Autoimmune hemolytic anemia following allogeneic hematopoietic stem cell transplantation in a patient: serological detection methods for mimicking antibodies and blood transfusion strategy

doi:10.3877/cma.j.issn.1674-0785.2022.05.015

Abstract

Abstract:

Objective

To investigate the causes of cross-matching incompatibility in patients with autoimmune hemolytic anemia (AIHA) following allogeneic hematopoietic stem cell transplantation (AHSCT), and the selection of serological detection methods for irregular antibody identification, treatment measures, and blood transfusion strategies when the irregular antibody screening test in plasma is positive.

Methods

A child aged 3 years with severe anemia following AHSCT was hospitalized at Sichuan Provincial People's Hospital for red blood cell (RBC) transfusion in order to alleviate the symptoms of anemia. The ABO and Rh blood groups of the child were determined through the brine test method, and then the cross-matching test was carried out. It was found that the blood of the child was inconsistent with that of multiple homogeneous donors. Considering the serious anemia of the child, the direct antiglobulin test was performed to judge whether the RBC was sensitized; irregular antibody screening tests outside the ABO blood group system were carried out using the brine test tube method, and microcolumn antiglobulin method and polybrene method were used to determine whether there were irregular antibodies in plasma. According to the results of the irregular antibody screening test, the polybrene method was selected to determine the specificity of antibody; the cross-matching experiment was carried out by the brine test tube method, classical antiglobulin method, and polybrene method. Combined with the results of antibody identification, the appropriate donor RBC infusion was comprehensively analyzed and selected.

Results

The ABO blood group in the child was AB, RH was CCDee, and the ABO blood group had changed to the donor blood group. The direct antiglobulin test was strongly positive, and the red blood cells were sensitized by antibodies. Irregular antibodies were detected in plasma, and sensitizing antibodies released from RBCs and irregular antibodies detected in plasma were anti-Ce mimicking antibodies. Type AB RBCs with negative Ce antigen avoiding anti-Ce mimicking antibodies were selected. Three days after transfusion, the hemoglobin increased to 79 g/L, and the blood transfusion was effective.

Conclusion

Any type of AHSCT may result in AIHA, that is, there may be some autoantibodies (mimicking antibodies) in plasma which can break the ring of autologous RBCs. If the mimicking antibodies can be identified in a patient's plasma, and a donor without corresponding antigen on RBCs can be screened, the hemolytic transfusion reaction can be avoided to ensure safe and effective blood transfusion.

Key words: Allogeneic hematopoietic stem cell transplantation, Autoimmune hemolytic anemia, Autoantibody, Alloantibody, Mimicking antibody, Safe blood transfusion

Jie Zhao, Lan Wang, Hongmei Yang, Yi He, Hong Yuan. Autoimmune hemolytic anemia following allogeneic hematopoietic stem cell transplantation in a patient: serological detection methods for mimicking antibodies and blood transfusion strategy[J]. Chinese Journal of Clinicians(Electronic Edition), 2022, 16(05): 452-456.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhlcyszz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-0785.2022.05.015

