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Yee MEM, Zerra PE, McCoy JW, Covington ML, Stowell SR, Joiner CH, Lough CM, Delvadia BB, Josephson CD, Roback JD, Fasano RM. Post-transfusion biotin-labeled red blood cell survival studies in pediatric sickle cell disease with antibodies of uncertain significance. Transfusion 2024. [PMID: 38506450 DOI: 10.1111/trf.17800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 03/06/2024] [Accepted: 03/08/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND Red blood cell (RBC) antibodies are common in multiply transfused patients with sickle cell disease (SCD). Unlike RBC alloantibodies, the potential of autoantibodies to cause post-transfusion hemolysis may be uncertain. Biotin-labeling provides a direct measurement of red cell survival (RCS) over time, thus can be used to assess the clinical significance of RBC antibodies. Antibodies to biotinylated RBC (B-RBC) occasionally are detected after exposure, which may impact B-RBC survival in subsequent RCS studies. STUDY DESIGN AND METHODS Pediatric patients with SCD receiving monthly chronic transfusions underwent RCS studies, receiving aliquots of allogeneic RBC labeled at distinct densities of biotin (2-18 μg/mL). B-RBC survival was followed for 4 months post-transfusion, and B-RBC antibody screening for 6 months. Patients with warm autoantibodies (WAA) or B-RBC antibodies are reported here. RESULTS RBC antibodies were detected during RCS in four patients: one with WAA, one with WAA followed by B-RBC-specific antibodies, and two with transient B-RBC antibodies within the first 5 weeks of exposure. B-RBC half-lives (T50 ) ranged 37.6-61.7 days (mean 47.8 days). There was no evidence of increased hemolysis or accelerated B-RBC clearance in the presence of WAA or B-RBC antibodies. DISCUSSION Biotinylation of allogenic RBC can be used to assess the possible effects of RBC antibodies on transfusion survival in individual cases, particularly when it is uncertain if the detected antibodies may result in hemolysis. In the cases presented here, neither WAA nor B-RBC antibodies were associated with significant shortening of B-RBC survival in individuals with SCD.
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Affiliation(s)
- Marianne E M Yee
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Patricia E Zerra
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Center for Transfusion and Cellular Therapies, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - James W McCoy
- Center for Transfusion and Cellular Therapies, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Mischa L Covington
- Joint Program in Transfusion Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sean R Stowell
- Joint Program in Transfusion Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Clinton H Joiner
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Christopher M Lough
- Medical Services, Lifesouth Community Blood Centers, Gainesville, Florida, USA
| | | | - Cassandra D Josephson
- Cancer and Blood Disorders Institute, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
- Departments of Oncology and Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - John D Roback
- Center for Transfusion and Cellular Therapies, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Ross M Fasano
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
- Center for Transfusion and Cellular Therapies, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
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Adamkiewicz TV, Yee MEM, Thomas S, Tunali A, Lai KW, Omole FS, Lane PA, Yildirim I. Pneumococcal infections in children with sickle cell disease before and after pneumococcal conjugate vaccines. Blood Adv 2023; 7:6751-6761. [PMID: 37698500 PMCID: PMC10660014 DOI: 10.1182/bloodadvances.2022009643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 07/13/2023] [Accepted: 07/13/2023] [Indexed: 09/13/2023] Open
Abstract
Children with sickle cell disease (SCD) are at increased risk of invasive pneumococcal disease (IPD). Over 25 years, the Georgia Emerging Infections Program/Centers for Disease Control and Prevention Active Bacterial Core Surveillance network identified 104 IPD episodes among 3707 children with hemoglobin SS (HbSS) or HbSC aged <10 years, representing 6% of IPD in Black or African American children residing in Metropolitan Atlanta (reference population). Children with IPD and HbSS/SC were older than those with IPD in the reference population (P < .001). From 1994-1999 to 2010-2018, IPD declined by 87% in children with HbSS aged 0 to 4 years, and by 80% in those aged 5 to 9 years. However, IPD incidence rate ratios when comparing children with SCD with the reference population increased from 20.2 to 29.2 over these periods. Among children with HbSS and IPD, death declined from 14% to 3% after 2002, and meningitis declined from 16% to 8%. Penicillin resistance was more prevalent in children with SCD before 7-valent pneumococcal conjugate vaccine (PCV7) licensure. After 2010, all IPD serotypes were not included in the 13-valent PCV (PCV13). Within 3 years of vaccination, the effectiveness of the 23-valent pneumococcal polysaccharide vaccine (PPSV23) against non-PCV13 serotypes included in PPSV23 plus 15A/15C was 92% (95% confidence interval, 40.8- 99.0, P = .014; indirect-cohort effect adjusted for age and hydroxyurea). PPSV23 would cover 62% of non-PCV13 serotype IPD in children with SCD, whereas PCV15, PCV20, and PCV21/V116 (in development) could cover 16%, 51%, and 92%, respectively. Although less frequent, IPD remains a life-threatening risk in children with SCD. Effective vaccines with broader coverage could benefit these children.
