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Transfusion of infants with activation of erythrocyte T antigen
R A Williams1, E F Brown, D Hurst
1Department of Pathology, Children's Hospital, Oakland, CA 94609.
Insights
A new transfusion protocol safely manages infants with erythrocyte T-antigen activation, a condition linked to sepsis. This approach minimizes hemolysis risk by using specific blood products and donor selection.
Area of Science:
- Neonatal intensive care
- Transfusion medicine
- Pediatric hematology
Background:
- Erythrocyte T-antigen activation, often due to bacterial enzymes in infants with sepsis or necrotizing enterocolitis, poses a risk of intravascular hemolysis during transfusions.
- Transfusion of plasma-containing blood products to these infants can precipitate severe hemolytic reactions.
Purpose of the Study:
- To evaluate the safety and effectiveness of a specialized transfusion protocol for infants experiencing erythrocyte T-antigen activation.
- To minimize the risk of hemolysis in critically ill infants requiring blood product transfusions.
Main Methods:
- A prospective, 3-year study of 1672 intensive care infants.
- Implementation of a protocol involving T-antigen activation testing.
- Restriction of plasma-containing products, favoring washed erythrocytes or platelets, and using low-titer anti-T plasma when necessary.
Main Results:
- Ten patients (0.6%) exhibited T-antigen activation, four with confirmed clostridial infections.
- One severe hemolysis case occurred in a patient receiving plasma before T-antigen activation was recognized.
- Among patients receiving low-titer anti-T plasma, three had mild hemolysis and two had none. Four patients receiving no plasma products experienced no hemolysis.
Conclusions:
- The developed transfusion protocol is safe and effective for managing infants with T-antigen activation.
- Cautious application of this protocol enables comprehensive transfusion therapy, mitigating hemolysis risks in vulnerable infants.
Abstract:
A protocol for transfusion of infants with erythrocyte T-antigen activation was evaluated for safety and effectiveness in a prospective, 3-year, sequential series of 1672 infants admitted for intensive care. Erythrocyte T antigens are activated by enzymes produced by clostridia or other bacteria in infants with sepsis, often in association with necrotizing enterocolitis. Transfusion of these infants with blood products containing plasma carries the risk of causing intravascular hemolysis. Our transfusion protocol included testing for T-antigen activation, restricting transfusion of patients with activated T antigens to washed erythrocytes or washed platelets whenever possible, and selecting donors with low-titer anti-T when plasma-containing blood products were required. In this series, 10 patients had T-antigen activation, including four with clostridial infections. Severe hemolysis occurred in one patient who received plasma before T-antigen activation developed. Of five patients who received low-titer anti-T plasma, mild hemolysis occurred in three and no hemolysis in two. Four patients who received no plasma-containing blood products experienced no hemolysis. Used cautiously, this protocol allows a full range of transfusion therapy to infants with T-antigen activation.