Characterization of the humoral immune response in two paediatric patients transplanted with split livers from ABO-incompatible living-related donors: appearance of cytomegalovirus-induced ABO antibodies

Two blood group O paediatric patients, 12 and 6 months old, were transplanted with liver segments from their blood group A2Le (a(-)b+) Se and blood group A1Le (a(-)b+) Se fathers, respectively. Recipient anti-A antibody titres were reduced prior to transplantation by blood exchange. Both patients had rejection episodes in the post-transplant period that were reversed by anti-rejection therapy. No anti-A antibody titre rise occurred concomitant with these rejections. Postoperatively both patients had cytomegalovirus (CMV) infections, and simultaneous with these infections, a strong increase in anti-A antibody titres was seen, but no rejection occurred. The anti-A antibody titre increase seemed to be specific for A antigens, because the anti-B and anti-alphaGal (anti-pig) antibody titres did not show any changes. CMV infection is a serious cause of morbidity and mortality in immunosuppressed patients, and the virus can influence glycosylation of infected cells. Whether this can explain the importance of the infection in relation to the increase in titre remains to be elucidated.     

Reduction of anti-A and anti-B isoagglutinin titers of group O whole blood units employing an ABO antibody immune adsorption column

BackgroundMassive hemorrhage is a leading cause of death from trauma. There is growing interest in group O whole blood transfusions to mitigate coagulopathy and hemorrhagic shock. Insufficient availability of low-titer group O whole blood is a barrier to routine use. We tested the efficacy of the Glycosorb® ABO immunoadsorption column to reduce anti-A/B titers in group O whole blood.MethodsSix group O whole blood units were collected from healthy volunteers, and centrifuged to separate platelet poor plasma. Platelet-poor plasma was filtered through a Glycosorb® ABO antibody immunoabsorption column, then reconstituted to prepare post-filtration whole blood. Anti-A/B titers, CBC, free hemoglobin, and thromboelastography (TEG) assays were performed on pre-and post-filtration whole blood.ResultsMean( ± SEM) anti-A (224 ± 65 pre vs 13 ± 4 post) and anti-B (138 ± 38 pre vs 11 ± 4 post) titers were significantly reduced (p = 0.004) in post-filtration whole blood. No significant changes were detected in CBC, free hemoglobin, and TEG parameters on day 0. Free hemoglobin increased throughout storage (48 mg/dl ± 24 Day 0 vs 73 ± 35 Day 7 vs 96 ± 44 Day 14; p = 0.14).ConclusionsThe Glycosorb® ABO column can significantly reduce anti-A/B isoagglutinin titers of group O whole blood units. Glycosorb® ABO could be employed to provide whole blood with lower risk of hemolysis and other consequences of infusing ABO incompatible plasma. Preparation of group O whole blood with substantially reduced anti-A/B would also increase the supply of low-titer group O whole blood for transfusion.     

The case for standardization of transfusion medicine practices in French blood banks

Despite a decrease in collection and transfusion of blood components and technical and quality assurance improvements, adverse effects of transfusion, particularly fatalities due to ABO incompatibility, remain high. In order to evaluate the immunohaematology and blood products recipient practices in French blood banks, we have mailed a questionnaire and analysed the answers. Our study shows a great variation in practices. Most blood banks (70.6%) perform a second ABO blood grouping test for patients before they consider it as valid and keep it in their laboratory's computer system. The use of faxed requisition forms for blood products (84.0%) or immunological data (89.4%) are commonly accepted by French blood banks before preparation of orders for blood components. Nevertheless, at the time of blood product delivery, 40.4% of them required the original order documents. Completion of the transfusion follow-up form for blood components is undertaken free of charge by blood banks. When immunohaematology data of a patient are in the blood banks computer system and if a hospital department wants patient's ABO rhesus (RHI) blood group card, a duplicate of this card is frequently edited. Lastly, a committee is needed to establish, as in United Kingdom, guidelines in blood products recipients practices in French blood banks. Standard operating procedures regarding organization, documentation, techniques, etc., at the blood banks and the hospital will be written and valided for each step of the process prior to blood transfusion of a patient.     

