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Kalai M, Moumni I, Ouragini H, Chaouechi D, Boudriga I, Menif S. Coinheritance of HbO Arab/β0-thalassemia with Severe Manifestation in Newborn. Am J Perinatol 2024; 41:594-597. [PMID: 35189650 DOI: 10.1055/s-0042-1743185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE In this study, we report a Tunisian newborn boy referred for neonatal hemolytic anemia with yellowish skin and enlarged spleen due to coinheritance of hemoglobin O (HbO) Arab and β-thalassemia. STUDY DESIGN Hematological parameters were collected using an automated blood cell counter. The amounts of Hb fractions were measured by capillary electrophoresis of Hb. Amplification and sequencing of the HBB gene were performed by Sanger's method. RESULTS Family study and genetic analysis revealed that the proband was a carrier of two hemoglobinopathies: HbO Arab and β0-thalassemia. CONCLUSION The coexistence of these two pathologies complicated the general state of the newborn boy and led to a severe anemia at birth. KEY POINTS · Severe neonatal anemia can be caused by hemoglobinopathy.. · Coinheritance of HbO Arab/β0-thalassemia complicated the general state of the newborn.. · Diagnosing hemoglobinopathy at an early age improves patient care..
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Affiliation(s)
- Miniar Kalai
- Laboratory of Molecular and Cellular Hematology, Pasteur Institute of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Imen Moumni
- Laboratory of Molecular and Cellular Hematology, Pasteur Institute of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Houyem Ouragini
- Laboratory of Molecular and Cellular Hematology, Pasteur Institute of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Dorra Chaouechi
- Laboratory of Molecular and Cellular Hematology, Pasteur Institute of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Imen Boudriga
- Laboratory of Molecular and Cellular Hematology, Pasteur Institute of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Samia Menif
- Laboratory of Molecular and Cellular Hematology, Pasteur Institute of Tunis, University of Tunis El Manar, Tunis, Tunisia
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Martini T, Biguzzi R, Francesconi I, Lelli S, Currà MF, Borsellino B. How We Prevented an anti-P1 Mediated Hemolytic Transfusion Reaction. Mediterr J Hematol Infect Dis 2024; 16:e2024009. [PMID: 38223483 PMCID: PMC10786142 DOI: 10.4084/mjhid.2024.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 12/14/2023] [Indexed: 01/16/2024] Open
Affiliation(s)
- Tiziano Martini
- Immunohematology and Transfusion Medicine Unit, AUSL Romagna, M. Bufalini Hospital, Cesena, Italy
| | - Rino Biguzzi
- Immunohematology and Transfusion Medicine Unit, AUSL Romagna, M. Bufalini Hospital, Cesena, Italy
| | - Irene Francesconi
- Immunohematology and Transfusion Medicine Unit, AUSL Romagna, M. Bufalini Hospital, Cesena, Italy
| | - Sabrina Lelli
- Immunohematology and Transfusion Medicine Unit, AUSL Romagna, M. Bufalini Hospital, Cesena, Italy
| | - Maria Federica Currà
- Immunohematology and Transfusion Medicine Unit, AUSL Romagna, M. Bufalini Hospital, Cesena, Italy
| | - Beatrice Borsellino
- Immunohematology and Transfusion Medicine Unit, AUSL Romagna, M. Bufalini Hospital, Cesena, Italy
- Department of Biomedicine and Prevention, PhD in Immunology, Molecular Medicine and Applied Biotechnology, University of Rome Tor Vergata, Rome, Italy
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Vuk T, Politis C, Laspina S, Lozano M, Haddad A, de Angelis V, Garraud O. Thirty years of hemovigilance - Achievements and future perspectives. Transfus Clin Biol 2023; 30:166-172. [PMID: 36216308 DOI: 10.1016/j.tracli.2022.09.070] [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: 09/30/2022] [Accepted: 09/30/2022] [Indexed: 02/04/2023]
Abstract
Since its emergence in the early 1990s, hemovigilance has gradually evolved from a blood safety concept focused on surveillance of adverse reactions and events in patients, to a well-defined system that monitors the entire transfusion chain and improves its safety. The importance of hemovigilance has been recognized globally in a relatively short time, but the level of its implementation varies significantly between countries. The cooperation of international organizations has significantly contributed to the promotion, implementation, and education in this field. Thanks to initiatives taken, the safety of transfusion practice has been improved in many segments, primarily related to the risks of adverse events in recipients of blood components. In parallel with changing transfusion practice, the hemovigilance process has also matured. In addition to the reduction of existing risks and the early detection of emerging risks, hemovigilance has also embraced the principles of patient blood management. Research in hemovigilance is more increasingly focused on specific categories of patients, specific blood components and methods of their preparation, rare reactions, and transfusion efficacy and efficiency. A proactive approach and use of big data can play an important role in achieving these goals. Additional and sustained efforts should be made to prevent underreporting of events and to improve data comparability through clear definitions and grading systems. This review provides a historical overview of hemovigilance and its achievements, current challenges, and future plans.
