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In Vitro and In Vivo Assessment of T, B and Myeloid Cells Suppressive Activity and Humoral Responses from Transplant Recipients
Published on: August 12, 2017
Case report: immune anti-D stimulated by transfusion of fresh frozen plasma
M Connolly1, W N Erber, D E Grey
1Transfusion Medicine Unit, The Western Australian Centre for Pathology and Medical Research, PathCentre, QEII Medical Centre, Western Australia 6009.
Abstract:
FFP has occasionally been reported to generate an immune response to RBC antigens (e.g., anti-D and anti-Fya). The Council of Europe requires that each unit of FFP have less than 6 x 10(9)/L RBCs. However, there is considerable variation internationally in the method of production and the level and assessment of RBC contamination of FFP. This study reports the case of a 63-year-old group B, D- man who received multiple transfusions of D- blood products over a 4-month period. Seven months later the patient's antibody screen remained negative and he was transfused with seven units of D- RBCs and six units of FFP, four of which were D+. Two months later anti-D, -E, and -K were detected in his plasma. Although the anti-E and anti-K could have resulted from transfusion of antigen-positive RBCs, the anti-D could have resulted only from transfusion of the D+ FFP. The D status of FFP is currently not considered when selecting products for transfusion even though the D antigen is highly immunogenic and the level of RBC contamination of FFP is not always known. This case highlights that transfusion of FFP is a stimulus for RBC antibodies and that when a patient has had a recent transfusion of FFP, consideration should be given to obtaining a sample for pretransfusion testing within 3 days before a scheduled RBC transfusion. In addition, the D status of FFP should be considered before administering FFP to premenopausal D- women.
Insights
Fresh frozen plasma (FFP) transfusions can trigger immune responses to red blood cell (RBC) antigens, even when RBC contamination is low. This case highlights the risk of developing anti-D antibodies from D+ FFP, emphasizing the need to consider FFP
Area of Science:
- Transfusion Medicine
- Immunology
- Hematology
Background:
- Fresh frozen plasma (FFP) transfusions are essential but can elicit immune responses against red blood cell (RBC) antigens.
- International standards limit RBC contamination in FFP, but production methods and contamination levels vary.
- The D antigen on RBCs is highly immunogenic, yet the D status of FFP is often not considered during product selection.
Observation:
- A 63-year-old D- male received multiple D- blood products, followed by D- RBCs and D+ FFP.
- Post-transfusion, the patient developed anti-D, anti-E, and anti-K antibodies.
- The anti-D antibodies were definitively linked to the transfusion of D+ FFP, as the patient was D- and received D- RBCs.
Findings:
- Transfusion of FFP, even with low levels of RBC contamination, can act as a potent stimulus for RBC antibody production.
- The D status of FFP is a critical, yet often overlooked, factor in preventing alloimmunization.
- This case demonstrates that anti-D can develop solely from transfusion of D+ FFP in a D- recipient.
Implications:
- Consideration of FFP's D antigen status is crucial before transfusion, particularly for D- individuals.
- Pretransfusion testing for RBC antibodies may need to be timed within 3 days of recent FFP transfusion.
- This highlights the need for standardized assessment and potential D-typing of FFP to mitigate transfusion-related immune responses.