https://zhlcyszz.cma-cmc.com.cn/EN/Y2022/V16/I05/452

Figures/Tables 3

References 18

1	Szanto CL, Langenhorst J, de Koning C, et al. Predictors for Autoimmune Cytopenias after Allogeneic Hematopoietic Cell Transplantation in Children[J]. Biol Blood Marrow Transplant, 2020, 26(1):114-122. DOI: 10.1016/j.bbmt.2019.07.022.
2	丁苏鄂. 常用血清学检查技术//刘达庄, 朱自严, 包于勤. 免疫血液学[M]. 上海: 上海科学技术出版社, 2002:194-219.
3	向东, 刘曦, 王健莲, 等. 红细胞温自身抗体的血清学特点分析及配血对策[J]. 中国输血杂志, 2008, 21(12):924-926.
4	Holbro A, Passweg JR. Management of hemolytic anemia following allogeneic stem cell transplantation[J]. Hematology Am Soc Hematol Educ Program, 2015, 2015:378-384. DOI: 10.1182/asheducation-2015.1.378.
5	Barcellini W, Fattizzo B, Zaninoni A. Management of refractory autoimmune hemolytic anemia after allogeneic hematopoietic stem cell transplantation: current perspectives[J]. J Blood Med, 2019, 10:265-278. DOI: 10.2147/JBM.S190327.
6	Park JA, Lee HH, Kwon HS, et al. Sirolimus for refractory autoimmune hemolytic anemia after allogeneic hematopoietic stem cell transplantation: a case report and literature review of the treatment of post-transplant autoimmune hemolytic anemia[J]. Transfus Med Rev, 2016, 30(1):6-14. DOI: 10.1016/j.tmrv.2015.09.001.
7	Buxbaum NP, Pavletic SZ. Autoimmunity following allogeneic hematopoietic stem cell transplantation[J]. Front Immunol, 2020, 11:2017. DOI: 10.3389/fimmu.2020.02017.
8	González-Vicent M, Sanz J, Fuster JL, et al. Autoimmune hemolytic anemia (AIHA) following allogeneic hematopoietic stem cell transplantation (HSCT): A retrospective analysis and a proposal of treatment on behalf of the Grupo Español De Trasplante de Medula Osea en Niños (GETMON) and the Grupo Español de Trasplante Hematopoyetico (GETH)[J]. Transfus Med Rev, 2018, DOI: 10.1016/j.tmrv.2018.02.005.
9	Koo J, Giller RH, Quinones R, et al. Autoimmune cytopenias following allogeneic hematopoietic stem cell transplant in pediatric patients: Response to therapy and late effects[J]. Pediatr Blood Cancer, 2020, 67(9):e28591. DOI: 10.1002/pbc.28591.
10	陈华桂, 丁爱华. 临床输血病例解析200例[M]. 湖南,长沙; 湖南科学技术出版社, 2020:17-29.
11	桂嵘, 张志昇, 王勇军. 输血相容性检测及疑难病例分析[M].北京:人民卫生出版社, 2018:89.
12	桂嵘, 陈秉宇, 黄远帅等译. AABB技术手册[M].18版. 长沙:中南大学出版社, 2019:291.
13	Dwyre DM, Clapper A, Heintz M, et al. A red blood cell autoantibody with mimicking anti-E specificity[J]. Transfusion, 2004, 44(9):1287-1292. DOI: 10.1111/j.0041-1132.2004.04112.x.
14	Harvey G, David J, Sally VR. Serologic problem solviing:mollison's blood transfusion in clinical mecicine[M]. New York: Blackwell Publishing, 2005:272-273.
15	Jang MJ, Cho D, Park KU, et al. Autoantibodies with mimicking specificity detected by the dilution technique in patients with warm autoantibodies[J]. Ann Lab Med, 2013, 33(5):343-348. DOI: 10.3343/alm.2013.33.5.343.
16	苑召虎, 杨惠宽, 陈小洁, 等. 2Me、DTT、ZAAP及酶等介质的处理对红细胞JMH抗原的影响[J]. 中国实验血液学杂志, 2019, 27(03):920-924.
17	Issitt PD, Combs MR, Bumgarner DJ, et al. Studies of antibodies in the sera of patients who have made red cell autoantibodies[J]. Transfusion, 1996, 36(6):481-486. DOI: 10.1046/j.1537-2995.1996.36696269503.x.
18	杨小刚, 李碧娟, 舒义刚, 等. 全血置换治疗重度自身免疫性溶血性贫血一例[J]. 临床内科杂志, 2008, 25(6):367-367. DOI: 10.3969/j.issn.1001-9057.2008.06.028.

序号	Rh					Kidd		MNS				Duffy		Lewis		P	患儿血清凝集强度
序号	D	C	E	c	e	Jka	Jkb	M	N	S	s	Fya	Fyb	Lea	Leb	P1	Brine多次离心	Gel	Poly
1	+	0	+	+	0	+	0	+	+	0	+	+	0	0	0	0	0	3+	2+
2	+	+	0	0	+	+	+	+	+	+	+	+	+	0	+	0	0	3+	4+
3	+	+	+	+	+	+	+	+	+	0	+	+	0	+	0	+	0	3+	4+

序号	Rh					Kidd		MNS				Duffy		Lewis		P	患儿血清凝集强度
序号	D	C	E	c	e	Jka	Jkb	M	N	S	s	Fya	Fyb	Lea	Leb	P1	Brine多次离心	Gel	Poly
1	+	0	+	+	0	+	0	+	+	0	+	+	0	0	0	0	0	3+	2+
2	+	+	0	0	+	+	+	+	+	+	+	+	+	0	+	0	0	3+	4+
3	+	+	+	+	+	+	+	+	+	0	+	+	0	+	0	+	0	3+	4+

