1/18. Use of recombinant human erythropoietin (EPO-alfa) in a mother alloimmunized to the Js(b) antigen.erythropoietin (EPO) is a glycoprotein hormone and the principal regulator of erythropoiesis in the fetus, newborn, and adult. EPO-alfa is erythropoietin manufactured by recombinant human dna technology (rhEPO). After counseling, a pregnant woman with anti-Js(b) in her serum was started on rhEPO (600 U/Kg, biweekly) to prevent anemia secondary to serial donations of her blood for fetal transfusions. After a total of 25 rhEPO infusions and autologous donation of 8 units of whole blood, maternal hemoglobin prior to the elective cesarean section at 37 weeks was 11.3 gm/dL. serum EPO concentration was determined in paired maternal and fetal blood samples, before ultrasound guided intravascular transfusions, in this alloimmunized Js(b)-negative and another Rh(D) alloimmunized pregnancy to determine possible correlations between maternal and fetal serum EPO. rhEPO prevented anemia in a patient who donated 8 units of blood from 18-37 weeks of pregnancy without inducing adverse biological effects such as hypertension or thrombotic complications in the placenta. Data presented in this study suggest that EPO does not cross the human placenta.- - - - - - - - - - ranking = 1keywords = rh (Clic here for more details about this article) |
2/18. Severe hemolytic reaction due to anti-JK3.A 35-year-old gravida 3, para 3 Filipino woman with a negative antibody screen, no prior history of transfusion, and no hemolytic disease of the newborn in her children suffered a massive postpartum hemorrhage requiring transfusion. A severe hemolytic transfusion reaction occurred 5 days after delivery. Subsequently, a panagglutinin on a routine antibody identification panel was identified as anti-Jk3. The patient's red blood cell phenotype was Jk(a-b-) and all of her children were Jk(a-b ), yet the antibody that formed reacted with equal strength against all Jk(a)- or Jk(b)-positive cells. The rare Jk(a-b-) phenotype is more common in Polynesians. Anti-Jk3, like other Kidd system antibodies, is difficult to detect because in vivo production may be absent between provocative episodes and because these antibodies often show weak in vitro reactions. The increasing numbers of Pacific Islanders in the united states could result in more frequent encounters with this rare phenotype. Increased awareness of ethnic variability in blood phenotypes and of the capricious nature of Kidd antibodies can help pathologists and technologists deal more effectively with these cases.- - - - - - - - - - ranking = 0.25keywords = rh (Clic here for more details about this article) |
3/18. Drug-induced hemolysis: cefotetan-dependent hemolytic anemia mimicking an acute intravascular immune transfusion reaction.Numerous cases of drug-induced hemolytic anemia have been described in patients treated with penicillin or cephalosporin. Second and third generation cephalosporins are more commonly implicated in hemolytic reactions than first generation cephalosporins. We report a case of severe cefotetan-induced hemolytic anemia in a previously healthy 46-year-old woman undergoing an elective hysterectomy. The patient received 2 g of intravenous cefotetan intraoperatively and subsequently at 12 and 24 h post-operatively. She complained of diarrhea and fever on the third post-operative day and was seen in her gynecologist's office on the fifth post-operative day (hemoglobin = 10.5 g/dL). On the seventh post-operative day, she complained of fever and soreness around the suprapubic catheter site and was given a prescription for 500 mg oral cephalexin four times a day. The next day she was seen in the gynecologist's office and reported feeling better. Ten days after the operation her fatigue worsened and her hemoglobin was 4.8 g/dL. She was transfused with 3 units of packed red blood cells (PRBC) and was given 1 g of cefotetan intravenously. During the transfusion of the second unit of PRBC nursing staff observed gross hemoglobinuria and she subsequently developed acute renal failure. Laboratory chemistry parameters were consistent with severe acute hemolysis. The patient's direct antiglobulin test was reactive and her serum reacted with cefotetan-coated red blood cells (RBCs) and serum plus soluble cefotetan reacted with untreated RBCs. The titration endpoint of the serum against cefotetan-coated RBCs was 40,960, while the serum plus soluble cefotetan against uncoated RBCs was 2,560. This case of severe cefotetan-induced hemolysis was complicated by an acute hemolytic event that occurred during the transfusion of PRBC. Clinical and transfusion service staff must consider drug-induced hemolysis in the differential diagnosis of acute anemia.- - - - - - - - - - ranking = 0.25keywords = rh (Clic here for more details about this article) |
4/18. A case of antenatal cerebral haemorrhage resulting from maternal alloimmunisation against fetal platelets.Prenatal thrombocytopenia is a rare event and is generally due to fetal infection. In very rare cases, fetal thrombocytopenia is induced by maternal IgG directed against the fetal platelets. This alloimmunisation could lead to in utero bleeding. We now report such a case, in which fetal thrombocytopenia was complicated by a huge temporal lobe haematoma. Such a prenatal event is rare: only eight cases have been published, with only one pathologically confirmed case. Our patient is the second one in which neuropathological examination demonstrated prenatal intracerebral bleeding.- - - - - - - - - - ranking = 1keywords = rh (Clic here for more details about this article) |