Detection of anti-B antibodies in a patient with A1B blood group: A case report and literature review

ABO antibodies occur naturally and usually exist as alloantibodies. They are the most clinically significant in cases of transfusions. However, there are very few reports on auto-anti-A or B. A 58-year-old man visited our hospital for evaluation of an inguinal mass. Blood typing was performed, while preparing the patient for an excisional biopsy. Forward and reverse typing showed a typical AB and A pattern. Results of the direct antiglobulin and unexpected antibody screening tests were negative. The serum did not react with AB3 cells. The biopsy revealed a diffuse large B-cell lymphoma. After completing four cycles of R-CHOP chemotherapy, the patient achieved complete remission. There were no anti-B antibodies found on repeat ABO typing. This report shares our experience on unexpected anti-B antibody findings in a patient with an A1B blood type. To the best of our knowledge, this is the first report of anti-B antibodies in a patient with an A1B blood type in Korea.     

Whole blood versus red cells and plasma for exchange transfusion in ABO haemolytic disease

Records of 381 neonates who underwent exchange transfusion (ET) due to ABO haemolytic disease at the Division of Neonatology of Hacettepe University, Ankara, Turkey, between January 1977 and December 2003 were reviewed. Records were kept for the type of blood used in ET, the number of ETs for each infant, adverse event attributable to ET and bilirubin levels before, and 4 and 8 h after each ET. Of 381 infants, 300 were transfused with whole blood, whereas 81 infants were transfused with O red cells suspended in A or B plasma. The re-exchange rate was higher in the whole blood group, compared with the erythrocyte and plasma group. Use of erythrocyte and plasma provided 30% reduction in the number of ETs per patient. Eight hours after the first ET, mean bilirubin levels were 84% of the pre-exchange values in the whole blood group and 73% of the pre-exchange values in the erythrocyte and plasma group (P = 0.001). As the use of O group red cells re-suspended in AB plasma decreased the re-exchange risk compared with O group whole blood, we suggest the use of O red cells re-suspended in AB plasma for the ET in cases of ABO haemolytic disease.     

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

The practice of transfusing ABO-incompatible platelets, driven primarily by concerns about inventory management, has been considered generally safe because the accompanying plasma is usually diluted in the recipient's total blood volume. However, if the platelet product contains a large volume of plasma or a high concentration of incompatible isoagglutinin, there may be hemolysis of the recipient's red cells. Patients with a small blood volume, such as babies and children, are considered to be at particular risk for such a complication. We describe the case of a baby who suffered massive hemolysis of her group A red cells after transfusion of group O Apheresis Platelets containing a high-titered anti-A isoagglutinin. We also offer a review of the literature on this subject and recommendations to avoid acute hemolytic reactions as a result of platelet transfusion.     

Plasma exchange and plasma modification for the removal of anti-red cell antibodies prior to ABO-incompatible marrow transplant

Plasma exchange (PE) is performed only rarely to remove a specific, well defined antibody. ABO incompatibility in marrow transplantation has allowed us a unique opportunity to compare the effectiveness of three apheresis procedures for removing anti-red cell antibodies. We performed 140 marrow transplants in which a major ABO incompatibility between donor and recipient existed. To avoid a hemolytic transfusion reaction at the time of marrow infusion PE, plasma immunoadsorption (PIA) or whole-blood immunoadsorption (WBIA) was performed a total of 243 times. PE removed a mean of 87% of intravascular IgM and 86% of intravascular IgG directed against red cell antigens. PIA removed 75% and 73% of IgM and IgG, respectively (P less than .001 when compared to PE). Results for WBIA were 66% and 65%, respectively. Thus, PIA and WBIA were less efficient at removing antibody than PE. Furthermore, there were a few specific instances in which PIA or WBIA removed little or no antibody owing to differences in antibody specificity. PIA and WBIA resulted in less platelet consumption than PE. Although somewhat less effective that PE, PIA and WBIA have other advantages that can make them more desirable.     

