Melanie Tokessy

Hemolytic transfusion reactions after administration of intravenous immune (gamma) globulin : a case series analysis

BACKGROUND: This case series summarizes our observations of hemolytic reactions after the administration of large amounts of intravenous immune (gamma) globulin (IVIG).

Red Blood Cell Storage Lesions and Related Transfusion Issues: A Canadian Blood Services Research and Development Symposium

For centuries, man has been trying to figure out how to revive sick and traumatized individuals using fluids of various types, even from animals. In the 17th century, it was determined that blood was the best fluid to use and, in the early 1900s, after the discovery of the ABO blood groups, human blood was found to provide significant benefit for patients with shock and/or anemia. In the 1950s and 1960s, various ways to obtain, process, and store human blood were developed. It soon became apparent that storage of human blood for transfusion was problematic because red cells, as they aged in vitro, underwent a multitude of physicochemical changes that greatly affected their shelf life, the so-called storage lesion. More recently, the question has arisen as to the potential detrimental effects of the storage lesion and suggestions that older blood may induce increased morbidity and even mortality despite its acceptable in vivo survival. To address this issue of the efficacy and safety of transfusion of aged stored blood, a number of controlled clinical trials have been instituted to determine if older blood is significantly detrimental compared with fresher blood in transfusion recipients.

Is Cytomegalovirus Testing of Blood Products Still Needed for Hematopoietic Stem Cell Transplant Recipients in the Era of Universal Leukoreduction

Hematopoietic stem cell transplantation (HSCT) recipients are a high-risk, immunocompromised group of patients who receive frequent transfusions after transplantation. Transfusion of cytomegalovirus (CMV)-negative blood products has long been the standard of care to prevent transfusion-transmitted CMV in this patient population. Leukoreduction of blood products before transfusion has been shown to significantly reduce the risk of transfusion-transmitted CMV. In the era of universal leukoreduction in Canada, the need for CMV testing of blood products remains unclear. We sought to identify whether there is a difference in transfusion-transmitted CMV viremia in patients receiving only leukoreduced versus CMV-negative and leukoreduced blood products in HSCT recipients. Patients who were CMV negative and received an allogeneic HSCT from a CMV-negative donor between October 1, 1999 and June 30, 2012 were included in the analysis. Transfusion data were collected from The Ottawa Hospital Blood Bank and Canadian Blood Services. CMV viremia was defined as PCR positivity. One hundred sixty-six patients were identified who met the inclusion criteria. Of these, 89 patients received an HSCT before January 2007, during the time when patients received leukoreduced and CMV-negative blood products. Seventy-seven patients received an HSCT after this time, receiving only leukoreduced blood products. The 2 groups did not differ in terms of age, gender, diagnosis, graft type, graft source, conditioning regimen, or ABO compatibility (P > .05). CMV viremia was detected in 3 patients who received CMV-negative leukoreduced blood products (3.37%) and in 1 patient who received only leukoreduced blood products (1.30%, P = .6244). Of the patients who developed CMV viremia, 2 developed suspected CMV disease. Both of these patients were transfused with CMV-negative blood products. Secondary outcomes, including total length of stay in hospital, admission to the intensive care unit, acute and chronic graft versus host disease, and 100-day nonrelapse mortality, did not differ between the groups. In the era of universal leukoreduction of blood products, this study demonstrates that testing for CMV-negative blood products is not needed for HSCT recipients.

Impact of platelet transfusion on toxicity and mortality after hematopoietic progenitor cell transplantation

Thrombocytopenia occurs commonly after hematopoietic progenitor cell transplantation (HPCT) and is associated with potential morbidity and mortality. Few studies have examined the impact of platelet (PLT) transfusion on clinical outcomes in HPCT while optimal PLT transfusion strategies after HSCT remain uncertain.

