Blood Group Incompatibility ; complications ; Erythroblastosis, Fetal ; etiology ; Humans ; Infant, Newborn ; MNSs Blood-Group System ; immunology ; Male

We report a case of two consecutive episodes of acute hemolytic transfusion reactions (HTRs) due to multiple alloantibodies in a 34-yr-old man who suffered from avascular necrosis of left femoral head. He received five units of packed red blood cells (RBCs) during surgery. Then the transfusion of packed RBCs was required nine days after the surgery because of the unexplained drop in hemoglobin level. The transfusion of the first two units resulted in fever and brown-colored urine, but he received the transfusion of another packed RBCs the next day. He experienced even more severe symptoms during the transfusion of the first unit. We performed antibody screening test, and it showed positive results. Multiple alloantibodies including anti-E, anti-c and anti-Jk(b) were detected by antibody identification study. Acute HTRs due to multiple alloantibodies were diagnosed, and the supportive cares were done for 6 days. We suggest the antibody screening test should be included in the panel of pretransfusion tests for safer transfusion, and it is particularly mandatory for the patients with multiple transfusions, pregnant women, and preoperative patients.
Adult ; Blood Group Antigens/immunology ; *Blood Group Incompatibility ; Blood Grouping and Crossmatching/methods ; Blood Transfusion/*adverse effects ; Female ; Hemolysis/*immunology ; Human ; Isoantibodies/*immunology ; Male ; Pregnancy

In the present day, pretransfusion tests include ABO and RhD grouping, antibody screening, antibody identification, and cross matching. Although error rates for these tests have decreased compared to those in the past, clerical errors still occur. When exposed to RhD positive RBCs, a RhD negative person can produce anti-D that causes a severe hemolytic disease of the fetus and the newborn in addition to hemolytic transfusion reactions. Therefore, administration of RhD positive RBCs to a RhD negative person should be avoided. We experienced a RhD negative patient who had been misidentified as positive and transfused 35 units of RhD positive RBCs eight years ago, but did not have detectable anti-D in present. The red cells of the patient showed no agglutination with the anti-D reagent and a negative result in the standard weak D test. The multiplex PCR with sequence-specific priming revealed that the patient was RhD negative.
*Blood Group Incompatibility ; Blood Transfusion ; Erythrocytes/*immunology ; Humans ; Isoantibodies/*analysis/immunology ; Male ; Middle Aged ; Polymerase Chain Reaction ; Rh-Hr Blood-Group System/*analysis/immunology

This study was purposed to investigate the effect of ABO-incompatible allogeneic hematopoietic stem cell transplantation (allo-HSCT) on erythroid lineage hematopoiesis. The changes of ABO group, IgM and IgG antibody in 16 patients received ABO-incompatible allo-HSCT were detected. The results showed that ABO-incompatible allo-HSCT were successfully engrafted in 16 patients, and there was no difference in reconstitution of platelets and neutrophils between ABO-incompatible and ABO-compatible transplantation (p > 0.05). The time of erythroid lineage reconstitution was prolonged (p < 0.05), the disappearance time of isoagglutinins against donor-type RBC in major and bidirectional ABO-incompatible recipients was correlated with the time of erythroid lineage reconstitution. It is concluded that ABO-incompatible allo-HSCT may lead to prolong recovery of erythroid lineage hematopoiesis. Before transplantation, the removal of anti-donor isoagglutinins by plasmapheresis or transfusion of donor's erythrocytes for neutralizing the isoagglutinins against donor's erythrocytes in the recipients may facilitate RBC engraftment and reduce erythrocyte transfusion.
ABO Blood-Group System ; immunology ; Adult ; Blood Group Incompatibility ; blood ; immunology ; Erythrocytes ; immunology ; Female ; Hematopoiesis ; Hematopoietic Stem Cell Transplantation ; methods ; Humans ; Male ; Transplantation, Homologous

