Related Experiment Videos
RBC T activation and hemolysis in a neonatal intensive care population: implications for transfusion practice
Harischandra Boralessa1, Neena Modi, Hazel Cockburn
1National Blood Service, Brentwood Center, Essex, United Kingdom. hari.boralessa@nbs.nhs.uk
Insights
T variant activation of red blood cells (RBCs) occurs in neonates, but transfusion-associated hemolysis was not observed. Specially prepared blood components for infants with necrotizing enterocolitis (NEC) are not necessary.
Area of Science:
- Neonatal Medicine
- Hematology
- Transfusion Medicine
Background:
- Reports of transfusion-associated hemolysis in infants with T-activated RBCs suggest screening and low-titer anti-T blood components.
- T-activated RBCs react with specific lectins; variants (Th, Tx, Tk) also react with some lectins but not others.
- T variants are defined as RBCs reactive with Arachis hypogea but not Glycine soja.
Purpose of the Study:
- To investigate T and T variant activation in neonatal intensive care populations.
- To determine the incidence of transfusion-associated hemolysis in infants with T-activated RBCs.
- To detect antibodies to T and T variant in donor plasma.
Main Methods:
- Prospective study analyzing 2041 samples from 375 infants for T and T variant activation using a lectin panel.
- Testing of 300 donor plasma samples for antibodies against T and T variant.
- Correlation of RBC activation with clinical outcomes like sepsis and necrotizing enterocolitis (NEC).
Main Results:
- 12.8% of infants showed T or T variant-activated RBCs; 27% of these had sepsis and 19% had NEC.
- T activation was not consistently linked to the onset of NEC or sepsis.
- No transfusion-associated hemolysis was observed in infants receiving standard blood components, even with T-activated RBCs. Donor plasma contained T antibodies, but not T variant antibodies.
Conclusions:
- T variant activation of RBCs is present in healthy neonates and those with NEC or sepsis.
- T activation appears to be rare.
- The use of specially prepared blood components for infants with NEC is not indicated due to the absence of transfusion-associated hemolysis.
Background:
Reports of transfusion-associated hemolysis in infants with T-activated RBCs have led to the suggestion that infants should be screened and provided with low-titer anti-T blood components. T-activated RBCs react with the lectins Arachis hypogea and Glycine soja; variants of T (Th and Tx) and Tk also react with A. hypogea, but not G. soja. Although Tk is not a true variant of T, for the purposes of this study, all RBCs that are reactive with A. hypogea but are not reactive with G. soja are called "T variants."
Study Design And Methods:
A prospective study was carried out to examine T and T variant activation and transfusion-associated hemolysis in a neonatal intensive care population and to determine if antibodies to T and T variant are detectable in donor plasma. A total of 2041 samples from 375 infants were tested for T and T variant activation utilizing a lectin panel. Three hundred donor plasma samples were tested for antibodies to T and T variant.
Results:
Forty-eight of 375 infants (12.8%) had T- and T-variant-activated RBCs. Of these, 13 of 48 (27%) developed at least one episode of sepsis and 9 of 48 (19%) developed necrotizing enterocolitis (NEC) at some point during their inpatient stay. T activation was not always temporally associated with the onset of NEC or sepsis. The remaining 26 of 48 (54%) were healthy infants receiving convalescent care in the neonatal intensive care units and showed no evidence of either NEC or sepsis. Twelve (of 375) additional infants (3.2%) who developed NEC and 100 (27%) who developed sepsis showed no RBC T activation. Twenty-three of 48 (48%) infants with T-activated RBCs received standard blood components, but no transfusion-associated hemolysis occurred. Donor plasma samples contained T but not T variant antibodies.
Conclusion:
T variant activation of RBCs occurs in healthy neonates as well as in infants with NEC and sepsis, but T activation appears rare. Transfusion- associated hemolysis was not seen. The provision of specially prepared blood components for infants with NEC is unnecessary.