Anti-AnWj causing acute hemolytic transfusion reactions in a patient with aplastic anemia

BACKGROUND: AnWj is a high‐prevalence red blood cell (RBC) antigen in the ISBT 901 series. Only nine reports of anti‐AnWj have been published since it was first documented in 1972; two of these cases involved transfusion reactions. We present a case of a patient with aplastic anemia who developed anti‐AnWj with clinically significant hemolysis after transfusion of AnWj‐positive RBCs.

Factors associated with the avoidance of red blood cell transfusion after hematopoietic stem cell transplantation

BACKGROUND: Red blood cell (RBC) transfusion is required frequently for most patients after hematopoietic stem cell transplantation (HSCT). RBC transfusion, however, can be associated with adverse events including transfusion reactions, acquiring transmissible disease, and delayed recovery. Factors associated with avoidance of transfusion are not well documented.

Acute extravascular hemolytic transfusion reaction due to anti-Kpa antibody missed by electronic crossmatch.

BACKGROUND Kpa antigen is a low incidence red blood cell antigen within the Kell system. Anti-Kpa alloantibody may be associated with acute and delayed hemolytic transfusion reactions. CASE STUDY We report a case of a clinically significant acute extravascular hemolytic transfusion reaction mediated by previously unrecognized (and undetected) anti-Kpa alloantibody. This reaction occurred in a patient who met all criteria for electronic crossmatch, resulting in the transfusion of an incompatible red cell unit. RESULTS Post-transfusion investigation showed the transfused red cell unit was crossmatch compatible at the immediate spin phase but was 3 + incompatible at the antiglobulin phase. No evidence of intravascular hemolysis was observed upon visual comparison of the pre- and post-transfusion peripheral blood plasma. Further testing showed the presence of anti-Kpa antibody. The clinical course of the patient included acute febrile and systemic reaction. CONCLUSION Acute extravascular hemolytic transfusion reaction may occur due to undetected anti-Kpa alloantibody. Various strategies for crossmatching are discussed in the context of antibodies to low incidence antigens.

Application of special techniques.

For the resolution of complex antibody problems, the investigation may require special techniques which are not necessarily performed in all laboratories. If the straightforward reactivity of the antibody is not obtained, these special techniques will assist with identification of the antibody specificity. Special techniques can enhance partially or weakly reactive antibodies or conversely eliminate or destroy those antibodies that are not of clinical significance.

Recurrent Pregnancy Loss in a 33-Year-Old Woman

### Patient: A 33-year-old pregnant woman of Asian-Indian descent. ### Chief Complaint: History of recurrent miscarriages (G4, P1, A2). The patient presents at 15 weeks gestation in her fourth pregnancy for antenatal care. ### History: Her first and third pregnancies ended with first trimester (less than 12 weeks gestational age) miscarriages of unknown cause. The second pregnancy was complicated by pregnancy-induced hypertension (PIH) and was successfully carried to term, with a living boy delivered by Cesarean section at 40 weeks gestation. The newborn boy was healthy, but was small (2300 gm) for gestational age. The patient had never been transfused blood products. The patient had a history of mild asthma and remote uneventful tonsillectomy. There was no significant family history. ### Physical Exam Findings: Physical examination was normal for gestational age. Initial Laboratory Findings: CBC, routine coagulation testing, type and screen, and thrombophilia workup were performed on the mother, at 15 weeks gestation (Table 1). Additional Laboratory Testing: Additional blood bank testing was performed on the mother (Tables 2, 3, and 4) and on family members (Table 5). 1. What are the patient’s most striking initial clinical laboratory findings? 2. What is the clinical significance in pregnancy of the abnormal thrombophilia test result? 3. What do the additional blood bank investigations demonstrate? 4. What is the nature of the red cell antibody? 5. What is the clinical significance of the red cell antibody for the patient? 6. What is this patient’s chance to get compatible red blood cell (RBC) units if blood transfusion is urgently required, and what are other possible alternatives if no compatible blood is accessible? 7. Does the maternal alloantibody in this case have any effect on the newborn baby and why? 1. The most striking laboratory findings include the positive RBC antibody screening test and the presence of heterozygosity for Factor V Leiden mutation. 2. The patient was shown to be …