Knull phenotype completely lacks all Kell system antigens. Anti-Ku antibody is seen in immunized persons with Knull phenotype by transfusion or pregnancy. It can cause a fatal hemolytic transfusion reaction. A 66-yr-old male patient with liver cirrhosis visited emergency center due to acute bleeding. The patient was at hypovolemic shock status: his blood pressure was 80/50 mmHg, pulse rate was 110/min and hemoglobin level was 4.4 g/dL. Because of the presence of antibody against high incidence antigen, we could not find any compatible blood for the patient. Nevertheless, 4 units of packed RBCs had to be transfused. Moderate hemolytic transfusion reaction was developed after transfusion. At endoscopic examination, blood was spurting from gastric cardiac varix. Endoscopic histoacryl injection was tried, and bleeding was successfully controlled. After bleeding stopped, he was managed for anemia using steroid and other medical therapy instead of transfusion. His hemoglobin level was improved to 7.7 g/dL at the time of discharge. Later he has been proved to have a Knull phenotype, which is very rare, and anti-Ku antibody. This report is the first case of anti-Ku in a Knull phenotype person in Korea, who experienced a moderate hemolytic transfusion reaction.
Aged ; Antigens, Nuclear/*immunology ; Blood Group Incompatibility ; Blood Transfusion/*adverse effects ; DNA-Binding Proteins/*immunology ; Humans ; Isoantibodies/blood ; Kell Blood-Group System/*genetics ; Korea ; Male ; Phenotype

OBJECTIVETo study the clinical effect and feasibility of blood type A donor liver transplantation in blood type O recipients.

METHODSThe clinical data were analyzed in 6 blood type O patients receiving transplantation of the liver grafts from blood type A donors. The clinical effect and outcomes of the transplantations were evaluated to assess the feasibility of ABO incompatible liver transplantation between type A donors and type O recipients.

RESULTSThe operations and the postoperative recovery were smooth in all the 6 recipients. Only one patient died 5 months postoperatively due to liver tumor metastasis, and the other 5 patients survived with the longest survival reaching 14 months. Acute graft rejection occurred in one patient 1 week after the operation on account of abnormally elevated serum bilirubin level, which was successfully managed with immediate methylprednisolone therapy. No such complications as acute graft rejection, bile duct stenosis or bile leakage was found in the other patients.

CONCLUSIONBlood type A donor liver transplantation in type O recipient is feasible in emergency or other special conditions.

ABO Blood-Group System ; immunology ; Adult ; Blood Group Incompatibility ; immunology ; Female ; Graft Survival ; Humans ; Liver Transplantation ; immunology ; Male ; Middle Aged ; Retrospective Studies ; Tissue Donors

To investigate the relations between morbidity of hemolytic diseases of newborn and ABO antibodies (HDN) in sera of Han and Yao nationality, pregnant women were examined before and after delivery. Antibodies screen, direct antiglobulin test, free antibodies and elution test were all performed. The results indicated that immunologic ABO antibodies of Han people were found in 673 cases out of 1,471 Han pregnant women, and was also found in 28 cases out of 65 Yao pregnant women, and there was no significant difference of incidences between Han and Yao nationality. 31 cases of HDN were found out of 288 newborn in Han and 3 cases of HDN were found out of 25 newborn in Yao, and there was no significant difference between Han and Yao nationalities. The characteristics of HDN in Han nationality were as same as in Yao nationality. In conclusion, the morbidity of HDN in Han and Yao nationalities of Shaoguan area did not showed essential difference, the immunologic ABO antibodies and its titration test, especially, elution test are important for prognosis of HDN.
ABO Blood-Group System ; immunology ; Adult ; Blood Group Incompatibility ; blood ; congenital ; China ; Erythroblastosis, Fetal ; blood ; pathology ; Female ; Humans ; Immunoglobulin G ; blood ; Infant, Newborn ; Male ; Pregnancy ; Prognosis

To evaluate the dynamic changes of erythropoietin (EPO) and its significance following ABO-incompatible allogeneic hematopoietic stem cell transplantation (allo-HSCT), sequential changes in serum EPO levels were measured by enzyme linked immunosorbent assay (ELISA) in 11 patients receiving allo-HSCT from ABO-incompatible donors. The results showed that the mean EPO level was markedly elevated and reached to its highest level at 0 day-2 week after allo-HSCT (233.73 +/- 81.95 mU/ml and 226.07 +/- 113.87 mU/ml respectively, P >0.05). Although the EPO levels were significantly lower at 1 month (128.49 +/- 108.92 mU/ml, P <0.05) and after the reversion of blood type (73.07 +/- 68.85 mU/ml, P <0.05), they were still elevated up to 2 months after allo-HSCT. The EPO levels always had significant positive correlation with the RBC transfusions. At 0 day and 4 week after allo-HSCT, the EPO levels had significant negative correlation with the Hb levels; at 6 and 8 week after allo-HSCT, the EPO levels had no relation with the Hb levels, they had significant positive correlation with the time of erythrocyte recovery and anti-A isoagglutinin titers at the same time. It is concluded that serum erythropoietin levels continuously increasing following ABO-incompatible allogeneic allo-HSCT suggest that exogenous recombinant human erythropoietin treatment for anemia may not be beneficial.
ABO Blood-Group System ; immunology ; Adolescent ; Adult ; Blood Group Incompatibility ; blood ; Erythropoietin ; blood ; Female ; Hematopoietic Stem Cell Transplantation ; Humans ; Male ; Transplantation, Homologous