5/18. Fetomaternal alloimmune thrombocytopenia presenting as intracerebral bleeding in utero.Feto-maternal alloimmune thrombocytopenia is a serious fetal disorder resulting from platelet antigen incompatibility between the mother and the fetus. Intracranial bleeding is the most serious complication of alloimmune thrombocytopenia and can result in severe disability and death in utero. The authors report a case of intracerebral hemorrhage in utero resulting from alloimmune thrombocytopenia.- - - - - - - - - - ranking = 0.25keywords = rh (Clic here for more details about this article) |
6/18. Severe hemolytic disease of the newborn due to anti-Cw.BACKGROUND: Pregnancies complicated by rh isoimmunization have decreased significantly since the widespread use of Rh immune globulin. Uncommon red blood cell antigens have therefore become more clinically evident. We report a case of anti-Cw immunization that resulted in severe fetal anemia that required multiple transfusions. CASE: A 28-year-old multigravida presented to our service at 18 weeks of gestation with her fourth pregnancy. Her pregnancy was complicated by anti-Cw isoimmunization that resulted in severe fetal anemia requiring in utero fetal blood transfusions. CONCLUSION: While previous reports recommend only postpartum surveillance when Cw isoimmunization is present, we report a case resulting in severe fetal anemia.- - - - - - - - - - ranking = 48.652146451523keywords = isoimmunization (Clic here for more details about this article) |
7/18. Temporary suppression of Kidd system antigen expression accompanied by transient production of anti-Jk3.This report describes an 85-year-old woman of Russian Jewish extraction whose red cell Kidd system phenotype changed during the 2 years in which her blood was studied. Certainly once, and perhaps twice, the patient's phenotype changed from Jk(a b-) to Jk(a-b-). On both occasions, it reverted to Jk(a b-). During the first episode of loss of Jka, she formed anti-Jk3. Although this antibody was weak, it was capable of in vivo destruction of Jk(a b-) and Jk(a-b ) red cells. A lack of details about the patient's clinical condition precludes speculation as to the cause of suppression of Jka expression. The phenomenon appeared to affect only the Kidd blood group system. This case should alert others that antigen loss can occur in the Kidd system as it has been shown to occur in, at least, the Rh, Kell, and Ge systems.- - - - - - - - - - ranking = 0.25keywords = rh (Clic here for more details about this article) |
8/18. Clinically significant allo-anti-I in an I-negative patient with massive hemorrhage.A 37-year-old white man who had never been transfused was admitted as an emergency patient with a ruptured spleen and a falling hematocrit (19% on admission). All crossmatches were incompatible. His serum contained anti-I, and his red cells (RBCs) were I-negative and strongly i-positive. Only 4 units of crossmatch-compatible I-negative frozen RBCs were available immediately. Because of the likelihood that more than 4 units would be required, chromium survival studies were performed using I-positive cells. Samples obtained at 15 and 30 minutes after injection revealed less than 1 percent survival of the donor RBCs. He received the 4 units of I-negative RBCs during the operation in addition to reinfusion of RBCs harvested from 1800 ml of blood aspirated from the abdominal cavity. The postoperative hematocrit remained greater than 30 percent and the bilirubin less than 1.5 mg per dl. Before recommending frozen storage of autologous RBCs, 51Cr labeled I-positive RBCs from the patient's daughter (obligate li heterozygote) were infused. survival was 100 percent at 15 and 30 minutes, 90 percent at 3 hours, 85 percent at 26 hours; the remaining RBCs disappeared at a normal rate (T 1/2 27 days) over the succeeding 2 weeks. A repeat 51Cr-labeled RBC study with the original I-positive donor confirmed greater than 92 percent destruction in 90 minutes. The clinical significance of this allo-anti-l (apparently primarily against RBCs from homozygous I-positive donors) is in marked contrast to reported findings with auto-anti-l antibodies.- - - - - - - - - - ranking = 1keywords = rh (Clic here for more details about this article) |
9/18. Hemophiliac with hemolytic anemia resulting from factor viii concentrate.Bilateral herniorrhaphy was successfully performed on a group AB hemophiliac with cirrhosis of the liver. Adequate hemostasis was maintained with infusions of commercial factor viii concentrates and fresh frozen plasma. An anti-A antibody mediated hemolytic reaction occurred in the postoperative period. hemolysis subsided after the cessation of commercial factor viii infusions. The risk of such hemolytic reactions could be eliminated through the use of group-specific cryoprecipitated factor viii.- - - - - - - - - - ranking = 0.5keywords = rh (Clic here for more details about this article) |
10/18. Detection of fetal-maternal hemorrhage in a mother with sickle trait and hereditary persistence of fetal hemoglobin.An Rh-negative term primigravida with sickle trait and hereditary persistence of fetal hemoglobin and an Rh-positive infant were evaluated postpartum for fetal-maternal hemorrhage (FMH) by the acid-elution test for fetal hemoglobin (HbF) cells. Using the acid-elution test, 100 percent of the cells contained HbF. The patient received one vial of Rh immune globulin and was discharged. This report illustrates that lack of specificity is a major problem of the acid-elution test for detection of fetal-maternal hemorrhage, due to its failure to differentiate true fetal Rh-positive cells from maternal Rh-negative HbF cells. Moreover, productivity studies suggest performance of agglutination tests such as the immune rosetting test is more convenient than performance of the acid-elution test to screen for FMH. The recently developed enzyme-linked antiglobulin test, however, may replace both of these procedures for detection of FMH.- - - - - - - - - - ranking = 1.5keywords = rh (Clic here for more details about this article) |
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