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Affiliation(s)
- Tomislav Vuk
- Croatian Institute of Transfusion Medicine, Zagreb, Croatia.
| | - Constantina Politis
- Coordinating Centre for Haemovigilance and Surveillance of Transfusion, National Public Health Organization, Athens, Greece
| | | | - Miquel Lozano
- Department of Hemotherapy and Hemostasis, ICMHO, University Clinic Hospital, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Antoine Haddad
- Department of Clinical Pathology and Blood Bank, Sacré-Coeur Hospital, Lebanese University, Beirut, Lebanon; Lebanese American University, Beirut, Lebanon
| | | | - Olivier Garraud
- SAINBIOSE-INSERM_U1059, Faculty of Medicine, University of Saint-Etienne, Saint-Etienne, France
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- SAINBIOSE-INSERM_U1059, Faculty of Medicine, University of Saint-Etienne, Saint-Etienne, France
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Wu Y, Ji Y, Dai B, Guo F, Wu Y, He Z, Mo C, Wu S, Hu Y. A case of hyperhaemolysis syndrome in a pregnant Chinese woman with β-thalassemia during perinatal transfusion. Transfus Med 2020; 31:24-29. [PMID: 33331032 DOI: 10.1111/tme.12748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 12/01/2020] [Accepted: 12/06/2020] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To report a case of hyperhaemolysis syndrome (HHS) that occurred during perinatal blood transfusion in a pregnant Chinese woman with β-thalassemia to deepen the understanding of HHS and the risk of transfusion therapy for patients with thalassemia. BACKGROUND Most HHS cases occur in people with sickle cell disease. So far, no cases of HHS have been reported in the Chinese population. Here, we report a pregnant Chinese women with β-thalassemia experiencing HHS. METHODS The patient received ABO- and RhD-matched red blood cell transfusion from six blood donors in four perinatal transfusions. Haemoglobinuria and lower haemoglobin levels compared to those before transfusion were observed after each transfusion, and the lactate dehydrogenase was consistently elevated. The blood samples were collected at different time points during the hospitalisation for direct antiglobulin test (DAT), antibody screening test and acid elution test. The antigens of six blood donors were identified, and the cross-matching tests were repeated using the blood sample of the patient with specific irregular antibodies after the last transfusion. RESULTS The DAT of the patient was negative for anti-IgG and positive (1+) for anti-C3d, and no red blood cell antibodies were detected in the eluent before, between and after transfusions. Before and between transfusions, blood samples were negative for red blood cell irregular antibodies, whereas IgM anti-P1 and IgG anti-Jka were detected in blood samples the next day after the last transfusion. In the six donors, two were negative for P1 and Jka , one was positive for P1 and negative for Jka , and three were negative for P1 and positive for Jka . The tentative cross-matching tests using the indirect antiglobulin method in saline showed that only agglutination occurred in the blood samples of the patient collected after last transfusion and the three Jka -positive blood donors. DISCUSSION The clinical manifestations and laboratory test results suggested that HHS occurred in this patient with β-thalassemia after each transfusion. Clinicians should be aware that HHS can occur with compatible blood transfusion.
