Case Of Hemolytic Transfusion Reaction Research Articles

The KANNO blood group system.

The KANNO blood group system (International Society of Blood Transfusion [ISBT] 037) includes one high-prevalence antigen, KANNO1, across ethnic groups. Sporadic KANNO1- cases among East and South Asians are theoretically estimated by the DNA database library. Anti-KANNO1 has been found most often among Japanese women with current or prior pregnancy. Thus far, there are no reported cases of hemolytic transfusion reaction or hemolytic disease of the fetus and newborn due to anti-KANNO1.

The First Korean Case Report of Anti-Gerbich

In this study, we report the first Korean case of an anti-Gerbich (Ge) alloantibody to a high-incidence antigen that belongs to the Ge blood group system. The alloantibody was detected in a middle-aged Korean woman who did not have a history of transfusion. Her blood type was B+, and findings from the antibody screening test revealed 1+ reactivity in all panels except the autocontrol. The cross-matching test showed incompatible results with all 5 packed red blood cells. Additional blood type antigen and antibody tests confirmed the anti-Ge alloantibody. While rare, cases of hemolytic transfusion reaction or hemolytic disease in newborns due to anti-Ge have been recently reported in the literature. Therefore, additional further studies on alloantibodies to high-incidence antigens, including anti-Ge, are necessary in the future.

Sixty Years of Antibodies to MNS System Hybrid Glycophorins: What Have We Learned?

The MNS system was the second blood group system discovered and at least 16 of the 46 antigens in the MNS system result from genetic recombination, producing a hybrid glycophorin. The incidence of these hybrid glycophorins is highest in East Asian populations. MNS system antigens defined by hybrid glycophorins are immunogenic with alloimmune IgG responses developing after transfusion or pregnancy; with reports originating from Asia, Europe, the Americas, and Australia. This demonstrates the global nature of problems associated with these antibodies. Since the initial report that production of anti-Mi(a) was a cause of hemolytic disease of the fetus and newborn (HDFN), antibodies to antigens defined by hybrid glycophorins have been reported in 27 cases of HDFN (1 fatal) and 8 cases of hemolytic transfusion reaction (HTR) (1 fatal). In at least 40% of these clinical cases, the disease was reported as severe. Hyporegenerative fetal anemia is a common feature of the reported HDFN cases. In all published cases, the causative antibodies were identified by reference laboratory investigative tests following clinical presentation. The failure to detect these antibodies by routine testing highlights the need for consideration of the medical importance of these antibodies when defining antibody screening practices and reagents. The aim of this review is to raise awareness of severe disease caused by antibodies to MNS antigens defined by hybrid glycophorins and, thus, to improve diagnosis and patient management.

Rh不適合輸血（抗e抗体）による溶血性黄疸の1例

Rh不適合輸血（抗e抗体）による溶血性黄疸の1例

Hemolytic transfusion reaction following transfusion of frozen and washed autologous red cells

A case of hemolytic transfusion reaction, accompanied by hypotension and followed by transient renal failure, occurred after the transfusion of 1 unit of previously frozen autologous red cells. Subsequent investigation revealed the probable cause of the hemolysis to be inadequate deglycerolization of the unit. The cause of the associated symptoms is unknown. Possibilities include nephrotoxic effects of hemoglobin or stroma, toxic effects of glycerol, or release of vasoactive or thrombogenic substances from lysed red cells. This case of a hemolytic reaction adds to the known risks of autologous transfusion.

A CASE OF A DELAYED HEMOLYTIC TRANSFUSION REACTION AFTER RE-OPERATION OF A RECTAL CARCINOMA

Prior to the blood transfusion, ABO blood grouping and detection of antigen-D due to Rh blood group should be done to prevent incompatible blood transfusion. Sometimes, however, delayed homolytic transfusion reaction can be induced by repeated transfusions. We experienced such a reaction in a patient following operation for rectal corcinoma.A 51-year-old woman with a rectal carcinoma received 400 ml of blood at a first operation of low anterior resection. Nine months later, she was reoperated for recurred carcinoma at the site of anastomosis. As the second operation, the patient received 1600 ml of blood, and 7 days after the last unit, she had a homolytic transfusion reaction manifested by high fever, fall in hematocrit and hemoglobinuria. Serologic studies showed that the donor and recipient bloods were completely compatible prior to the transfusion and no unexpected antibodies were detected even before second operation. Re-transfusion with 1600 ml of blood might offer an opportunity to produce a secondary immunologic reaction accompanying a reproduction of a large quantity of irregular antibodies, leading to hemolytic reaction. Fortunately this case had not so sever course, but in many cases of hemolytic transfusion reaction, patients go on to sever courses and sometimes die. It is important to have careful observations on the cases of multiple blood transfusions.

