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Flegel WA. COVID-19 insights from transfusion medicine. Br J Haematol 2020; 190:715-717. [PMID: 32640485 PMCID: PMC7361384 DOI: 10.1111/bjh.17005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 07/06/2020] [Indexed: 01/04/2023]
Affiliation(s)
- Willy A Flegel
- Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, MD, USA.,Huazhong University of Science and Technology, Wuhan, Hubei, China
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Pandey P, Anani WQ, Pugh T, Gottschall JL, Denomme GA. Complement activating ABO anti-A IgM/IgG act synergistically to cause erythrophagocytosis: implications among minor ABO incompatible transfusions. J Transl Med 2020; 18:216. [PMID: 32466782 PMCID: PMC7257204 DOI: 10.1186/s12967-020-02378-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 05/14/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Typically minor ABO incompatible platelet products are transfused without any incident, yet serious hemolytic transfusion reactions occur. To mitigate these events, ABO 'low titer' products are used for minor ABO incompatible transfusions. We sought to understand the role of IgM/IgG and complement activation by anti-A on extravascular hemolysis. METHODS Samples evaluated included (i) Group O plasma from a blood donor whose apheresis platelet product resulted in an extravascular transfusion reaction, (ii) Group O plasma from 12 healthy donors with matching titers that activated complement (N = 6) or not (N = 6), and (iii) Group O sera from 10 patients with anti-A hemolysin activity. A flow cytometric monocyte erythrophagocytosis assay was developed using monocytes isolated by immunomagnetic CD14-positive selection from ACD whole blood of healthy donors. Monocytes were frozen at - 80 °C in 10% dimethyl sulfoxide/FBS and then thawed/reconstituted on the day of use. Monocytes were co-incubated with anti-A-sensitized fluorescently-labeled Group A1 + RBCs with and without fresh Group A serum as a source of complement C3, and erythrophagocytosis was analyzed by flow cytometry. The dependency of IgM/IgG anti-A and complement C3 activation for RBC erythrophagocytosis was studied. Anti-A IgG subclass specificities were examined for specific samples. RESULTS The plasma and sera had variable direct agglutinating (IgM) and indirect (IgG) titers. None of 12 selected samples showed monocyte-dependent erythrophagocytosis with or without complement activation. The donor sample causing a hemolytic transfusion reaction and 2 of the 10 patient sera with hemolysin activity showed significant erythrophagocytosis (> 10%) only when complement C3 was activated. The single donor plasma and two sera demonstrating significant erythrophagocytosis had high IgM (≥ 128) and IgG titers (> 1024). The donor plasma anti-A was IgG1, while the patient sera were an IgG3 and an IgG1 plus IgG2. CONCLUSION High anti-A IgM/IgG titers act synergistically to cause significant monocyte erythrophagocytosis by activating complement C3, thus engaging both Fcγ- and CR1-receptors.
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Affiliation(s)
- Priyanka Pandey
- Diagnostic Laboratories, Versiti Blood Center of Wisconsin, 638 N 18th Street, Milwaukee, WI, 53233, USA
| | - Waseem Q Anani
- Diagnostic Laboratories, Versiti Blood Center of Wisconsin, 638 N 18th Street, Milwaukee, WI, 53233, USA
- Department of Pathology, Medical College of Wisconsin, Wauwatosa, WI, USA
| | - Tina Pugh
- Diagnostic Laboratories, Versiti Blood Center of Wisconsin, 638 N 18th Street, Milwaukee, WI, 53233, USA
| | - Jerome L Gottschall
- Diagnostic Laboratories, Versiti Blood Center of Wisconsin, 638 N 18th Street, Milwaukee, WI, 53233, USA
- Department of Pathology, Medical College of Wisconsin, Wauwatosa, WI, USA
| | - Gregory A Denomme
- Diagnostic Laboratories, Versiti Blood Center of Wisconsin, 638 N 18th Street, Milwaukee, WI, 53233, USA.
- Versiti Blood Research Institute, Milwaukee, USA.
