Dave Krugh

Management of pregnancies complicated by anti-E alloimmunization.

OBJECTIVE: To review cases of anti-c isoimmunization and determine the most appropriate management strategies. METHODS: We performed a review of 102 pregnancies managed at The Ohio State University from 1967 to 2001 for anti-c isoimmunization. Of these, 55 had complete data and are included in this report. Information collected included serum titers, ΔOD450 values, Liley zones, fetal and neonatal hemoglobin levels and antigen typing, neonatal direct antiglobulin test, and neonatal outcomes. The appropriateness of traditional management was then evaluated. RESULTS: Of the 55 pregnancies, 46 had fetuses with positive direct antiglobulin test, and nine pregnancies had unaffected fetuses. Of the affected neonates, 12 (26%) had serious hemolytic disease of the newborn. Of these 12, 8 required fetal transfusion, and the remaining 4 newborns had hemoglobin levels of less than 10 g/dL at the time of delivery. A titer of 1:32 or greater or the presence of hydrops fetalis identified all such fetuses. There were 58 amniocenteses performed for ΔOD450. When plotted on modified Liley graphs, ΔOD450 values corresponded to disease severity. There were no perinatal deaths attributable to anti-c hemolytic disease of the newborn. CONCLUSION: Anti-c isoimmunization might cause significant fetal and newborn hemolytic disease. A titer of 1:32 or greater or evidence of hydrops fetalis identified all the serious hemolytic disease at our institution. The significance of antibody titers and ΔOD450 values was similar to Rh-D sensitized pregnancies, and management by the same modalities is appropriate. LEVEL OF EVIDENCE: II-3

Severe Hemolysis Due to Passenger Lymphocyte Syndrome After Hematopoietic Stem Cell Transplantation From an HLA-Matched Related Donor

A 61-year-old white man (group A, Rh-positive) was allotransplanted for acute myelogenous leukemia from his HLA-matched related sister (group O, Rh-positive) in 2 separate infusions. Three days after the second graft infusion, the patients front blood type converted to O Rh-positive, with a negative direct antiglobulin test and elevated anti-A1 titer. Severe hemolysis developed, and the patient expired 14 days posttransplantation.

Is It Really Anti-D and Anti-C or Is It Anti-G?

© case study [transfusion medicine | immunology | hematology] Is It Really Anti-D and Anti-C or Is It Anti-G? Nada Rikabi, MD,1 Lisa Dunn-Albanasse, MD,2 Dave Krugh, MT(ASCP)SBB,1 Diane Snider, MT(ASCP),1 Kristi Frenken, RN,2 Karen Rossi, RN,2 Richard O’Shaughnessy, MD,2 Melanie S. Kennedy, MD1 Departments of 1Pathology and 2Obstetrics & Gynecology, MaternalFetal Medicine, The Ohio State University, Columbus, OH

Thrombocytopenia in a Neonate

case study [transfusion medicine | hematology | immunology] Thrombocytopenia in a Neonate Maria A. B. Reed, MD,1 Nada Rikabi, MD,1 Dave Krugh, MT(ASCP)SBB, CLS(NCA),1 Sandra Dietrich, MT(ASCP),1 Karen Rossi, RN,2 Eric Knudtson, MD,2 Richard O’ Shaughnessy, MD,2 Melanie S. Kennedy, MD1 Departments of 1Transfusion Medicine and 2Obstetrics & Gynecology, Maternal-Fetal Medicine, The Ohio State University, Columbus, OH

Muscle Weakness and Fatigue in a Woman With Recurrent Upper Respiratory and Urinary Tract Infections

History of Present Illness The patient had been admitted to an outlying facility for complications stemming from an upper respiratory infection (URI) beginning 3 weeks previously, for which a course of oral antibiotics was prescribed. In addition, the patient complained of symptoms attributable to a previously diagnosed urinary tract infection (UTI), which had since recurred. Multiple therapeutic modalities, including administration of steroids, intravenous immunoglobulin (IVIG), cyclophosphamide (Cytoxan), and plasmapheresis were implemented; however, her anemia and respiratory status worsened and progressed to multisystem organ failure.