抗Ｌｅ｀ｂ´抗体による溶血反応を呈した１症例

A case of hemolytic transfusion reaction due to Lewis b antibody was reported.The patient, 62-year-old farmer, was suffered from echinococcosis. He has no history to be transfused. His blood types were A, CCDee, Le (a-b-), MNSs, P2, kk, Fy (a+b-), Jk (a+b+), Xg (a+), Di (a-), and he had anti Lea & Leb antibodies.Right hepatic lobectomy was undergone. Total amount of bleeding in this operation was about 3, 000ml. And during the operation, 1, 600ml of Le (a-b-) blood and 800ml of Le(a-b+) blood was given.Two days after the operation, hemolytic jaundice and bleeding tendency from DIC appeared. Some part of the lost blood volume was replaced by incompatible Le (a-b+) blood, because Le (a-b-) blood was difficult to obtain due to its low frequency. Moreover few papers reported on hemolytic reaction by anti Leb antibody. Hemolytic reaction and DIC syndrome became even stronger as the days go by.After the transfusions of Le (a-b-) blood units alone, hemolytic anemia, jaundice and bleeding tendency were improved before long. Anti-Leb antibody titer which elevated initially decreased gradually after stoppage of using Le (b+) blood.According to these clinical features and laboratory data, we concluded that this hemolytic reaction was occured from Le (b+) incompatible blood transfusion.

Biological significance of the York, Cost, McCoy and Knops alloantibodies

The biological significance of alloantibodies directed against the red blood cell antigens York, Cost, McCoy, and Knops has been investigated by means of a literature search and an analysis of 304 patient referrals received since 1965. Neither method detected documented cases of erythroblastosis fetalis due to these antibodies. The analysis of the patient referrals identified 11 women immunized by pregnancy. The literature search provided one documented case of hemolytic transfusion reaction and one probable case of successful transfusion of incompatible blood. The analysis of the patient referrals revealed two cases of probable successful transfusions of incompatible blood, nine patients with documented evidences of extravascular hemolytic transfusion reactions, and one patient with documented evidence of intravascular hemolytic transfusion reaction. The conclusion reached is that alloantibodies directed against the York, Cost, McCoy, and Knops antigens are biologically significant with respect to red blood cell transfusions in some patients. Transfusion practices show that most patients have received compatible transfusions, an indication that the physicians in the hospitals adhere to the philosophy of compatible transfusions, whenever possible.

Intravascular hemolytic transfusion reaction due to anti-Vw+Mia with fatal outcome.

Because of the increasing use of type, screen and hold protocols and minimal surgical blood order protocols in transfusion services, a number of patients are receiving un-cross-matched blood in elective situations. There are many low-frequency red blood cell antigens which are lacking on reagent cells used for antibody screening procedures, and alloantibodies directed against these antigens are relatively common and occur in either natural or immune forms. A case of an intravascular hemolytic transfusion reaction resulting in death is reported. The patients had a naturally occurring anti-Vw+Mia and received 1 U of Vw+Mia-positive donor red cells. It is the 1st documented case of a hemolytic transfusion reaction due to this incompatibility. The potential threat of transfusion reactions due to low-frequency antigens must be recognized by the physicians who design type, screen and hold protocols and it has particular reference to the selection of possible recipients for whom the protocols are applied.

HEMOLYTIC TRANSFUSION REACTION AFTER THE ADMINISTRATION OF APPARENTLY COMPATIBLE BLOOD.

