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Red Blood Cell Transfusion in Patients With Autoantibodies: Is It Effective and Safe Without Increasing Hemolysis Risk?

Park SH, Choe WH, Kwon SW - Ann Lab Med (2015)

Bottom Line: Post-transfusion patients positive for alloantibodies only or those without RBC-specific antibodies were considered as control groups (N=100 for both groups).In addition, changes in hemoglobin levels were significantly higher (P<0.001) in severe anemia (<5 g/dL) than in other patients.Transfusion of the least-incompatible RBCs in AIHA patients is effective and safe without any associated increase in hemolysis risk when compared with post-transfusion patients positive for alloantibodies or those lacking RBC-specific antibodies.

View Article: PubMed Central - PubMed

Affiliation: Department of Laboratory Medicine, Pusan National University School of Medicine, Pusan National University Hospital, Busan, Korea. ; Biomedical Research Institute, Pusan National University Hospital, Busan, Korea.

ABSTRACT

Background: The therapeutic efficacy of red blood cell (RBC) transfusions in patients with autoimmune hemolytic anemia (AIHA) is highly debated because of speculations on the increased risk of transfusion reactions; yet it is a suggested adjuvant therapy in anemic patients with life-threatening hypoxemia. In this study, we evaluated the safety and efficacy of RBC transfusions in AIHA patients.

Methods: Daily changes in hemoglobin, total bilirubin, and lactate dehydrogenase (LDH) were assessed in 161 AIHA patients without bleeding history who were transfused once with 1-5 units of the least-incompatible RBCs and monitored over a seven-day period. Post-transfusion patients positive for alloantibodies only or those without RBC-specific antibodies were considered as control groups (N=100 for both groups).

Results: The three groups revealed similar increases in hemoglobin of 1.40-1.70 g/dL (autoantibodies), 1.20-1.60 g/dL (alloantibodies only), and 1.40-1.55 g/dL (no antibodies) for seven days following transfusion of 10 mL RBCs/kg. During follow-up, no significant changes in total bilirubin or LDH levels were detected in the AIHA group compared with controls. Influences due to autoantibody type, direct antiglobulin test (DAT) specificity and strength, and steroid therapy status on transfusion reactions were not evident in AIHA patients. In addition, changes in hemoglobin levels were significantly higher (P<0.001) in severe anemia (<5 g/dL) than in other patients.

Conclusions: Transfusion of the least-incompatible RBCs in AIHA patients is effective and safe without any associated increase in hemolysis risk when compared with post-transfusion patients positive for alloantibodies or those lacking RBC-specific antibodies.

No MeSH data available.


Related in: MedlinePlus

Comparison of hemoglobin changes (medians) at days 1 and 7 after transfusion of 10 mL RBCs/kg in the patients with autoantibodies with respect to (A) autoantibody type, (B) DAT specificity, (C) DAT strength in IgG, (D) DAT strength in C3d, (E) initial hemoglobin level, and (F) steroid therapy status.*P values were obtained from the Kruskal-Wallis test and †the Mann-Whitney U test.Abbreviations: RBC, red blood cell; DAT, direct antiglobulin test.
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Figure 1: Comparison of hemoglobin changes (medians) at days 1 and 7 after transfusion of 10 mL RBCs/kg in the patients with autoantibodies with respect to (A) autoantibody type, (B) DAT specificity, (C) DAT strength in IgG, (D) DAT strength in C3d, (E) initial hemoglobin level, and (F) steroid therapy status.*P values were obtained from the Kruskal-Wallis test and †the Mann-Whitney U test.Abbreviations: RBC, red blood cell; DAT, direct antiglobulin test.

Mentions: In this analysis, we focused on the hemoglobin changes at days 1 and 7 after RBC transfusion, and hemoglobin changes were compared among the patient groups categorized by each variable described previously. These results are illustrated in Fig. 1.


Red Blood Cell Transfusion in Patients With Autoantibodies: Is It Effective and Safe Without Increasing Hemolysis Risk?

Park SH, Choe WH, Kwon SW - Ann Lab Med (2015)

Comparison of hemoglobin changes (medians) at days 1 and 7 after transfusion of 10 mL RBCs/kg in the patients with autoantibodies with respect to (A) autoantibody type, (B) DAT specificity, (C) DAT strength in IgG, (D) DAT strength in C3d, (E) initial hemoglobin level, and (F) steroid therapy status.*P values were obtained from the Kruskal-Wallis test and †the Mann-Whitney U test.Abbreviations: RBC, red blood cell; DAT, direct antiglobulin test.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4446583&req=5

Figure 1: Comparison of hemoglobin changes (medians) at days 1 and 7 after transfusion of 10 mL RBCs/kg in the patients with autoantibodies with respect to (A) autoantibody type, (B) DAT specificity, (C) DAT strength in IgG, (D) DAT strength in C3d, (E) initial hemoglobin level, and (F) steroid therapy status.*P values were obtained from the Kruskal-Wallis test and †the Mann-Whitney U test.Abbreviations: RBC, red blood cell; DAT, direct antiglobulin test.
Mentions: In this analysis, we focused on the hemoglobin changes at days 1 and 7 after RBC transfusion, and hemoglobin changes were compared among the patient groups categorized by each variable described previously. These results are illustrated in Fig. 1.

Bottom Line: Post-transfusion patients positive for alloantibodies only or those without RBC-specific antibodies were considered as control groups (N=100 for both groups).In addition, changes in hemoglobin levels were significantly higher (P<0.001) in severe anemia (<5 g/dL) than in other patients.Transfusion of the least-incompatible RBCs in AIHA patients is effective and safe without any associated increase in hemolysis risk when compared with post-transfusion patients positive for alloantibodies or those lacking RBC-specific antibodies.

View Article: PubMed Central - PubMed

Affiliation: Department of Laboratory Medicine, Pusan National University School of Medicine, Pusan National University Hospital, Busan, Korea. ; Biomedical Research Institute, Pusan National University Hospital, Busan, Korea.

ABSTRACT

Background: The therapeutic efficacy of red blood cell (RBC) transfusions in patients with autoimmune hemolytic anemia (AIHA) is highly debated because of speculations on the increased risk of transfusion reactions; yet it is a suggested adjuvant therapy in anemic patients with life-threatening hypoxemia. In this study, we evaluated the safety and efficacy of RBC transfusions in AIHA patients.

Methods: Daily changes in hemoglobin, total bilirubin, and lactate dehydrogenase (LDH) were assessed in 161 AIHA patients without bleeding history who were transfused once with 1-5 units of the least-incompatible RBCs and monitored over a seven-day period. Post-transfusion patients positive for alloantibodies only or those without RBC-specific antibodies were considered as control groups (N=100 for both groups).

Results: The three groups revealed similar increases in hemoglobin of 1.40-1.70 g/dL (autoantibodies), 1.20-1.60 g/dL (alloantibodies only), and 1.40-1.55 g/dL (no antibodies) for seven days following transfusion of 10 mL RBCs/kg. During follow-up, no significant changes in total bilirubin or LDH levels were detected in the AIHA group compared with controls. Influences due to autoantibody type, direct antiglobulin test (DAT) specificity and strength, and steroid therapy status on transfusion reactions were not evident in AIHA patients. In addition, changes in hemoglobin levels were significantly higher (P<0.001) in severe anemia (<5 g/dL) than in other patients.

Conclusions: Transfusion of the least-incompatible RBCs in AIHA patients is effective and safe without any associated increase in hemolysis risk when compared with post-transfusion patients positive for alloantibodies or those lacking RBC-specific antibodies.

No MeSH data available.


Related in: MedlinePlus