043 in group E; and 19 (1.88%) of 1010 in group F. Clearly different incidences of alloimmunization emerged in group A compared to B, C, D, E, or F, as confirmed by logistic regression analysis adjusted by numbers of donor exposure. Alloimmunization did not occur from RBC transfusions within the first month of life and rarely occurred (0.46%-0.80%) after transfusion within the first decade of life. Alloimmunization occurred in 1.15%-1.88% of young pubescents and adolescents/young adults. These findings support the use of guidelines developed in Europe and the United States for East Asian pediatric recipients.
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Affiliation(s)
- Yoshiko Tamai
- Japan Society of Blood Transfusion and Cell Therapy, Tokyo, Japan; Hirosaki University Post-Graduate School of Medicine, Hirosaki, Japan
| | - Hitoshi Ohto
- Japan Society of Blood Transfusion and Cell Therapy, Tokyo, Japan; Fukushima Medical University, Fukushima, Japan.
| | | | - Junichi Kitazawa
- Japan Society of Blood Transfusion and Cell Therapy, Tokyo, Japan; Aomori Prefectural Central Hospital, Aomori, Japan
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Hauser RG, Esserman D, Karafin MS, Tan S, Balbuena-Merle R, Spencer BR, Roubinian NH, Wu Y, Triulzi DJ, Kleinman S, Gottschall JL, Hendrickson JE, Tormey CA. The evanescence and persistence of RBC alloantibodies in blood donors. Transfusion 2020; 60:831-839. [PMID: 32061102 DOI: 10.1111/trf.15718] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 01/30/2020] [Accepted: 01/30/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Blood donors represent a healthy population, whose red blood cell (RBC) alloantibody persistence or evanescence kinetics may differ from those of immunocompromised patients. A better understanding of the biologic factors impacting antibody persistence is warranted, as the presence of alloantibodies may impact donor health and the fate of the donated blood product. METHODS Donor/donation data collected from four US blood centers from 2012 to 2016 as part of the Recipient Epidemiology and Donor Evaluation Study-III (REDS-III) were analyzed. Clinically significant antibodies from blood donors with more than one donation who underwent at least one follow-up antibody screen after the initial antibody identification were included. Of 632,378 blood donors, 481 (128 males and 353 females) fit inclusion criteria. RESULTS Antibody screens detected 562 alloantibodies, with 368 of 562 (65%) of antibodies being persistently detected and with 194 of 562 (35%) becoming evanescent. Factors associated with antibody persistence included antibody specificity, detection at the first donation, reported history of transfusion, and detection of multiple antibodies concurrently. Anti-D, C, and Fya were most likely to persist, while anti-M, Jka , and S were most frequently evanescent. CONCLUSIONS These data provide insight into variables impacting the duration of antibody detection, and they may also influence blood donor center policies regarding donor recruitment/acceptance.
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Affiliation(s)
- Ronald G Hauser
- Yale University, Department of Laboratory Medicine, New Haven, Connecticut.,Department of Pathology & Laboratory Medicine Service, Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut
| | - Denise Esserman
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut
| | - Matthew S Karafin
- Versiti, Milwaukee, Wisconsin.,Department of Pathology & Laboratory Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - Raisa Balbuena-Merle
- Yale University, Department of Laboratory Medicine, New Haven, Connecticut.,Department of Pathology & Laboratory Medicine Service, Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut
| | - Bryan R Spencer
- Yale University, Department of Laboratory Medicine, New Haven, Connecticut.,American Red Cross Scientific Affairs, Dedham, Massachusetts
| | - Nareg H Roubinian
- Department of Laboratory Medicine, University of California, San Francisco, California.,Blood Systems Research Institute, San Francisco, California
| | - Yanyun Wu
- Yale University, Department of Laboratory Medicine, New Haven, Connecticut.,Bloodworks Northwest, Seattle, Washington
| | | | - Steve Kleinman
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jerome L Gottschall
- Versiti, Milwaukee, Wisconsin.,Department of Pathology & Laboratory Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Jeanne E Hendrickson
- Yale University, Department of Laboratory Medicine, New Haven, Connecticut.,Department of Pediatrics, Yale University, New Haven, Connecticut
| | - Christopher A Tormey
- Yale University, Department of Laboratory Medicine, New Haven, Connecticut.,Department of Pathology & Laboratory Medicine Service, Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut
