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Immunohematology JOURNAL of BLOOD GROUP SEROLOGY and EDUCATION Immunohematology JOURNAL OF BLOOD GROUP SEROLOGY AND EDUCATION V OLUME 20, NUMBER 3, 2004 This Issue of Immunohematology Is Supported by a Contribution From Dedicated to Education in the Field of Blood Banking Immunohematology JOURNAL OF BLOOD GROUP SEROLOGY AND EDUCATION VOLUME 20, NUMBER 3, 2004 CONTENTS 137 Letter to the readers Introduction to the review articles S.T.NANCE 138 Review: drug-induced immune hemolytic anemia—the last decade G.GARRATTY 147 Review: what to do when all RBCs are incompatible—serologic aspects S.T.NANCE AND P.A.ARNDT 161 Review: transfusing incompatible RBCs—clinical aspects G. MENY 167 Review: evaluation of patients with immune hemolysis L.D. PETZ 177 Case report: exacerbation of hemolytic anemia requiring multiple incompatible RBC transfusions A.M. SVENSSON,S.BUSHOR,AND M.K. FUNG 184 Delayed hemolytic transfusion reaction due to anti-Fyb caused by a primary immune response: a case study and a review of the literature H.H. KIM,T.S.PARK, S.H. OH, C.L. CHANG,E.Y.LEE,AND H.C. SON 187 Maternal alloanti-hrS—an absence of HDN R. KAKAIYA,J.CSERI,B.JOCHUM,L.GILLARD,AND S. SILBERMAN 190 193 C O M M U N I C A T I O N S Letter to the Editor-in-Chief Letter to the Editors Immunohematology to be listed in Index Medicus HAMA (Human Anti-Mouse Antibodies) do not and MEDLINE Cause False Positive Results in PAKPLUS S.G. SANDLER L.A.TIDEY,S.CHANCE,M.CLARKE,AND R.H.ASTER Reply to letter M.F.LEACH AND J.P.AUBUCHON 195 196 Letters From the Editor-in-Chief SPECIAL SECTION Ortho dedication Exerpts from the American Red Cross Reference The final 20th anniversary issue Laboratory Newsletter—1976 198 199 202 ANNOUNCEMENTS ADVERTISEMENTS INSTRUCTIONS FOR AUTHORS EDITOR-IN-CHIEF MANAGING EDITOR Delores Mallory, MT(ASCP)SBB Mary H. McGinniss,AB, (ASCP)SBB Supply, North Carolina Bethesda, Maryland TECHNICAL EDITOR SENIOR MEDICAL EDITOR Christine Lomas-Francis, MSc Scott Murphy, MD New York, New York Philadelphia, Pennsylvania GUEST EDITOR Sandra T.Nance, MS, MT(ASCP)SBB Philadelphia, Pennsylvania ASSOCIATE MEDICAL EDITORS David Moolton, MD S. Gerald Sandler, MD Geralyn Meny, MD Ralph Vassallo, MD Philadelphia, Pennsylvania Washington, District of Columbia Philadelphia, Pennsylvania Philadelphia, Pennsylvania EDITORIAL BOARD Patricia Arndt, MT(ASCP)SBB W. John Judd, FIBMS, MIBiol Paul M. Ness, MD Los Angeles, California Ann Arbor, Michigan Baltimore, Maryland James P.AuBuchon, MD Christine Lomas-Francis, MSc Mark Popovsky, MD Lebanon, New Hampshire New York, New York Braintree, Massachusetts Geoffrey Daniels, PhD Gary Moroff, PhD Marion E. Reid, PhD, FIBMS Bristol, United Kingdom Rockville, Maryland New York, New York Richard Davey, MD Ruth Mougey, MT(ASCP)SBB Susan Rolih, MS, MT(ASCP)SBB New York, New York Carrollton, Kentucky Cincinnati, Ohio Sandra Ellisor, MS, MT(ASCP)SBB John J. Moulds, MT(ASCP)SBB David F.Stroncek, MD Anaheim, California Raritan, New Jersey Bethesda, Maryland George Garratty, PhD, FRCPath Marilyn K. Moulds, MT(ASCP)SBB Marilyn J.Telen, MD Los Angeles, California Houston, Texas Durham, North Carolina Brenda J. Grossman, MD Sandra Nance, MS, MT(ASCP)SBB St. Louis, Missouri Philadelphia, Pennsylvania EDITORIAL ASSISTANT PRODUCTION ASSISTANT Linda Berenato Marge Manigly COPY EDITOR ELECTRONIC PUBLISHER PROOFREADER Lucy Oppenheim Paul Duquette George Aydinian Immunohematology is published quarterly (March, June, September, and December) by the American Red Cross, National Headquarters,Washington, DC 20006. The contents are cited in the EBASE/Excerpta Medica and Elsevier BIOBASE/ Current Awareness in Biological Sciences (CABS) databases. The subscription price is $30.00 (U.S.) and $35.00 (foreign) per year. Subscriptions, Change of Address, and Extra Copies: Immunohematology, P.O. Box 40325 Philadelphia, PA 19106 Or call (215) 451-4902 Web site: www.redcross.org/pubs/immuno Copyright 2004 by The American National Red Cross ISSN 0894-203X LETTER TO THE READERS Introduction to the review articles Dr. Larry Petz completes the invited review section Welcome to the third issue of 2004, celebrating with “Evaluation of Patients With Immune Hemolysis.” Immunohematology’s 20 years of publication. As with This review takes the reader through the differential the first two issues of 2004, it contains four invited diagnoses of a patient that presents with immune review articles. This issue’s focus is on diagnostic uses hemolysis and discusses the importance of the precise of immunohematology serologic testing. diagnosis in prognosis and therapy. The first review is a recurring favorite, “Drug- This third issue is a good mix of reviews that Induced Immune Hemolytic Anemia—The Last discuss serologic testing and clinical use of results for Decade,”by George Garratty, PhD. Over the years, the diagnostic and therapeutic measures. These reviews editors of Immunohematology have invited Dr. are written by authors with a great deal of experience Garratty to write