Reply [6]

[No abstract available]46610621063Mota, M., Fonseca, N.L., Rodrigues, A., Kutner, J.M., Castilho, L., Anti-D alloimmunization by weak D type 1 red blood cells with a very low antigen density (2005) Vox Sang, 88, pp. 130-

Statistical Analysis

In this Appendix, we provide an outline of methods used in analyzing molecular biology data. We give a summary of types of data encountered and the appropriate methods to apply for the questions of interest. Statistical techniques described include the t test, the Wilcoxon rank sum test, the Mann-Whitney-Wilcoxon test, ANOVA, regression, and the chi-square test. For each method, we give the appropriate assumptions, the details of the test, and a complete concrete example to follow. We also discuss related ideas such as multiple comparisons and why correlation does not imply causation

Autoantibody Formation After Alloimmunization Inducing Bystander Immune Hemolysis

The development of RBC autoantibodies resulting from or associated with allogeneic blood transfusions is not an easily determined complication of RBC transfusions. This report discusses one patient who developed RBC autoantibodies in association with an allogeneic blood transfusion and alloimmunization leading to a temporary bystander immune hemolysis. A 72-year-old woman was hospitalized as a result of severe anemia and received two units of ABO- and D-compatible RBCs. She had a history of two pregnancies 40 years before, but no history of RBC transfusion, and her antibody screen was negative. On the tenth day after transfusion her hemoglobin dropped, and alloanti-c was identified in her serum and eluate. At this time she received another two units of compatible blood according to her phenotype (group O, R1R1, K:-i). After 48 hours, she developed joint pain, pyrexia, and hemoglobinuria, and her Hb dropped from 9.2 g/dL to 5.3 g/dL. The direct antiglobulin test was positive, an IgG autoantibody was present in the eluate, and the antibody investigation revealed the presence of anti-Jkb in addition to the previously identified alloanti-c. Her genotype was determined, and, based on the findings, two additional units were selected, found to be compatible, and transfused without incident. Transfusions were discontinued, and she was treated with IVIG and corticosteroids. Her Hb increased to 9.7 g/dL, and the patient made an uneventful recovery. It was concluded that transfusion of incompatible RBCs induced the formation of an autoantibody in this patient, resulting in lysis of bystander RBCs. The need for additional blood transfusion was successfully avoided by treatment with IVIG, steroid therapy, and rituximab.251912Young, P.P., Uzieblo, A., Trulock, A., Autoantibody formation following alloimmunization: Are blood transfusions a risk factor for autoimmune hemolytic anemia? (2004) Transfusion, 44, pp. 67-72Ayun, B., Padmanabhan, S., Paley, C., Chandrasekaran, V., Clinical significance of RBC alloantibodies and autoantibodies in sickle cell patients who received transfusions (2002) Transfusion, 42, pp. 37-40Win, N., Doughty, H., Telfer, P., Wild, B.J., Pearson, T.C., Hyperhemolytic transfusion reaction in sickle cell disease (2001) Transfusion, 41 (3), pp. 323-328. , DOI 10.1046/j.1537-2995.2001.41030323.xVichinsky, E.P., Luban, N.L.C., Wright, E., Olivieri, N., Driscoll, C., Pegelow, C.H., Adams, R.J., Prospective RBC phenotype matching ina stroke-Prevention trial in sickle cell anemia: A multicenter transfusion trial (2001) Transfusion, 41 (9), pp. 1086-1092. , DOI 10.1046/j.1537-2995.2001.41091086.xCox, J.V., Steane, E., Cunningham, G., Frenkel, E.P., Risk of alloimmunization and delayed hemolytic transfusion reactions in patients with sickle cell disease (1988) Archives of Internal Medicine, 148 (11), pp. 2485-2489. , DOI 10.1001/archinte.148.11.2485Dameshek, W., Autoimmunity: Theoretical aspects (1965) Ann NY Acad Sci, 124, pp. 6-28Petz, L.D., Garratty, G., Blood transfusion in autoimmune hemolytic anemia (1980) Acquired Immune Hemolytic Anemias, 1st Ed., pp. 358-391. , Petz LD, Garratty G, eds. New York: Churchill LivingstoneGarratty, G., Novel mechanisms for immune destruction of circulating autologous cells (1996) Autoimmune Disorders of Blood, pp. 79-114. , Silberstein LE, ed. Bethesda, MD: American Association of Blood Banks(1997) Blood Transfusion in Clinical Medicine, p. 85. , Mollison PL, Engelfriet CP, Contreras M, eds. Oxford: Blackwell ScienceCook, I.A., Primary rhesus immunization of male volunteers (1971) Br J Haematol, 20, pp. 369-375Petz, L.D., Garratty, G., Bystander immune hemolysis (2004) Immune Hemolytic Anemias. 2nd Ed., pp. 358-364. , Petz LD, Garratty G. Philadelphia: Churchill LivingstoneSalama, A., Bhakdi, S., Mueller-Eckhardt, C., Evidence suggesting the occurrence of C3-independent intravascular immune hemolysis. Reactive hemolysis in vivo (1987) Transfusion, 27 (1), pp. 49-53Reid, M.E., Rios, M., Powell, V.I., Charles-Pierre, D., Malavade, V., DNA from blood samples can be used to genotype patients who have recently received a transfusion (2000) Transfusion, 40 (1), pp. 48-53. , DOI 10.1046/j.1537-2995.2000.40010048.xPetz, L.D., Garraty, G., Development of RBC autoantibodies and AIHA following transfusion (2004) Immune Hemolytic Anemias. 2nd Ed., pp. 335-340. , Petz LD, Garratty G. Philadelphia: Churchill LivingstonePetz, L.D., Bystander immune cytolysis (2006) Transfus Med Rev, 20, pp. 110-140Cox, K.O., Keast, D., Erythrocyte autoantibodies induced in mice immunized with rat erythrocytes (1973) Immunology, 25, pp. 531-539Cox, K.O., Keast, D., Autoimmune haemolytic anaemia induced in mice immunized with rat erythrocytes (1974) Clin Exp Immunol, 17, pp. 319-327Naysmith, J.D., Ortega-Pierres, M.G., Elson, C.J., Rat erythrocyte-induced anti-erythrocyte autoantibody production and control in normal mice (1981) Immunological Reviews, NO.55, pp. 55-87Lalezari, P., Talleyrand, N.P., Wenz, B., Development of direct antiglobulin reaction accompanying alloimmunization in a patient with RhD (D category III) phenotype (1975) Vox Sang, 28, pp. 19-24Chaplin Jr., H., Zarkowsky, H.S., Combined sickle cell disease and autoimmune hemolytic anemia (1981) Arch Intern Med, 141, pp. 1091-1093Argiolu, F., Diana, G., Arnone, M., Batzella, M.G., Piras, P., Cao, A., High-dose intravenous immunoglobulin in the management of autoimmune hemolytic anemia complicating thalassemia major (1990) Acta Haematologica, 83 (2), pp. 65-68Wodzinski, M.A., Collin, R.C., Booker, D.J., Stamps, R., Bellamy, J.D., Sokol, R.J., Delayed hemolytic transfusion reaction and paroxysmal cold hemoglobinuria: An unusual association (1997) Immunohematology, 13, pp. 54-57Dameshek, W., Levine, P., Isoimmunization with Rh factor in acquired hemolytic anemia (1943) N Engl J Med, 228, pp. 641-64