National audit of the blood transfusion process in the UK

The objectives of this initiative were to produce nationally tested audit tools, to influence the content of national guidelines, and to enable performance indicators to be set for the clinical transfusion process. Audit tools were developed for blood transfusion practice through a collaboration between Royal Colleges and specialist Societies with an interest in blood transfusion. National audits were carried out involving 50 hospitals in the first audit and 23 of the same hospitals in the second. Over 20% of participating hospitals did not have Hospital Transfusion Committees. Most hospitals had written policies for the taking of blood samples for grouping and compatibility testing. Formal training for the phlebotomists and nurses who took blood samples was almost universal, but only one-third gave training to doctors. The audits of transfusion practice demonstrated considerable variation in the performance of standard procedures in relation to the administration of blood, and little change in practice between the two audits. The first two objectives have been met in that audit tools were developed and published, and information from the first audits was used in the development of national guidelines for the administration of blood. A significant shortfall in the systems for monitoring and delivering transfusions is present in many hospitals. This justifies pursuing the third objective but this will require a new initiative. The type of analysis and the method used for the presentation of audit data developed in this study may be useful for setting performance indicators for the clinical transfusion process.     

广西三级医院临床用血有关问题的调查研究

目的了解广西三级医院临床输血现状,研究今后监管的方向。方法严格按照国家颁布的相关法律法规、技术操作规程与规范,对42家广西三级医院的临床安全用血进行调查。结果合格率为92．86％。结论并非所有三级医院都能认真按《临床输血技术规范》开展工作,距卫生部相关要求仍有距离。     

南宁地区疑难输血患者红细胞不规则抗体的分析

目的对南宁地区疑难输血患者中红细胞不规则抗体检出情况进行分析,以了解本地区患者红细胞不规则抗体的发生情况。方法对2008—2018年间南宁市各医院送检的疑难配血案例标本1 463例,应用盐水法、凝聚胺法、抗球蛋白法、微柱凝集法、酶法、吸收放散法检测红细胞不规则抗体。结果共鉴定确认红细胞不规则抗体335例,发生率为22.90%(335/1463)。主要涉及6个血型系统:Rh系统55.52%(186/335),Kidd系统2.69%(9/335),MNS系统18.21%(61/335),Lewis系统4.48%(15/335),P系统5.07%(17/335),Rh合并Lewis系统0.30%(1/335),Rh合并P系统0.60%(2/335),Rh合并MNS系统5.97%(20/335),Rh合并Kidd系统5.67%(19/335),Rh、MNS合并Kidd系统1.19%(4/335),Rh、Kidd合并Duffy系统0.30%(1/335)。结论从南宁地区疑难输血患者红细胞不规则抗体检出情况分布看,以Rh和MNS血型系统为主,以Rh合并MNS血型系统的不规则抗体比率最高,尤其是Rh...     

Safe blood transfusion practices in blood banks of Karachi, Pakistan

Background: Since 1997, legislations pertaining to safe blood transfusion (SBT) have evolved considerably in Pakistan. The objective of this study was to evaluate the SBT practices in the blood banks of Pakistan. Methods: Twenty‐three blood banks were randomly selected from a list of registered 40 in Karachi, the largest city in Pakistan. To evaluate the SBT practices in the selected blood banks, a questionnaire and a checklist were administered during 2007–2008. Results: Of the 23 blood banks surveyed, 4 (17%) were affiliated with government or a semi‐government institution; 16 (70%) blood banks had a healthy donor recruitment program and 2 (9%) of the blood banks agreed that they recruited remunerated (paid) blood donors. Donors were screened for HIV, Hepatitis B, Hepatitis C and syphilis by all 23 blood banks, whereas malaria was screened by all blood banks but one. Conclusion: SBT practices in Karachi have improved since 1995; an active role by the government in policy‐making has proven effective.     