review articles on drug-induced in their field. I sincerely hope you enjoy the issue as hemolytic anemia and he has kept our readers current. much as I have enjoyed being the guest editor. This review continues the tradition with another excellent review. Sandra T. Nance, MS, MT(ASCP)SBB The second and third reviews focus on what to do Member of the Editorial Board and when all units of blood are incompatible. Serologic Guest Editor of this issue, aspects are covered by Sandra Nance and Patricia American Red Cross Blood Services Arndt; these aspects include the testing often Penn-Jersey Region performed in the immunohematology reference 700 Spring Garden Street laboratory (IRL) and monocyte monolayer assays Philadelphia, PA 19123 performed as a specialty test in two IRLs in the United States. This second review also includes cases that demonstrate the points under discussion. Dr. Geralyn Meny reviews clinical responses when all units of blood are incompatible and reminds us of all the elements that should be considered when this situation arises in your facility. IMMUNOHEMATOLOGY, VOLUME 20, NUMBER 3, 2004 137 Review: drug-induced immune hemolytic anemia—the last decade G. GARRATTY I have written three previous reviews on drug- Because of these statistics, I will be emphasizing induced immune hemolytic anemia (DIIHA) for this the cephalosporins in this review. journal.1–3 The last one was written in 1994.3 This year, I would like to review what has happened in the last Cephalosporin-Induced Immune Hemolytic decade. Anemia When Dr. Petz and I published the first edition of There are about 70 individual published case our book (Acquired Immune Hemolytic Anemias) in reports of cephalosporin-induced immune hemolytic 1980,4 we found that there was reasonable evidence to anemia (CIIHA),8–64 but many more are contained in support that about 30 drugs could cause DIIHA. One reviews or tables without case histories65–67 (see Table drug,methyldopa,was by far the most common drug to 3). Most patients have had severe hemolytic anemia do this. Almost 70 percent of DIIHAs referred to our (HA), often with intravascular lysis, and 40 percent laboratory in the 1970s were associated with methyl- were associated with fatal HA. It is not known if this is dopa. Antibodies associated with methyldopa were the tip of the iceberg and there are many more cases drug-independent and the patients showed all the serologic and hematologic characteristics of “warm of milder HA or positive DATs that are not reported; type” autoimmune hemolytic anemia (WAIHA). the same questions apply to cephalosporin-induced Twenty-three percent of the DIIHAs were associated thrombocytopenia. Tables 4 and 5 summarize the with high-dose IV penicillin therapy; only about 10 clinical and serologic findings associated with percent of DIIHAs were associated with other drugs cefotetan- and ceftriaxone-induced immune HA. It (e.g., quinine, rifampicin, and hydrochlorothiazide). should be emphasized that cefotetan antibodies always In the next 20 years, methyldopa and high dose IV react with cefotetan-coated RBCs and almost always penicillin were used less and less; we have not seen a react with untreated RBCs in the presence of cefotetan case of DIIHA associated with these two drugs for (“immune complex” method), and about one-third will many years. By 1994 about 71 drugs had been react with RBCs without the presence of drug (i.e.,will implicated in DIIHA.5 Recently published results appear to be autoantibodies). The latter findings can reflect a changing picture in the spectrum of DIIHA in lead to problems in the blood transfusion service. If a the last 25 years.6,7 There are now approximately 100 patient receives cefotetan prophylactically for surgery, drugs associated with DIIHA (see Table 1), and receives a blood transfusion during or after surgery,and methyldopa and penicillin have been replaced by a then develops HA 7 to 10 days afterwards, a delayed single group of drugs, the cephalosporins (93% of hemolytic transfusion reaction is often suspected. The cases), with cefotetan alone accounting for 83 percent hematologic findings can also mimic AIHA. If the HA is of the DIIHAs we have encountered in the last 10 due to cefotetan,the DAT will be positive (although we years. Table 2 shows the drugs causing DIIHA that we have reported one case where the DAT was negative).68 have encountered in the past 26 years (1978–2003). Sometimes the serum will react with all untreated Methyldopa is probably underrepresented as, by 1978, RBCs, mimicking an alloantibody to a high-frequency cases of autoimmune hemolytic anemia (AIHA) in antigen, or a mixture of alloantibodies or autoantibody, patients taking methyldopa were not usually sent to and many hours may be wasted investigating these specialist laboratories such as ours for investigation. possibilities. If there is a history of cefotetan 138 IMMUNOHEMATOLOGY, VOLUME 20, NUMBER 3, 2004 Review: drug-induced hemolytic anemia Table 1.
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