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Affiliation(s)
- Thomas V. Adamkiewicz
- Department of Family Medicine, Morehouse School of Medicine, Atlanta, GA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
| | - Marianne E. M. Yee
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA
| | - Stepy Thomas
- Department of Medicine, Emory University School of Medicine, Atlanta, GA
- Georgia Emerging Infections Program, Atlanta, GA
- Atlanta Veterans Administration Health System, Decatur, GA
| | - Amy Tunali
- Department of Medicine, Emory University School of Medicine, Atlanta, GA
- Atlanta Veterans Administration Health System, Decatur, GA
| | - Kristina W. Lai
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA
- University of California, Davis, CA
| | - Folashade S. Omole
- Department of Family Medicine, Morehouse School of Medicine, Atlanta, GA
| | - Peter A. Lane
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA
| | - Inci Yildirim
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT
- Yale Center for Infection and Immunity, Yale Institute of Global Health, New Haven, CT
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Weaver MS, Yee MEM, Lawrence CE, Matheny Antommaria AH, Fasano RM. Requests for Directed Blood Donations. Pediatrics 2023; 151:e2022058183. [PMID: 36897227 PMCID: PMC10998552 DOI: 10.1542/peds.2022-058183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/20/2022] [Indexed: 03/11/2023] Open
Abstract
This Ethics Rounds presents a request for directed blood donation. Two parents feel helpless in the setting of their daughter's new leukemia diagnosis and want to directly help their child by providing their own blood for a transfusion. They express hesitancy about trusting the safety of a stranger's blood. Commentators assess this case in the setting of blood as a scarce community resource during a national blood shortage. Commentators review the child's best interest, future risks, and harm-benefit considerations. Commentators recognize the professional integrity, humility, and courage of the physician to admit his own lack of knowledge on the subject and to seek help rather than claim directed donation is not possible without further investigation into options. Shared ideals such as altruism, trust, equity, volunteerism, and solidarity are recognized as values relevant to sustainment of a community blood supply. Pediatric hematologists, a blood bank director, transfusion medicine specialists, and an ethicist conclude that directed donation is only justified by lower risks to the recipient in particular circumstances.
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Affiliation(s)
- Meaghann S Weaver
- Department of Pediatrics, University of Nebraska, Omaha, Nebraska
- VA National Center for Ethics in Health Care, Washington, District of Columbia
| | - Marianne E M Yee
- Department of Pathology and Laboratory Medicine, Center for Transfusion and Cellular Therapy
- Division of Hematology/Oncology, Department of Pediatrics, Emory University, Atlanta, Georgia
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Courtney E Lawrence
- Division of Pediatric Hematology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
- American Red Cross Biomedical Services, Medical Office, Virginia Region, Richmond, Virginia
| | - Armand H Matheny Antommaria
- Ethics Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Ross M Fasano
- Department of Pathology and Laboratory Medicine, Center for Transfusion and Cellular Therapy
- Division of Hematology/Oncology, Department of Pediatrics, Emory University, Atlanta, Georgia
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia
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Wade J, Yee MEM, Easley KA, Pahz S, Butler H, Zerra PE, Josephson CD, Fasano RM. Procedural adverse events in pediatric patients with sickle cell disease undergoing chronic automated red cell exchange. Transfusion 2022; 62:584-593. [PMID: 35072269 DOI: 10.1111/trf.16807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 12/27/2021] [Accepted: 12/27/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Chronic automated red cell exchange (RCE) is increasingly employed for sickle cell disease (SCD). There is a paucity of data on the incidence of RCE adverse events (AEs) and potential patient and procedural risk factors for AEs. METHODS A retrospective review of pediatric SCD patients receiving chronic RCE over 3 years was performed to determine the frequency of AEs and identify procedural and patient AE risk factors. AE incidence, AE rate, incidence rate ratios (IRRs), and relative risks (RRs) were calculated based on various procedural and patient characteristics by univariable (UV) and multivariable (MV) analyses. RESULTS In 38 patients receiving 760 procedures, there were 150 (19.7%) AEs, 36 (4.7%) were symptomatic AEs. AE rates were 20.2 [95% CI 17.2, 23.6] and 4.8 [95% CI 3.49, 6.70] per 100 person months for AEs and symptomatic AEs, respectively. AE incidences were: hypocalcemia (117; 15.4%), dizziness (22; 3.0%), hypotension (15; 2.0%), and nausea (14; 1.8%). Patients with baseline Hct ≥30% experienced more total AEs and symptomatic AEs. Patients with pre-procedure systolic BP <50th percentile, severe CNS vasculopathy, and non-SCA genotype (HbSC or Sβ+ thalassemia) exhibited more total AEs. IHD depletion was not associated with an increased incidence of AEs or symptomatic AEs. CONCLUSION SCD patients with Hct ≥30%, systolic BP <50th percentile, severe CNS vasculopathy, and possibly non-SCA genotype may be at higher risk for RCE-related AEs. The effect of IHD on AE risk is likely minimal. Individualized AE risk assessment should be performed in all SCD patients undergoing chronic automated RCE.
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Affiliation(s)
- Jenna Wade
- Center for Transfusion and Cellular Therapy, Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia, USA.,Medical Sciences Institute, Blood Center of Wisconsin, Part of Versiti, Milwaukee, Wisconsin, USA.,Department of Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Marianne E M Yee
- Center for Transfusion and Cellular Therapy, Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia, USA.,Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA.,Department of Pediatrics, Division of Hematology/Oncology, Emory University, Atlanta, Georgia, USA
| | - Kirk A Easley
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Atlanta, Georgia, USA
| | - Shannon Pahz
- Department of Pathology, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Hailly Butler
- Center for Transfusion and Cellular Therapy, Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia, USA
| | - Patricia E Zerra
- Center for Transfusion and Cellular Therapy, Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia, USA.,Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA.,Department of Pediatrics, Division of Hematology/Oncology, Emory University, Atlanta, Georgia, USA
| | - Cassandra D Josephson
- Center for Transfusion and Cellular Therapy, Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia, USA.,Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA.,Department of Pediatrics, Division of Hematology/Oncology, Emory University, Atlanta, Georgia, USA
| | - Ross M Fasano
- Center for Transfusion and Cellular Therapy, Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia, USA.,Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
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5
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Yee MEM, Batsuli G, Chonat S, Park S. Thrombocytosis with acquired von Willebrand disease in an adolescent with sickle cell disease. Clin Case Rep 2021; 9:457-460. [PMID: 33489197 PMCID: PMC7813102 DOI: 10.1002/ccr3.3556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 11/03/2020] [Indexed: 11/08/2022] Open
Abstract
Thrombocytosis is common in sickle cell disease and may contribute to vaso-occlusion. Hydroxyurea treats extreme thrombocytosis. Acquired von Willebrand disease should be considered prior to aspirin therapy.