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Delayed haemolytic and serologic transfusion reactions: pathophysiology, treatment and prevention. Curr Opin Hematol 2019; 25:459-467. [PMID: 30124474 DOI: 10.1097/moh.0000000000000462] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE OF REVIEW The aim of this study was to summarize the basic epidemiology, pathophysiology and management of delayed serologic and delayed haemolytic transfusion reactions (DHTRs), as well as recent developments in our understanding of these adverse events. RECENT FINDINGS Several studies have identified risk factors for DHTRs, including high alloantibody evanescence rates among both general patient groups and those with sickle cell disease (SCD). Antibody detection is also hampered by the phenomenon of transfusion record fragmentation. There have also been enhancements in understanding of what may contribute to the more severe, hyperhaemolytic nature of DHTRs in SCD, including data regarding 'suicidal red blood cell death' and immune dysregulation amongst transfusion recipients with SCD. With growing recognition and study of hyperhaemolytic DHTRs, there have been improvements in management strategies for this entity, including a multitude of reports on using novel immunosuppressive agents for preventing or treating such reactions. SUMMARY Delayed serologic and haemolytic reactions remain important and highly relevant transfusion-associated adverse events. Future directions include further unravelling the basic mechanisms, which underlie DHTRs and developing evidence-based approaches for treating these reactions. Implementing practical preventive strategies is also a priority.
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Giraud C, Thibert JB, Desbrosses Y, Debiol B, Alsuliman T, Bardiaux L, Garban F, Huynh TNP, Samsonova O, Yakoub-Agha I, Bruno B. Transfusion dans l’autogreffe et l’allogreffe de cellules souches hématopoïétiques chez l’adulte et l’enfant : recommandations de la Société francophone de greffe de moelle et de thérapie cellulaire (SFGM-TC). Bull Cancer 2019; 106:S52-S58. [DOI: 10.1016/j.bulcan.2018.08.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 07/19/2018] [Accepted: 08/27/2018] [Indexed: 01/07/2023]
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Dinh A, Eliason K, Dzik WS. Time interval between antibody investigations among patients who demonstrate serial red cell antibody formation. Transfusion 2018; 59:738-743. [PMID: 30418670 DOI: 10.1111/trf.15013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 08/31/2018] [Accepted: 09/29/2018] [Indexed: 01/22/2023]
Abstract
BACKGROUND Current national standards for pretransfusion testing do not address the frequency or optimal time interval to repeat antibody identification testing for patients in whom antibodies have been previously detected. STUDY DESIGN AND METHODS A retrospective review was performed of patients with existing red blood cell (RBC) antibodies who subsequently developed new antibody specificities. Data were drawn from a single institution where the antibody investigation was repeated if the screen suggested a new antibody or if 14 days had elapsed since the previous investigation. Clinically insignificant or drug-dependent antibodies were excluded. Among cases in which new antibodies were detected within 30 days of a previous sample that already demonstrated existing antibodies, the median and lower 95% confidence intervals for the number of days between the detection of the existing and new antibodies were determined. RESULTS Over a 9-year period, among 2114 patients with more than 1 antibody, 699 (33%) had serially detected antibodies from separate samples. Among 152 patients whose subsequent antibody was detected within 30 days of the existing antibodies, the median time interval to detection of the new antibody was 13 days. The lower 95% confidence interval was 1 day. By Day 3, 18% of the new antibodies had already appeared. CONCLUSION In patients who form multiple antibodies, the serial emergence of clinically significant antibodies is common. In some patients, detection of a new specificity occurs in a sample drawn shortly after the sample that demonstrated the first antibody. These results have implications for the frequency of pretransfusion testing.
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Affiliation(s)
- Anh Dinh
- Harvard Joint Fellowship Program in Transfusion Medicine, Boston, Massachusetts
| | - Kent Eliason
- Department of Pathology and Laboratory Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Walter Sunny Dzik
- Department of Pathology and Laboratory Medicine, Massachusetts General Hospital, Boston, Massachusetts
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