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Affiliation(s)
- Yuanjun Wu
- Department of Blood Transfusion, Dongguan Maternal and Child Health Hospital, Dongguan, China
| | - Yanli Ji
- Institute of Clinical Blood Transfusion, Guangzhou Blood Center, Guangzhou, China
| | - Bingmei Dai
- Department of obstetrics, Dongguan Maternal and Child Health Hospital, Dongguan, China
| | - Faliang Guo
- Department of Critical Care Medicine, Dongguan Maternal and Child Health Hospital, Dongguan, China
| | - Yong Wu
- Department of Blood Transfusion, Affiliated Tungwah Hospital of Sun yat-sen University, Dongguan, China
| | - Ziyi He
- Blood Transfusion Research Center, Dongguan City Blood Station, Dongguan, China
| | - Chunyan Mo
- Institute of Clinical Blood Transfusion, Guangzhou Blood Center, Guangzhou, China
| | - Shujie Wu
- Department of Blood Transfusion, Dongguan Maternal and Child Health Hospital, Dongguan, China
| | - Yingming Hu
- Blood Transfusion Research Center, Dongguan City Blood Station, Dongguan, China
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Vasanthamohan L, Choo S, Marshall T, Symons YT, Matsui D, Eastabrook G, Solh Z. Peripartum hyperhemolysis prophylaxis and management in sickle cell disease: A case report and narrative review. Transfusion 2020; 60:2448-2455. [PMID: 32851670 DOI: 10.1111/trf.16003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 05/26/2020] [Accepted: 06/29/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Sickle cell disease (SCD) is associated with hematologic complications including delayed hemolytic transfusion reactions (DHTRs) and pregnancy-related morbidity and mortality. Hyperhemolysis syndrome (HS) is the most severe form of DHTR in patients with SCD, in which both transfused and native red blood cells are destroyed. Further transfusions are avoided after a history of HS. Immunosuppressive agents can be used as prophylaxis against life-threatening hemolysis when transfusion is necessary. There is a paucity of evidence for the use of HS prophylaxis before transfusions, the continuation of hydroxyurea (HU) in lieu of chronic transfusion, and the use of erythropoiesis-stimulating agents (ESA) in pregnant SCD patients. CASE REPORT We present a case of a pregnant patient with SCD and a previous history of HS. HS prophylaxis was given before transfusion with corticosteroids, intravenous immunoglobulin, and rituximab. In addition, HU was continued during pregnancy to control SCD, along with the use of concomitant ESA to maintain adequate hemoglobin levels and avoid transfusion. We describe a multidisciplinary approach to pregnancy and delivery management including tailored anesthetic and obstetric planning. CONCLUSION This is the first published case of HS prophylaxis in a pregnant SCD patient, with good maternal and fetal outcomes after transfusion. HU and ESAs were able to control SCD and mitigate anemia in lieu of prophylactic transfusions during pregnancy. Further prospective studies are necessary to elucidate the ideal management of pregnant SCD patients with a history of HS or other contraindications to chronic transfusion.
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Affiliation(s)
- Lakshman Vasanthamohan
- Department of Medicine, Division of Hematology, Western University, London, Ontario, Canada
| | - Sheryl Choo
- Department of Obstetrics & Gynecology, Western University, London, Ontario, Canada
| | - Tonisha Marshall
- Department of Obstetrics & Gynecology, Western University, London, Ontario, Canada
| | | | - Doreen Matsui
- Department of Pediatrics, Division of Clinical Pharmacology, Western University, London, Ontario, Canada
| | - Genevieve Eastabrook
- Department of Obstetrics & Gynecology, Western University, London, Ontario, Canada
| | - Ziad Solh
- Department of Medicine, Division of Hematology, Western University, London, Ontario, Canada.,Department of Pathology & Laboratory Medicine, Division of Transfusion Medicine, Western University, London, Ontario, Canada
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Eluate testing with monospecific antisera unmasks multiple immunoglobulin classes and identifies frequent IgA involvement in severe autoimmune hemolytic anemia. Transfus Apher Sci 2018; 57:384-387. [PMID: 29716828 DOI: 10.1016/j.transci.2018.04.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Revised: 03/18/2018] [Accepted: 04/17/2018] [Indexed: 11/23/2022]
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