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Affiliation(s)
- Marianne E. M. Yee
- Aflac Cancer and Blood Disorders CenterChildren's Healthcare of AtlantaAtlantaGAUSA
- Department of PediatricsDivision of Hematology/OncologyEmory University School of MedicineAtlantaGAUSA
| | - Glaivy Batsuli
- Aflac Cancer and Blood Disorders CenterChildren's Healthcare of AtlantaAtlantaGAUSA
- Department of PediatricsDivision of Hematology/OncologyEmory University School of MedicineAtlantaGAUSA
| | - Satheesh Chonat
- Aflac Cancer and Blood Disorders CenterChildren's Healthcare of AtlantaAtlantaGAUSA
- Department of PediatricsDivision of Hematology/OncologyEmory University School of MedicineAtlantaGAUSA
| | - Sunita Park
- Department of Pathology and Laboratory MedicineChildren's Healthcare of AtlantaAtlantaGAUSA
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Hawkins LM, Sinha CB, Ross D, Yee MEM, Quarmyne MO, Krishnamurti L, Bakshi N. Patient and family experience with chronic transfusion therapy for sickle cell disease: A qualitative study. BMC Pediatr 2020; 20:172. [PMID: 32305060 PMCID: PMC7165370 DOI: 10.1186/s12887-020-02078-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 04/07/2020] [Indexed: 11/25/2022] Open
Abstract
Background There is a limited understanding of the patient and family experience of Chronic Transfusion Therapy (CTT) for prevention of complications of Sickle Cell Disease (SCD). We sought to understand patient and family experience with CTT using qualitative methods. Methods Fifteen parents of children < 18 years old and nine children 12–18 years old with SCD who were receiving CTT for > 1 year were interviewed using a semi-structured interview format, and interviews were analyzed using open coding methods. Results Four themes created a narrative of the patient and family experience of CTT: 1) Burden of CTT, 2) Coping with CTT, 3) Perceived benefits and risks of CTT, and 4) Decision making regarding CTT. Participants reported substantial burden of CTT, including the impact of CTT on daily life and family, distress about venous access, burden of chelation therapy, and anxiety about CTT complications. Participants described how they coped with CTT. Participants reported increased energy, decreased pain, fewer hospitalizations, and stroke prevention with CTT, but also recognized complications of CTT, though awareness was limited in adolescents. Parents described sharing in the informed decision-making process with their healthcare provider about CTT, but adolescent patient participants reported that they were not involved in this process. Conclusions CTT is associated with significant patient and family burden. Support from family, healthcare providers and school may help individuals cope with some of this burden. These findings provide the basis for future studies to identify strategies to mitigate the burden of CTT and improve the patient experience with this therapy. Future studies should also systematically assess patient knowledge about the key components of CTT and chelation using quantitative assessments.
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Affiliation(s)
| | - Cynthia B Sinha
- Division of Pediatric Hematology-Oncology-BMT, Emory University School of Medicine, Atlanta, GA, USA
| | - Diana Ross
- Division of Pediatric Hematology-Oncology-BMT, Emory University School of Medicine, Atlanta, GA, USA
| | - Marianne E M Yee
- Division of Pediatric Hematology-Oncology-BMT, Emory University School of Medicine, Atlanta, GA, USA.,Aflac Cancer and Blood Disorders, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Maa-Ohui Quarmyne
- Division of Pediatric Hematology-Oncology-BMT, Emory University School of Medicine, Atlanta, GA, USA.,Aflac Cancer and Blood Disorders, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Lakshmanan Krishnamurti
- Division of Pediatric Hematology-Oncology-BMT, Emory University School of Medicine, Atlanta, GA, USA.,Aflac Cancer and Blood Disorders, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Nitya Bakshi
- Division of Pediatric Hematology-Oncology-BMT, Emory University School of Medicine, Atlanta, GA, USA. .,Aflac Cancer and Blood Disorders, Children's Healthcare of Atlanta, Atlanta, GA, USA.
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Arthur CM, Chonat S, Fasano R, Yee MEM, Josephson CD, Roback JD, Stowell SR. Examining the Role of Complement in Predicting, Preventing, and Treating Hemolytic Transfusion Reactions. Transfus Med Rev 2019; 33:217-224. [PMID: 31679762 PMCID: PMC7147990 DOI: 10.1016/j.tmrv.2019.09.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 09/04/2019] [Accepted: 09/05/2019] [Indexed: 12/24/2022]
Abstract
Red blood cell (RBC) transfusion is a critical component of optimal management for a broad range of conditions. Regardless of the indication, pretransfusion testing is required to appropriately match RBC donors and recipients to provide immunologically compatible blood. Although this approach is effective in the vast majority of situations, occasionally, patients will inadvertently receive an incompatible RBC transfusion, which can result in a hemolytic transfusion reaction (HTR). In addition, patients with life-threatening anemia and a complex alloantibody profile, which precludes rapid procurement of compatible RBCs, may also receive incompatible RBCs, placing them at risk for an HTR. Despite the rarity of these clinical situations, when incompatible blood transfusion results in an HTR, the consequences can be devastating. In this review, we will explore the challenges associated with actively preventing and treating acute HTRs following incompatible RBC transfusion. In doing so, we will focus primarily on the role of complement, not only as a key player in HTRs, but also as a potential target for the prevention and treatment of HTRs.
