Acute Hemolytic Transfusion Reaction Due to Pooled Platelets: A Rare but Serious Adverse Event

2020 ◽  
Author(s):  
Richard Gammon ◽  
Susan Cook ◽  
Anthony Trinkle ◽  
Korena Thomas ◽  
Kaaron Benson
Keyword(s):  
High Titer ◽  
Donor Number ◽  
Transfusion Reaction ◽  
Normal Range ◽  
Dark Urine ◽  
Hemolytic Transfusion Reaction ◽  
Group A ◽  
Relapsed Lymphoma ◽  
Blood And Urine Samples ◽  
Apheresis Platelets

Abstract A female patient aged 65 years with blood group A with relapsed lymphoma had thrombocytopenia; leukocyte-reduced group O prestorage pooled platelet concentrates (PPLTs) were transfused without adverse events. She was discharged home, but 1.5 hours later she returned with fever and dark urine. Hypotension and tachycardia developed; she was admitted to the intensive care unit. Post-transfusion blood and urine samples were obtained. Serial dilutions from 5 donor testing tubes and a simulated PLT pool were performed and read at immediate spin and IgG. Testing confirmed an acute hemolytic transfusion reaction (AHTR): elevated lactate dehydrogenase (996 U/L; normal range 135 U/L–225 U/L) and undetectable haptoglobin (<10 mg/dL; normal range 30 mg/dL–200 mg/dL) levels. Urinalysis showed dark amber urine but no significant quantity of red blood cells. At 37ºC the simulated pool and donor number 5 had high-titer anti-A. As a precaution, the donor was permanently deferred. Research has shown that PLT-associated AHTR has occurred with apheresis platelets but is very rare with whole blood–derived PLTs.

scholarly journals Acute Hemolytic Transfusion Reaction in Group B Recipient Associated with Group A Apheresis Platelet Donor: Case Report and Literature Review

2018 ◽  
Vol 2018 ◽  
pp. 1-4 ◽  
Author(s):  
Tracy R. Shachner ◽  
Christopher T. Clark
Keyword(s):  
Case Report ◽  
High Titer ◽  
Transfusion Reaction ◽  
Potential Adverse Event ◽  
Hemolytic Transfusion Reaction ◽  
Group A ◽  
Unknown Status ◽  
Group B ◽  
Apheresis Platelets ◽  
Transfusion Reactions

Acute hemolytic transfusion reaction is a known but rare potential adverse event related to platelet transfusion. Most reported cases of platelet-related hemolytic transfusion reaction have resulted from transfusion of platelets from group O donor to group A recipient. We identified only one prior case report in the literature of hemolytic transfusion reactions resulting from transfusion of apheresis platelets from group A donor to group B recipient. In that case report, two platelet units were obtained from a single donation and transfused into two separate patients. Both patients exhibited acute hemolytic reactions. The donor is reported to have high anti-B titers, as well as report of probiotic use. We report a case of acute hemolytic reaction in group B recipient following transfusion of apheresis platelets from group A donor with high-titer anti-B but unknown status of probiotic use. This case demonstrates that while low, there still exists potential risk for hemolysis from out-of-group A plasma transfusion.

Complement activating ABO IgM/IgG act synergistically to cause erythrophagocytosis: implications among minor ABO incompatible platelet transfusions

2020 ◽  
Author(s):  
Priyanka Pandey ◽  
Waseem Q. Anani ◽  
Tina Pugh ◽  
Jerome L. Gottschall ◽  
Gregory A Denomme
Keyword(s):  
Complement Activation ◽  
Complement C3 ◽  
Transfusion Reaction ◽  
Single Donor ◽  
Healthy Donors ◽  
Hemolytic Transfusion Reaction ◽  
Group A ◽  
Donor Sample ◽  
Donor Plasma

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 IgG and complement activation by anti-A on extravascular hemolysis. Samples evaluated: 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. Monocytes from healthy donors 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 phagocytosis was analyzed by flow cytometry. The plasma and sera had variable direct agglutinating (IgM) and indirect (IgG) titers. Results 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.

Severe Acute Hemolytic Transfusion Reaction Following ABO-Mismatched Platelet Transfusion: Should ABO-Mismatched Platelet Transfusion Policy Be Evaluated.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 4095-4095 ◽  
Author(s):  
Abba Zubair ◽  
Rhonda Grant ◽  
Neta Black ◽  
Marsha Bertholf ◽  
Archana Roy ◽  
...  
Keyword(s):  
Blood Group ◽  
Platelet Transfusion ◽  
Room Temperature ◽  
High Titer ◽  
Fresh Frozen Plasma ◽  
Total Serum ◽  
Transfusion Reaction ◽  
Hemolytic Transfusion Reaction ◽  
Seriously Ill Patients ◽  
Platelet Transfusions