During the last 25 years there has been a vast increase in the understanding of re­ actions between red cell antigens and anti­ bodies, and this increased knowledge has lessened the hazards of transfusion by im­ provement of pre-transfusion tests. These include tests in saline solution and high protein media, as well as enzyme and anti­ globulin methods. Despite such refinements, experiences have been reported in which transfusion of seemingly compatible blood has resulted in hemolysis of the donor cells. Lou tit and associates 8 observed incompati­ bility without demonstrable antibodies in 1943. Severe hemolytic transfusion reaction after the administration of apparently compatible blood was observed in 2 cases presented by Fudenberg and Allen. 2 Osborn and Bailey 10 described a case of hemolytic transfusion reaction without demonstrable incompatibility with saline solution, al­ bumin, or antiglobulin technics. Sensitiza­ tion in this case was believed to have oc­ curred 46 years previously. Other examples may be cited. 3 - 6 ' 7 - 9 - • 12

Management of acute toxic nephrosis

Acute toxic nephrosis is a distinctive clinical syndrome, with a striking uniformity of clinical manifestations, clinical course, laboratory findings, and pathology despite a varied etiology. This discussion is restricted to the acute renal injury resulting from carbon tetrachloride poisoning, hemolytic transfusion reaction and crush syndrome. The disorder usually terminates either in death or in spontaneous, complete recovery within two weeks after the initial injury. The details of a case of carbon tetrachloride poisoning (Case I) and a case of hemolytic transfusion reaction (Case II) are presented to illustrate the clinical and laboratory features of this syndrome. These cases are not presented as models of therapy. Rather, they reflect the lack of any specific therapy, the problems of management, and the fallacy of imputing therapeutic value to medical and surgical measures that are currently advocated. Both cases recovered spontaneously, diuresis occurring on the eleventh and twelfth day of illness, respectively. Recovery was substantially complete. The acute renal insufficiency of this syndrome is manifested by severe impairment of excretion of water and marked depression of tubular function. The acute, initial and persistent oliguria-anuria is followed, at times very rapidly, by fluid retention, increased circulating blood volume, circulatory overload, cardiac strain, rapid cardiac failure and pulmonary edema. Azotemia and hypertension are of subsidiary importance. Both cases demonstrate clearly that the striking clinical improvement that occurred promptly after the onset of diuresis resulted from the release of retained fluid and the relief of circulatory overload. This improvement bore no relationship to the degree of azotemia or hypertension. The generally accepted therapy of intravenous fluids in acute toxic nephrosis is challenged as being harmful as well as ineffective. Intravenous fluids, ranging from “adequate” to “massive,” consistently fail to improve urinary output. The cumulative harm of excess of intake over output lies not only in aggravation of the consequences of fluid retention but also in the fact that this harm is potentiated by another, hitherto unrecognized, source of fluid retention, endogenous fluid derived from tissue destruction. Restriction of fluids, on the contrary, does not hinder the diuresis that heralds recovery. Death in acute toxic nephrosis usually occurs in from seven to eight days. Uremia is not the usual cause of death. The cardiovascular complications deserve the greater emphasis and wider recognition. Selective tubular damage is the outstanding pathological feature of this syndrome. The objections to the therapeutic implications drawn from the pathological studies in this syndrome are stated. The pathogenesis of acute toxic nephrosis still remains obscure and the mechanism of recovery is unknown. Tubular regeneration and diuresis parallel each other although evidences of tubular dysfunction persist for months after clinical recovery. None of the numerous medical and surgical procedures advocated in the treatment of acute toxic nephrosis has been found effective in a significant number of cases. The basic approach to the present treatment of this syndrome should therefore be the selection of a plan of management that will tide the patient over the acute renal injury and that will favor spontaneous recovery. It is believed that fluid restriction is the keystone of this plan of management. Fluids should be restricted below the amount that will produce manifest edema or aggravation of circulatory overload. An initial daily intake of 700 cc. of physiological saline, not necessarily intravenously, is advocated; this amount should be increased or decreased as clinical observations indicate. Other features of management and various therapeutic adjuvants are discussed. Acute toxic nephrosis can be induced experimentally by a variety of agents. Such experiments are urged to determine the efficacy of proposed therapeutic procedures and to assess the value of plans of management.