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Methods for Quantitative Detection of Antibody-induced Complement Activation on Red Blood Cells
Published on: January 29, 2014
Anti-i causing acute hemolysis following a negative immediate-spin crossmatch
W J Judd1, E A Steiner, L V Abruzzo
1Department of Pathology, University of Michigan Medical Center, Ann Arbor.
Transfusion
|July 1, 1992
Summary
A rare anti-i antibody caused acute hemolysis after a compatible red blood cell (RBC) transfusion. This immune-mediated reaction occurred despite initial negative antibody screening tests, highlighting a unique transfusion complication.
Area of Science:
- Transfusion Medicine
- Immunology
- Hematology
Background:
- Acute hemolytic transfusion reactions (AHTRs) are serious complications.
- Compatibility testing aims to prevent AHTRs by detecting antibodies against red blood cell (RBC) antigens.
- Standard pretransfusion testing includes immediate-spin (IS) crossmatch and antibody screening.
Observation:
- A patient experienced acute hemolysis despite receiving RBCs compatible by immediate-spin (IS) crossmatch.
- Antibody screening using low-ionic-strength saline (LISS) and anti-IgG was initially nonreactive.
- Further testing revealed an anti-i antibody in the patient's serum, causing incompatibility by indirect antiglobulin technique (IAT).
Findings:
- The patient's anti-i antibody reacted strongly with certain RBCs but not with their own or dominant Lu(a-b-) RBCs.
- The patient's i antigen expression was likely altered by disease or chemotherapy, lacking specific epitopes targeted by the anti-i antibody.
- In vivo studies confirmed the clinical significance of the anti-i antibody in causing hemolysis.
Implications:
- This case represents a unique cause of AHTR due to an anti-i antibody against altered self-antigens.
- It highlights a scenario of immune-mediated hemolysis following IS crossmatch-compatible blood transfusion when initial antibody screens are negative.
- Given the rarity, modifications to current pretransfusion protocols are not proposed, but awareness of such unique cases is crucial.
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