Abstract Transfusion of ABO-mismatched platelets is common practice. Although a unit of single donor apheresis platelet (SDP) contains as much plasma and passive anti-A or/and anti-B antibodies (allo-agglutinins) as a unit of fresh frozen plasma, ABO- mismatched platelet transfusions are considered safe and hemolytic transfusion reactions have only rarely been reported. We report a case of a 67-year old male, blood group A, with mantle cell lymphoma who received 1 SDP for chemotherapy induced thrombocytopenia. Several prior platelet transfusions had been uneventful. After 150 ml of irradiated, leukoreduced, SDP from blood group O donor had been infused, he developed nausea, light-headiness, chills, and back pain. He became bradycardic and hypotensive. Platelet transfusion was discontinued and intravenous dexamethasone and rapid saline infusion was administered. Later, his hemoglobin dropped from 10.6 to 7.4 g/dl and total serum bilirubin increased by 9 fold. A direct antiglobulin test (DAT) on post-transfusion sample demonstrated 1+ reactivity at room temperature. An elution test performed on the patient’s circulating red blood cells contained anti-A antibodies. These results are consistent with a severe acute hemolytic transfusion reaction. The donor anti-A and anti-B antibodies titers at room temperature and at 37°C were 512 and 2048 with A1 cells and 128 and 256 with B cells, respectively.This case illustrates the rare possibility of hemolytic transfusion reaction occurring as a result of ABO-mismatched platelets from group O donor with high-titer anti-A antibodies. SDP (in contrast to pooled platelets) offers the advantages of reduced risk of infection transmission and alloimmunization by limiting exposure to one donor only. However, it increases the opportunity for hemolytic transfusion reaction to occur if the donor has high-titer antibodies which would have been diluted if pooled platelets were used. As SDP use becomes more widespread, the risk of clinically significant hemolytic reactions is likely to increase, especially in seriously ill patients who tolerate these reactions particularly poorly. Moreover, increasingly, apheresis platelets are being donated by a small group of highly motivated donors, raising the chances of repeated transfusions from the same donors. We propose that the safety of ABO-mismatched platelet transfusions be re-evaluated. Effectiveness (and costs) of potential preventive strategies such as screening all SDP units for high-titer antibodies and/or plasma volume reduction of all mismatched SDP units should be studied.

Acute hemolytic transfusion reaction in a pediatric patient following transfusion of apheresis platelets

2005 ◽  
Vol 20 (4) ◽  
pp. 225-229 ◽  
Author(s):  
Suneeti Sapatnekar ◽  
Girish Sharma ◽  
Katharine A. Downes ◽  
Susan Wiersma ◽  
Claire McGrath ◽  
...  
Keyword(s):  
Pediatric Patient ◽  
Transfusion Reaction ◽  
Hemolytic Transfusion Reaction ◽  
Apheresis Platelets

A CLINICO-COMPARATIVE STUDY ON THE EFFECT OF LASHUNA SIDDHA TAILPANA POORVAK VAMANA KARMA AND NITYA VIRECHANA BY GOMUTRA HARITAKI IN THE MANAGEMENT OF HYPOTHYROIDISM

2021 ◽  
Vol 12 (4) ◽  
pp. 49-55
Author(s):  
Sheetal R Tokle
Keyword(s):  
Comparative Study ◽  
Thyroid Stimulating Hormone ◽  
Normal Range ◽  
End Of Treatment ◽  
Group A ◽  
Insignificant Difference ◽  
Randomized Control ◽  
Drug Dependent ◽  
Group B ◽  
Stimulating Hormone

Hypothyroidism is a condition in which thyroid gland doesn’t produce enough thyroid hormone. This is more prevalent among women. Management through levothyroxine is safe & may bring the value of Thyroid stimulating hormone and thyroxine to normal range but the increased dosage and continuous medication are cost expensive and make the patient into drug dependent till the end of mortal life. So, better, therapy is needed for the society through the heritage of Ayurveda especially with Shodhana therapy. Aim of Clinico-comparative study was to evaluate and compare the efficacy of Lashuna siddha Tailpana Poorvak Vamana Karma and Nityavirechana by Gomutra Haritaki in the management of Hypothyroidism. Study was conducted at Govt. Akhandanada Ayurvedic hospital, Ahmedabad, Gujarat. This study was Open labelled parallel randomized control trial. 15 patients were treated with Lashuna siddha Tailpana Poorvak Vamana Karma in group A. 15 patients was treated with Nitya Virechana by Gomutra Haritaki in group B. Washout period was 14 days. Triiodothyronine and thyroxine were compared at the end of treatment by paired t-test and Mann Whitney-U test. Lashuna siddha Tailpana Poorvak Vamana Karma was more beneficial than Nitya Virechana by Gomutra Haritaki. Insignificant difference was found on subjective and objective parameters (Weight gain, Basal metabolic rate, Serum triiodothyronine) but significance difference found on objective parameters (Thyroid stimulating hormone, Serum thyroxine).

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