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Bacterial-induced RBC alterations complicating necrotizing enterocolitis
Insights
Bacterial enzymes can alter red blood cells (RBCs), making them vulnerable to antibodies. This was observed in infants with necrotizing enterocolitis, highlighting a risk associated with plasma transfusions.
Area of Science:
- Microbiology
- Immunology
- Neonatal Medicine
Background:
- Bacterial enzymes can modify red blood cell (RBC) surfaces.
- Altered RBCs become susceptible to antibody-mediated destruction.
- Necrotizing enterocolitis (NEC) is a serious condition in infants.
Purpose of the Study:
- To investigate the role of bacterial enzymes in RBC alterations in infants with NEC.
- To determine the association between RBC changes, bacterial isolates, and transfusion reactions.
- To assess the efficacy of different plasma product types in preventing hemolysis.
Main Methods:
- Observational study of 20 infants with radiologically confirmed NEC.
- Isolation and in vitro enzyme activity testing of bacterial species (Clostridium).
- Clinical monitoring for hemolysis in relation to transfusion products (plasma-containing vs. washed products).
Main Results:
- RBC alterations were detected in 4 of 20 NEC cases, often severe (3/4 with bowel perforation).
- Clostridium species were isolated from 3/4 affected infants and produced RBC-altering enzymes.
- Two infants receiving plasma-containing products experienced hemolysis; those treated with washed products did not.
Conclusions:
- Bacterial enzymes, particularly from Clostridium, can cause RBC membrane alterations in NEC.
- These alterations increase susceptibility to hemolysis, especially with plasma-containing transfusions.
- Using washed products or plasma protein fractions without immunoglobulins may prevent transfusion-related hemolysis in NEC.
Abstract:
Enzymes released from bacteria can alter the surfaces of RBCs rendering them susceptible to destruction by antibodies present in a high percentage of adult plasmas. Such RBC alterations were observed in four of 20 consecutive cases of radiologically proved necrotizing enterocolitis. Involved infants were seriously ill, three of four demonstrating bowel perforation. Bacteria of the genus Clostridium were isolated from blood or peritoneal fluid in three of four affected patients and elaborated appropriate RBC-altering enzymes in vitro. Two patients who had received plasma-containing products experienced notable hemolysis. Patients treated with washed products and plasma protein fractions lacking immunoglobulins had no hemolytic problems. The alteration of the RBC membrane is easily detected by a rapid, simple lectin agglutination test.