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Affiliation(s)
- Connie M Arthur
- Aflac Cancer and Blood Disorders Center, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
| | - Satheesh Chonat
- Center for Transfusion Medicine and Cellular Therapies, Department of Laboratory Medicine and Pathology, Emory University School of Medicine, Atlanta, GA
| | - Ross Fasano
- Aflac Cancer and Blood Disorders Center, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA; Center for Transfusion Medicine and Cellular Therapies, Department of Laboratory Medicine and Pathology, Emory University School of Medicine, Atlanta, GA
| | - Marianne E M Yee
- Aflac Cancer and Blood Disorders Center, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA; Center for Transfusion Medicine and Cellular Therapies, Department of Laboratory Medicine and Pathology, Emory University School of Medicine, Atlanta, GA
| | - Cassandra D Josephson
- Aflac Cancer and Blood Disorders Center, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA; Center for Transfusion Medicine and Cellular Therapies, Department of Laboratory Medicine and Pathology, Emory University School of Medicine, Atlanta, GA
| | - John D Roback
- Center for Transfusion Medicine and Cellular Therapies, Department of Laboratory Medicine and Pathology, Emory University School of Medicine, Atlanta, GA
| | - Sean R Stowell
- Center for Transfusion Medicine and Cellular Therapies, Department of Laboratory Medicine and Pathology, Emory University School of Medicine, Atlanta, GA.
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Chonat S, Arthur CM, Zerra PE, Maier CL, Jajosky RP, Yee MEM, Miller MJ, Josephson CD, Roback JD, Fasano R, Stowell SR. Challenges in preventing and treating hemolytic complications associated with red blood cell transfusion. Transfus Clin Biol 2019; 26:130-134. [PMID: 30979566 DOI: 10.1016/j.tracli.2019.03.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Red blood cell (RBC) transfusion support represents a critical component of sickle cell disease (SCD) management. However, as with any therapeutic intervention, RBC transfusion is not without risk. Repeat exposure to allogeneic RBCs can result in the development of RBC alloantibodies that can make it difficult to find compatible RBCs for future transfusions and can directly increase the risk of developing acute or delayed hemolytic transfusion reactions, which can be further complicated by hyperhemolysis. Several prophylactic and treatment strategies have been employed in an effort to reduce or prevent hemolytic transfusion reactions. However, conflicting data exist regarding the efficacy of many of these approaches. We will explore the challenges associated with predicting, preventing and treating different types of hemolytic transfusion reactions in patients with SCD in addition to describing future strategies that may aid in the management of the complex transfusion requirements of SCD patients.
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Affiliation(s)
- Satheesh Chonat
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, and Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Connie M Arthur
- Center for Transfusion Medicine and Cellular Therapies, Department of Laboratory Medicine and Pathology, Emory University School of Medicine, 101, Woodruff Circle, 30322 Atlanta, GA, USA
| | - Patricia E Zerra
- Center for Transfusion Medicine and Cellular Therapies, Department of Laboratory Medicine and Pathology, Emory University School of Medicine, 101, Woodruff Circle, 30322 Atlanta, GA, USA
| | - Cheryl L Maier
- Center for Transfusion Medicine and Cellular Therapies, Department of Laboratory Medicine and Pathology, Emory University School of Medicine, 101, Woodruff Circle, 30322 Atlanta, GA, USA
| | - Ryan P Jajosky
- Center for Transfusion Medicine and Cellular Therapies, Department of Laboratory Medicine and Pathology, Emory University School of Medicine, 101, Woodruff Circle, 30322 Atlanta, GA, USA
| | - Marianne E M Yee
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, and Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Maureen J Miller
- Center for Transfusion Medicine and Cellular Therapies, Department of Laboratory Medicine and Pathology, Emory University School of Medicine, 101, Woodruff Circle, 30322 Atlanta, GA, USA
| | - Cassandra D Josephson
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, and Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA; Center for Transfusion Medicine and Cellular Therapies, Department of Laboratory Medicine and Pathology, Emory University School of Medicine, 101, Woodruff Circle, 30322 Atlanta, GA, USA
| | - John D Roback
- Center for Transfusion Medicine and Cellular Therapies, Department of Laboratory Medicine and Pathology, Emory University School of Medicine, 101, Woodruff Circle, 30322 Atlanta, GA, USA
| | - Ross Fasano
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, and Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA; Center for Transfusion Medicine and Cellular Therapies, Department of Laboratory Medicine and Pathology, Emory University School of Medicine, 101, Woodruff Circle, 30322 Atlanta, GA, USA.