Jr(a) is a high-frequency antigen found in all ethnic groups. However, the clinical significance of the anti-Jr(a) antibody has remained controversial. Most studies have reported mild hemolytic disease of the newborn and fetus (HDNF) in Jr(a)-positive patients. Recently, fatal cases of HDNF have also been reported. We report the first case of HDNF caused by anti-Jr(a) alloimmunization in twins in Korea. A 33-yr-old nulliparous woman with no history of transfusion or amniocentesis was admitted at the 32nd week of gestation because of vaginal bleeding caused by placenta previa. Anti-Jr(a) antibodies were detected in a routine laboratory examination. An emergency cesarean section was performed at the 34th week of gestation, and 2 premature infant twins were delivered. Laboratory examination showed positive direct antiglobulin test and Jr(a+) phenotype in the red blood cells and the presence of anti-Jr(a) antibodies in the serum in both neonates. The infants underwent phototherapy for neonatal jaundice; this was followed by conservative management. They showed no further complications and were discharged on the 19th postpartum day. Preparative management to ensure the availability of Jr(a-) blood, via autologous donation, and close fetal monitoring must be performed even in cases of first pregnancy in Jr(a-) women.
Adult ; Blood Group Antigens/immunology ; *Blood Group Incompatibility ; Diseases in Twins/diagnosis/*immunology ; Erythroblastosis, Fetal/*diagnosis/immunology ; Female ; Gestational Age ; Humans ; Infant, Newborn ; Isoantigens/immunology ; Jaundice, Neonatal/complications/immunology/therapy ; Male ; Phenotype ; Phototherapy ; Pregnancy ; Pregnancy Complications, Hematologic/diagnosis/*immunology ; Twins

BACKGROUND: In the past, ABO incompatibility was an absolute contraindication for solid organ transplantation. However, multiple recent trials have suggested strategies for overcoming the reactions between graft antigens and recipient antibodies that cause graft rejection. In this study, we determined the usefulness of plasma exchange (PE) for removing anti-A/B antibodies that cause hyperacute/acute humoral graft rejection in patients undergoing ABO-incompatible kidney transplantation. METHODS: In our study, 12 patients underwent ABO-incompatible kidney transplantation. All recipients received pre-transplantation conditioning by PE or intravenous immunoglobulin (IVIG) administration. After pre-transplantation conditioning, anti-A/B antibody titers were evaluated, and transplantation was performed when the titer was below 1:8. To assess the transplantation outcome, anti-A/B antibody titers, creatinine level, estimated glomerular filtration rate (eGFR), and proteinuria levels were measured. RESULTS: Anti-A/B antibody titers were below 1:8 in all patients at the time of transplantation. eGFR measured on post-transplant day 14 showed that 10 patients had immediate recovery of graft function, while 2 patients had slow recovery of graft function. Short-term outcomes of ABO-incompatible kidney transplantation (measured as creatinine levels) after reducing anti-A/B antibody titers were similar to those of ABO-compatible kidney transplantation. After transplantation, the anti-A/B antibody titers were below 1:8 in 7 patients, but the remaining 5 patients required post-transplantation PE and IVIG treatment to prevent antigen-antibody reactions. CONCLUSIONS: With the increasing demand for kidney donations, interest in overcoming the ABO incompatibility barrier has increased. PE may be an important breakthrough in increasing the availability of kidneys for transplantation.
ABO Blood-Group System/*immunology ; Adult ; *Blood Group Incompatibility/immunology ; Creatinine/blood ; Female ; Glomerular Filtration Rate ; Graft Rejection/therapy ; Humans ; Immunoglobulins, Intravenous/therapeutic use ; Isoantibodies/immunology/physiology ; Kidney Transplantation/*immunology ; Male ; Middle Aged ; *Plasma Exchange ; Proteinuria ; Transplantation Conditioning ; Transplantation Immunology