序号	Rh					Kell		Duffy		Kidd		Lewis		P	MNS				血清凝集强度		酸放散液凝集强度
序号	C	D	E	c	e	K	k	Fya	Fyb	JKa	JKb	Lea	Leb	P₁	M	N	S	s	Gel	Poly	Poly（稀释16倍）
1	+	+	0	0	+	0	+	+	0	+	0	0	+	+	+	+	+	0	3+	4+	3+
2	+	+	0	0	+	+	+	0	+	+	+	0	+	+	0	+	0	+	3+	4+	3+
3	0	+	+	+	0	0	+	+	0	+	0	+	0	+	0	+	0	+	3+	2+^w	±
4	0	+	0	+	+	0	+	0	0	+	0	0	0	+	0	+	0	+	3+	2+^s	1+
5	+	0	0	0	+	0	+	+	+	+	+	0	+	+	+	0	+	+	3+	4+	3+
6	0	0	+	+	0	0	+	0	+	+	0	0	+	+	+	+	0	+	3+^s	2+^w	±
7	0	0	0	+	+	+	0	0	+	+	+	0	+	0	+	0	+	0	3+^s	2+^s	1+
8	0	0	0	+	+	0	+	0	+	0	+	+	0	+	+	+	0	+	3+	2+^s	1+
9	0	0	0	+	+	+	+	+	0	+	0	+	0	+	0	+	0	+	3+^s	2+^s	1+
10	0	0	0	+	+	0	+	+	0	+	0	+	0	+	+	0	+	+	3+	2+^s	1+
11	+	+	+	0	+	+	+	+	+	0	+	0	+	0	+	+	+	+	3+^s	4+	3+
12	w	+	+	+	0	0	+	+	0	+	+	0	+	+	+	+	+	+	3+^s	2+	±
13	0	0	+	+	+	0	+	0	+	+	+	0	+	+	0	+	0	+	3+	2+^s	1+
14	+	+	+	+	+	0	+	+	0	0	+	+	0	+	+	+	0	+	3+^s	4+	3+
15	+	0	0	+	+	0	+	0	+	+	0	+	0	+	+	0	+	+	3+^s	4+	3+
16	+	0	0	+	+	0	+	+	+	+	0	0	+	0	+	0	+	+	3+^s	4+	3+

序号	Rh					Kell		Duffy		Kidd		Lewis		P	MNS				血清凝集强度		酸放散液凝集强度
序号	C	D	E	c	e	K	k	Fya	Fyb	JKa	JKb	Lea	Leb	P₁	M	N	S	s	Gel	Poly	Poly（稀释16倍）
1	+	+	0	0	+	0	+	+	0	+	0	0	+	+	+	+	+	0	3+	4+	3+
2	+	+	0	0	+	+	+	0	+	+	+	0	+	+	0	+	0	+	3+	4+	3+
3	0	+	+	+	0	0	+	+	0	+	0	+	0	+	0	+	0	+	3+	2+^w	±
4	0	+	0	+	+	0	+	0	0	+	0	0	0	+	0	+	0	+	3+	2+^s	1+
5	+	0	0	0	+	0	+	+	+	+	+	0	+	+	+	0	+	+	3+	4+	3+
6	0	0	+	+	0	0	+	0	+	+	0	0	+	+	+	+	0	+	3+^s	2+^w	±
7	0	0	0	+	+	+	0	0	+	+	+	0	+	0	+	0	+	0	3+^s	2+^s	1+
8	0	0	0	+	+	0	+	0	+	0	+	+	0	+	+	+	0	+	3+	2+^s	1+
9	0	0	0	+	+	+	+	+	0	+	0	+	0	+	0	+	0	+	3+^s	2+^s	1+
10	0	0	0	+	+	0	+	+	0	+	0	+	0	+	+	0	+	+	3+	2+^s	1+
11	+	+	+	0	+	+	+	+	+	0	+	0	+	0	+	+	+	+	3+^s	4+	3+
12	w	+	+	+	0	0	+	+	0	+	+	0	+	+	+	+	+	+	3+^s	2+	±
13	0	0	+	+	+	0	+	0	+	+	+	0	+	+	0	+	0	+	3+	2+^s	1+
14	+	+	+	+	+	0	+	+	0	0	+	+	0	+	+	+	0	+	3+^s	4+	3+
15	+	0	0	+	+	0	+	0	+	+	0	+	0	+	+	0	+	+	3+^s	4+	3+
16	+	0	0	+	+	0	+	+	+	+	0	0	+	0	+	0	+	+	3+^s	4+	3+

供者	供者抗原							主侧试验方法
供者	-A	-B	-D	-C	-c	-E	-e	Brine	Gel	Poly
1	+	+	+	+	+	+	+	-	3+^s	4+
2	+	+	+	+	-	-	+	-	3+	3+^s
3	+	+	+	-	+	+	-	-	3+^s	2+^w

Please choose a citation manager

Content to export