| | - Sean R Stowell
- Center for Transfusion Medicine and Cellular Therapies, Department of Laboratory Medicine and Pathology, Emory University School of Medicine, 101, Woodruff Circle, 30322 Atlanta, GA, USA.
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Yee MEM, Josephson CD, Winkler AM, Webb J, Luban NLC, Leong T, Stowell SR, Roback JD, Fasano RM. Hemoglobin A clearance in children with sickle cell anemia on chronic transfusion therapy. Transfusion 2018; 58:1363-1371. [PMID: 29664198 DOI: 10.1111/trf.14610] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 01/24/2018] [Accepted: 01/29/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Chronic transfusion therapy for sickle cell anemia reduces disease complications by diluting sickle-erythrocytes with hemoglobin A (HbA)-containing erythrocytes and suppressing erythropoiesis. Minor antigen mismatches may result in alloimmunization, but it is unknown if antigen mismatches or recipient characteristics influence HbA clearance posttransfusion. STUDY DESIGN AND METHODS Children with sickle cell anemia on chronic transfusion therapy were followed prospectively for 12 months. All patients received units serologically matched for C/c, E/e, and K; patients with prior red blood cell (RBC) antibodies had additional matching for Fya , Jkb , and any previous alloantibodies. Patients' RBC antigen genotypes, determined by multiplexed molecular assays (PreciseType Human Erythrocyte Antigen, and RHCE and RHD BeadChip, Immucor) were compared to genotypes of transfused RBC units to assess for antigen mismatches. Decline in hbA (ΔHbA) from posttransfusion to the next transfusion was calculated for each transfusion episode. RESULTS Sixty patients received 789 transfusions, 740 with ΔHbA estimations, and 630 with donor Human Erythrocyte Antigen genotyping. In univariate mixed-model analysis, ΔHbA was higher in patients with past RBC antibodies or splenomegaly and lower in patients with splenectomy. RBC antigen mismatches were not associated with ΔHbA. In multivariate linear mixed-effects modeling, ΔHbA was associated with RBC antibodies (2.70 vs. 2.45 g/dL/28 d, p = 0.0028), splenomegaly (2.87 vs. 2.28 g/dL/28 d, p = 0.019), and negatively associated with splenectomy (2.46 vs. 2.70 g/dL/28 d, p = 0.011). CONCLUSIONS HbA decline was increased among patients with sickle cell anemia with prior immunologic response to RBC antigens and decreased among those with prior splenectomy, demonstrating that recipient immunologic characteristics influenced the clearance of transfused RBCs.
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Affiliation(s)
- Marianne E M Yee
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Department of Pediatrics and Hematology/Oncology, Emory University School of Medicine and the
| | - Cassandra D Josephson
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Department of Pediatrics and Hematology/Oncology, Emory University School of Medicine and the.,Center for Transfusion and Cellular Therapies, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia; the
| | - Anne M Winkler
- Center for Transfusion and Cellular Therapies, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia; the
| | - Jennifer Webb
- Center for Cancer and Blood Disorders, Children's National Medical Center, Departments of Hematology and Laboratory Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Naomi L C Luban
- Center for Cancer and Blood Disorders, Children's National Medical Center, Departments of Hematology and Laboratory Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Traci Leong
- Department of Biostatistics and Bioinformatics, Emory University, Rollins School of Public Health, Atlanta, Georgia
| | - Sean R Stowell
- Center for Transfusion and Cellular Therapies, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia; the
| | - John D Roback
- Center for Transfusion and Cellular Therapies, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia; the
| | - Ross M Fasano
- Center for Transfusion and Cellular Therapies, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia; the
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Yee MEM, Lane PA, Archer DR, Joiner CH, Eckman JR, Guasch A. Estimation of glomerular filtration rate using serum cystatin C and creatinine in adults with sickle cell anemia. Am J Hematol 2017; 92:E598-E599. [PMID: 28670697 DOI: 10.1002/ajh.24840] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 06/21/2017] [Accepted: 06/24/2017] [Indexed: 11/06/2022]
Affiliation(s)
- Marianne E. M. Yee
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta; Atlanta Georgia