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Nelson RC, Fellowes V, Jin P, Liu H, Highfill SL, Ren J, Szymanski J, Flegel WA, Stroncek DF. Group O plasma as a media supplement for CAR-T cells and other adoptive T-cell therapies. Transfusion 2020; 60:1004-1014. [PMID: 32167176 DOI: 10.1111/trf.15745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 02/17/2020] [Accepted: 02/18/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Most chimeric antigen receptor T (CAR-T) cells and other adoptive T-cell therapies (ACTs) are currently manufactured by ex vivo expansion of patient lymphocytes in culture media supplemented with human plasma from group AB donors. As lymphocytes do not express A or B antigens, the isoagglutinins of non-AB plasmas are unlikely to cause deleterious effects on lymphocytes in culture. STUDY DESIGN AND METHODS Seeding cultures with peripheral blood mononuclear cell (PBMNC) concentrates from group A1 donors and using a CAR-T culture protocol, parallel cultures were performed, each with unique donor plasmas as media supplements (including group O plasmas with high-titer anti-A and group AB plasmas as control). An additional variable, a 3% group A1 red blood cell (RBC) spike, was added to simulate a RBC-contaminated PBMNC collection. Cultures were monitored by cell count, viability, flow cytometric phenotype, gene expression analysis, and supernatant chemokine analysis. RESULTS There was no difference in lymphocyte expansion or phenotype when cultured with AB plasma or O plasma with high-titer anti-A. Compared to controls, the presence of contaminating RBCs in lymphocyte culture led to poor lymphocyte expansion and a less desirable phenotype-irrespective of the isoagglutinin titer of the plasma supplement used. CONCLUSIONS This study suggests that ABO incompatible plasma may be used as a media supplement when culturing cell types that do not express ABO antigens-such as lymphocytes for CAR-T or other ACT. The presence of contaminating RBCs in culture was disadvantageous independent of isoagglutinin titer.
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Affiliation(s)
- Randin C Nelson
- Department of Transfusion Medicine, National Institutes of Health Clinical Center, Bethesda, Maryland.,Center for Cellular Engineering, National Institutes of Health Clinical Center, Bethesda, Maryland.,Department of Pathology, Montefiore Medical Center & Albert Einstein College of Medicine, Bronx, New York
| | - Vicki Fellowes
- Department of Transfusion Medicine, National Institutes of Health Clinical Center, Bethesda, Maryland.,Center for Cellular Engineering, National Institutes of Health Clinical Center, Bethesda, Maryland
| | - Ping Jin
- Department of Transfusion Medicine, National Institutes of Health Clinical Center, Bethesda, Maryland.,Center for Cellular Engineering, National Institutes of Health Clinical Center, Bethesda, Maryland
| | - Hui Liu
- Department of Transfusion Medicine, National Institutes of Health Clinical Center, Bethesda, Maryland.,Center for Cellular Engineering, National Institutes of Health Clinical Center, Bethesda, Maryland
| | - Steven L Highfill
- Department of Transfusion Medicine, National Institutes of Health Clinical Center, Bethesda, Maryland.,Center for Cellular Engineering, National Institutes of Health Clinical Center, Bethesda, Maryland
| | - Jiaqiang Ren
- Department of Transfusion Medicine, National Institutes of Health Clinical Center, Bethesda, Maryland.,Center for Cellular Engineering, National Institutes of Health Clinical Center, Bethesda, Maryland
| | - James Szymanski
- Department of Transfusion Medicine, National Institutes of Health Clinical Center, Bethesda, Maryland.,Center for Cellular Engineering, National Institutes of Health Clinical Center, Bethesda, Maryland.,Department of Pathology, Montefiore Medical Center & Albert Einstein College of Medicine, Bronx, New York
| | - Willy A Flegel
- Department of Transfusion Medicine, National Institutes of Health Clinical Center, Bethesda, Maryland
| | - David F Stroncek
- Department of Transfusion Medicine, National Institutes of Health Clinical Center, Bethesda, Maryland.,Center for Cellular Engineering, National Institutes of Health Clinical Center, Bethesda, Maryland
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Byrne KM, Mercado CMC, Nnabue TN, Paige TD, Flegel WA. Inhibition of blood group antibodies by soluble substances. Immunohematology 2019; 35:19-22. [PMID: 30908075 PMCID: PMC6436639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The presence of multiple alloantibodies or an antibody to a highprevalance antigen in a patient sample can pose challenges in antibody identification. The pattern of reactivity seen on an antibody panel may show various strengths of reactivity by different methods of testing or same strength of reactivity at one or more phases of testing. To ensure proper identification, multiple investigative tools may be used. We review one of these methods-inhibition by soluble substances-which has become an expansion of our toolbox within the past 10 years. Alloantibodies can be inhibited using specific soluble substances. These soluble substances occur naturally in various fluids or can be manufactured. When a patient sample contains multiple antibodies, clinically significant or not, inhibition of one may help determine specificities of others. Specific inhibition of a particular antibody will also help to confirm its presence.
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Affiliation(s)
- Karen M Byrne
- SBB Program Education Coordinator, National Institutes of Health (NIH) Clinical Center, Department of Transfusion Medicine, 10 Center Drive, Bethesda, MD
| | | | - Thaddeus N Nnabue
- Training Technologist, Transfusion Medicine, Walter Reed National Military Medical Center
| | - Traci D Paige
- SBB Program Director and Supervisor of Transfusion Services, National Institutes of Health (NIH) Clinical Center, Department of Transfusion Medicine, Bethesda, MD
| | - Willy A Flegel
- SBB Program Medical Director, Chief of Laboratory Services Section, National Institutes of Health (NIH) Clinical Center, Department of Transfusion Medicine, Bethesda, MD
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