Delayed hemolytic reaction due to anti Jk a alloimmunization

ABSTRACT Introduction: Kidd blood group system has a special importance in transfusion medicine as the antibodies to Kidd antigens tend to go down to undetectable levels but show an anamnestic response on exposure through pregnancy or blood transfusion and cause hemolytic transfusion reaction, most commonly delayed transfusion reaction. Case Report: We report a patient who developed alloantibodies to 'Kidd a' antigen leading to delayed hemolytic transfusion reaction. Conclusion: We emphasize the steps for detecting these antibodies and the precautions to be taken once these antibodies are identified

Hemolytic disease of the fetus and newborn: Current trends and perspectives

The spectrum of hemolytic disease of the newborn has changed over the last few decades. With the implementation of Rhesus D immunoprophylaxis, hemolytic disease due to ABO incompatibility and other alloantibodies has now emerged as major causes of this condition. Though in developing countries, anti D is still a common antibody in pregnant women, many Asian countries have identified alloantibodies other than anti D as a cause of moderate-severe hemolytic disease. The most concerned fact is that, some of these have been described in Rh D positive women. It appears that universal antenatal screening in all pregnant women needs to be initiated, since Rh D positive women are just as likely as D negative women to form alloantibodies. Many developed nations have national screening programs for pregnant women. This is necessary to ensure timely availability of antigen negative blood and reduce effects on the newborn. Although universal screening seems justified, the cost and infrastructure required would be immense. Developing countries and under resourced nations need to consider universal antenatal screening and frame guidelines accordingly

Clinically Significant Minor Blood Group Antigens amongst North Indian Donor Population

Background. Racial differences in blood group antigen distribution are common and may result in striking and interesting findings. These differences in blood group antigen distribution are important due to their influence on the clinical practice of transfusion medicine. Study Design and Methods. This is a prospective study, involving 1000 healthy regular repeat voluntary blood donors associated with the department. The clinically significant minor blood group antigens of these donors were studied. Results. Out of 1000 healthy regular repeat voluntary blood donors, 93% were D positive and 2.8% were K positive. Amongst the Rh antigens, e was the most common (99%), followed by D (93%), C (85.1%), c (62.3%), and E (21.5%). Within the MNS blood group system, antigen frequency was M (88%), N (57.5%), S (57.8%), and s (87.5%). Within the Duffy blood group system, antigen frequency was Fya (87.3%) and Fyb (58.3%). Conclusions. This data base will help us to prevent alloimmunisation in young females, pregnant women, and patients who are expected to require repeated transfusions in life by providing them with antigen matched blood. Antigen negative blood can also be made available without delay to already alloimmunized multitransfused patients

Evaluation of two methods for counting residual leukocytes in leuko-reduced platelets: Nageotte's method and flow cytometry

Introduction: Leukoreduced (LR) blood components are used for the prevention of several transfusion adverse effects. Advancement in technology has led to newer methods to count residual leukocytes (rWBC) which miss detection on most standard automated hematology analyzers. Materials and Methods: Samples from thirty eight platelet concentrates (prepared by Buffy-coat method) were randomly taken on the day of preparation for rWBC count using Nageotte's chamber and flowcytometer. Results: The rWBC count on Nageotte's ranged from 2.5 WBC/μL to a maximum of 600 WBC/μL where as the flowcytometric count had a lowest of 1.97 WBC/μL to a highest of 740 WBC/μL. We found that the WBC counts using the Nageotte's method and flowcytometeric method are highly correlated. The concordance correlation coefficient or intraclass correlation coefficient which is a measure of reliability was 0.78 Conclusion: In view of the high concordance in correlation coefficient between the two methods, Nageotte's method could be skillfully performed for assessing leukoreduction in LR platelet concentrates of resource constrained blood banks of developing nations

Clinico-serologic co-relation in bi-directional ABO incompatible hemopoietic stem cell transplantation

Background: The ABO blood group system is of prime significance in red cell transfusion and organ transplantation. However, ABO compatibility is not critical in allogenic hemopoietic stem cell transplantation (HSCT) and approximately 40-50% of hemopoietic stem cell transplants are ABO incompatible. This incompatibility may be major, minor or bi-directional. Though there are descriptions of transfusion practice and protocols in ABO incompatible HSCT, there are considerable variations and transfusion support in these patients can be very challenging. Aims: The immunohematologic observations in two cases of bi-directional ABO incompatible HSCT have been described, and clinico-serologic correlation has been attempted. Materials and Methods: In both cases, peripheral blood stem cell harvests were obtained using the Cobe spectra cell separator. Immunohematologic assessments in the donor and recipient were done as a part of pre HSCT evaluation. Both the standard tube technique and column agglutination method (Ortho Biovue Micro Bead System) was used. Antibody screen was done by column agglutination method using three cell panel (Surgiscreen cells). Isoagglutinin titration was done by the master dilution method and standard validated techniques were used. Results: The pattern of laboratory findings in the two cases was different and so were the clinical outcomes. Although there was early engraftment in the first case, the second case developed pure red cell aplasia and this was well-reflected in the immunohematologic assessments. Conclusion: Immunohematologic assessment correlated well with the clinical picture and could be used to predict clinical outcome and onset of complications in ABO incompatible HSCT