- Division of Hematology/Oncology; Department of Pediatrics, Emory University School of Medicine; Atlanta Georgia
| | - Peter A. Lane
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta; Atlanta Georgia
- Division of Hematology/Oncology; Department of Pediatrics, Emory University School of Medicine; Atlanta Georgia
| | - David R. Archer
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta; Atlanta Georgia
- Division of Hematology/Oncology; Department of Pediatrics, Emory University School of Medicine; Atlanta Georgia
| | - Clinton H. Joiner
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta; Atlanta Georgia
- Division of Hematology/Oncology; Department of Pediatrics, Emory University School of Medicine; Atlanta Georgia
| | - James R. Eckman
- Department of Hematology and Oncology; Winship Cancer Institute, Emory University School of Medicine; Atlanta Georgia
| | - Antonio Guasch
- Department of Medicine; Renal Division, Emory University School of Medicine; Atlanta Georgia
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11
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Yee MEM, Josephson CD, Winkler AM, Webb J, Luban NLC, Leong T, Stowell SR, Fasano RM. Red blood cell minor antigen mismatches during chronic transfusion therapy for sickle cell anemia. Transfusion 2017; 57:2738-2746. [PMID: 28840600 DOI: 10.1111/trf.14282] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 06/08/2017] [Accepted: 06/13/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Red blood cell (RBC) alloimmunization occurs at a high frequency in sickle cell anemia (SCA) despite serologic matching for Rh (C/c, E/e) and K antigens. RBC minor antigen genotyping allows for prediction of antigens and RH variants that may lead to alloimmunization. STUDY DESIGN AND METHODS RBC antigen genotyping was performed on chronically transfused pediatric SCA patients, using PreciseType human erythrocyte antigen (HEA), RHCE, and RHD BeadChip arrays. All patients received C/c, E/e, and K serologically matched units (Category 1); patients with prior RBC antibodies were also matched for Fya , Jkb , and any antibodies (Category 2). The RBC genotypes of all leukoreduced (LR) units transfused over a 12-month period were determined by the prototype HEA-LR BeadChip assay. RESULTS There were 2320 RBC units transfused to 90 patients in 1135 transfusion episodes. Thirty-five (38.9%) patients had homozygous or compound heterozygous RH variants. Seven new alloantibodies were detected, with alloantibody incidence of 0.706 in 100 units for Category 2 transfusions and 0.068 in 100 units for Category 1 (p = 0.02). Three patients on Category 2 transfusions formed new anti-Jsa and had a higher rate of exposure to Jsa than those who did not form anti-Jsa (20.4 vs. 8.33 exposures/100 units, p = 0.02). The most frequent mismatches were S (43.9%), Doa (43.9%), Fya (29.2%), M (28.4%), and Jkb (28.1%). CONCLUSIONS Alloimmunization incidence was higher in those with prior RBC antibodies, suggesting that past immunologic responders are at higher risk for future alloimmunization and therefore may benefit from more extensive antigen matching beyond C/c, E/e, K, Fya , and Jkb .
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Affiliation(s)
- Marianne E M Yee
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Department of Pediatrics, Division of Hematology/Oncology, Emory University School of Medicine, Atlanta, Georgia
| | - Cassandra D Josephson
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Department of Pediatrics, Division of Hematology/Oncology, Emory University School of Medicine, Atlanta, Georgia.,Center for Transfusion and Cellular Therapies, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Anne M Winkler
- Center for Transfusion and Cellular Therapies, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Jennifer Webb
- Center for Cancer and Blood Disorders, Children's National Health System, Departments of Hematology and Laboratory Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Naomi L C Luban
- Center for Cancer and Blood Disorders, Children's National Health System, Departments of Hematology and Laboratory Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Traci Leong
- Department of Biostatistics and Bioinformatics, Emory University, Rollins School of Public Health, Atlanta, Georgia
| | - Sean R Stowell
- Center for Transfusion and Cellular Therapies, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Ross M Fasano
- Center for Transfusion and Cellular Therapies, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia
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