Blood Transfusion Research Today is a free monthly online journal that collates and summarizes the latest research about Blood Transfusion, including details on blood donation, blood types, leukemia. | ||||||||
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Nonfatal intravascular hemolysis in a pediatric patient after transfusion of a platelet unit with high-titer anti-A.Harris SB, Josephson CD, Kost CB, Hillyer CD Transfusion Medicine Program, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, 1364 Clifton Road NE, Atlanta, GA 30322, USA. BACKGROUND: In the pediatric population, hemolysis after out-of-group platelet (PLT) transfusion is a potentially fatal event that is thought to be underrecognized. Group A patients transfused with group O single-donor PLTs (SDPs) with "high-titer" anti-A are at greatest risk for hemolysis. STUDY DESIGN AND METHODS: A clinical and serologic evaluation of a pediatric patient with hemolysis of initially unknown etiology was conducted. Retrospective testing for anti-A titer of an admission sample and a transfused group O SDP was performed. RESULTS: The group A patient (previously group O) was found to have a history of engrafted major ABO-mismatched hematopoietic peripheral blood progenitor cell transplant (HPBPCT). Immune-mediated intravascular hemolysis with a delayed presentation was determined. Testing identified passive anti-A in the patient's plasma and high-titer anti-A (IgG 4096, IgM 256) in the group O SDP unit. CONCLUSION: Hemolysis after out-of-group SDP transfusion may be delayed in presentation and, thus, clinically unrecognized. When evaluating these cases, the limitations of routine type and screen for detection of passive anti-A must be considered. Group A individuals with a history of engrafted major ABO-mismatched HPBPCT potentially have increased susceptibility to hemolysis from group O SDP transfusion due to their lack of tissue and soluble A antigen. Published 27 July 2007 in Transfusion, 47(8): 1412-7.
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