T-cryptantigen (TCA) activation in surgical neonates: a hidden problem

Area of Science:

• Neonatal Surgery
• Immunology
• Transfusion Medicine

Background:

• The Thomsen-Friedenreich cryptantigen (TCA) is normally hidden on red blood cells by neuraminic acid.
• Bacterial neuraminidase can expose TCA, leading to potential haemolysis if anti-TCA antibodies are present.
• TCA's role in necrotising enterocolitis is known, but its incidence in other neonatal sepsis is unclear.

Purpose of the Study:

• To determine the incidence of TCA activation in septic surgical neonates.
• To assess the risk of haemolysis in TCA-activated neonates receiving blood products.
• To provide recommendations for testing and transfusion strategies in this population.

Main Methods:

• Prospective study of 117 neonates in a Surgical Neonatal Nursery.
• Clinical assessment for sepsis and laboratory testing for TCA activation.
• Monitoring of transfusion reactions, specifically haemolysis, in relation to TCA status.

Main Results:

• TCA activation was found in 1.4% of non-septic infants and 17% of septic infants.
• Two TCA-activated infants receiving unwashed red cells experienced haemolysis; none of the four receiving washed cells did.
• Mortality was observed in both TCA-activated and non-activated septic infants.

Conclusions:

• Routine TCA testing is not recommended for well neonates.
• Routine TCA testing is recommended for all clinically septic infants due to significant activation incidence.
• A selective transfusion policy using washed red blood cells for TCA-activated patients is advised to prevent haemolysis and reduce mortality.