1例罕见AB3亚型的分子机制

目的探讨1例罕见AB3亚型的分子机制。方法对1例ABO血型正反定型不符患者的血型通过血清学鉴定、PCR-SSP、ABO基因直接测序、TA克隆单体型分析等方法分析其分子机制。结果该患者血型鉴定为比较少见的A102/B301亚型,该亚型是由于ABO基因第七外显子存在1054C/T杂合导致R352W氨基酸改变所致。结论 ABO基因存在1054CT,该突变可能是导致B301亚型的分子遗传基础之一。关健词:     

某院2007～2011年临床输血情况调查分析

目的：通过相关资料调查分析,了解临床输血情况,为提高合理用血提供参考。方法对成都市第三人民医院2007～2011年临床输血总量、成分用血情况、内科及外科用血情况等进行调查分析。结果成都市第三人民医院临床用血总量呈逐年上升趋势,成分血使用比例一直维持在99％以上;存在血浆用量偏高现象。结论虽临床成分输血比例高,但仍存在用血不合理现象,需加强相关人员培训,以期进一步提高临床输血质量。     

2012年大连市医院输血科（血库）输血相容性检测能力评价

目的：通过对大连市医院输血相容性检测的督导评价,进一步规范检测程序,提高检测水平。方法以现场检查和发放自制室间质评样本检测方式对大连市62家医院输血科（血库）输血相容性检测能力进行评价。现场检查包括设备、试剂、开展项目、操作规程和记录5个方面;室间质评项目包括ABO正、反定型,Rh（D）血型,受血者抗体筛选及交叉配血5项。结果督导评价合格医院42家,不合格20家;仅1家医院因未开展抗体筛查项目检测而判为现场检查不合格;二级医院室间质评结果不合格率最高（42．3％）;正、反定型和 Rh （D ）定型试验符合率为100．0％,抗体筛查和交叉配血试验不符合率分别为82．0％、77．4％。结论在保证相对固定人员配置同时加强培训提升检测人员鉴别分析能力是目前提高大连市医院输血科（血库）输血相容性检测能力的重要措施。     

2005年与2010年大量输血患者临床用血对比分析

目的 为制定大量输血患者合理成分输血的治疗方案提供依据.方法 回顾2005年和2010年大量输血患者各种血液成分输注情况,分析不同性别、血型、治疗结果的患者人均红细胞输用量,计算不同科室患者各血液成分搭配输注比例,比较输血后患者凝血功能变化.结果 2010年较2005年总用血量增加,主要为血浆用量增加,红细胞用量减少;女性患者、AB血型患者人均红细胞用量低于男性患者和其他血型患者,死亡患者明显高于治愈患者,两年统计结果一致;不同科室选择各种血液成分应用比例不同,2005年红细胞∶血浆比例为7.9∶1.0,患者死亡率为21.62%,比2010年(红细胞∶血浆比例为2.1∶1.0,患者死亡率为4.44%)明显增高(χ2=4.9,P<0.05);输血后患者凝血功能检测2005年凝血酶原时间(PT)、凝血酶时间(TT)、活化部分凝血时间(APTT)比2010年明显延长,纤维蛋白原(Fg)降低(P<0.05).结论 大量输血时根据病情制定合理输血方案,选择有效血液成分,可减少大量输血并发症的发生,提高抢救成功率.     

系统追踪在安全输血护理管理中的应用

目的探讨系统追踪在安全输血护理管理中的应用方法与效果。方法成立系统追踪小组,制订追踪标准,确定追踪路径及内容,运用追踪方法对输血患者进行安全输血追踪检查。根据追踪结果,确定高风险项目,制订改进措施并严格落实。结果护理人员输血相关知识考核成绩提高(P0.01);安全输血合格率、血标本采集合格率、输血前评估率、护理记录合格率、血袋返回率均提高(P0.01或P0.05)。结论系统追踪方法在安全输血护理管理中是行之有效的。