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Transfusion Problems in Hemolytic Anemias*
Transfusion Problems in Hemolytic Anemias* ALI A. HOSSAIN! Department of Pathdlogy, Medical College of Virginia, Richmond 23219 All hemolytic anemias feature shortened red cell Extrinsic Mechanisms survival due to premature hemolysis of the cell. For the Those hemolytic anemias which are due to extrinsic purposes of this presentation, we may classify the factors may be classified, further, as non-immune or hemolytic anemias, most broadly, according to the immune. Non-immune mechanisms include a) drugs mechanisms leading to hemolysis. and chemicals (phenylhydrazine, naphthalene, lead, snake venoms); b) physical agents (heat); c) bacteria Intrinsic Mechanisms and parasites (hemolytic streptococci, Clostridium Hemolytic anemias due to intrinsically defective welchii, Bartonella, plasmodia); and d) acquired sen erythrocytes are essentially of three types. First are sitivity to penicillin, methylodopa, Keftin®, or fava those anemias in which the red cells are defective due plant as examples. Some of the agents in this. last to lack of an essential factor, eg, pernicious anemia group serve to lyse the cells, either through duect in relapse. The second type includes those in which action or by formation of antibodies. the red cells have an abnormal shape because of an These hemolytic anemias due to extrinsic factors inherited error in the chemical makeup of the hemo of the non-immune variety present no transfusion globin molecules; eg, sickle cells, elliptocytes, sphero problem for the Blood Bank. However, it ~~st b.e cytes, and the target -
Hemolytic Disease of the Newborn
Intensive Care Nursery House Staff Manual Hemolytic Disease of the Newborn INTRODUCTION and DEFINITION: Hemolytic Disease of the Newborn (HDN), also known as erythroblastosis fetalis, isoimmunization, or blood group incompatibility, occurs when fetal red blood cells (RBCs), which possess an antigen that the mother lacks, cross the placenta into the maternal circulation, where they stimulate antibody production. The antibodies return to the fetal circulation and result in RBC destruction. DIFFERENTIAL DIAGNOSIS of hemolytic anemia in a newborn infant: -Isoimmunization -RBC enzyme disorders (e.g., G6PD, pyruvate kinase deficiency) -Hemoglobin synthesis disorders (e.g., alpha-thalassemias) -RBC membrane abnormalities (e.g., hereditary spherocytosis, elliptocytosis) -Hemangiomas (Kasabach Merritt syndrome) -Acquired conditions, such as sepsis, infections with TORCH or Parvovirus B19 (anemia due to RBC aplasia) and hemolysis secondary to drugs. ISOIMMUNIZATION A. Rh disease (Rh = Rhesus factor) (1) Genetics: Rh positive (+) denotes presence of D antigen. The number of antigenic sites on RBCs varies with genotype. Prevalence of genotype varies with the population. Rh negative (d/d) individuals comprise 15% of Caucasians, 5.5% of African Americans, and <1% of Asians. A sensitized Rh negative mother produces anti-Rh IgG antibodies that cross the placenta. Risk factors for antibody production include 2nd (or later) pregnancies*, maternal toxemia, paternal zygosity (D/D rather than D/d), feto-maternal compatibility in ABO system and antigen load. (2) Clinical presentation of HDN varies from mild jaundice and anemia to hydrops fetalis (with ascites, pleural and pericardial effusions). Because the placenta clears bilirubin, the chief risk to the fetus is anemia. Extramedullary hematopoiesis (due to anemia) results in hepatosplenomegaly. -
A Newly Recognized Blood Group in Domestic Shorthair Cats: the Mik Red Cell Antigen
J Vet Intern Med 2007;21:287–292 A Newly Recognized Blood Group in Domestic Shorthair Cats: The Mik Red Cell Antigen Nicole M. Weinstein, Marie-Claude Blais, Kimberly Harris, Donna A. Oakley, Lillian R. Aronson, and Urs Giger Background: Naturally occurring alloantibodies produced against A and B red cell antigens in cats can cause acute hemolytic transfusion reactions. Blood incompatibilities, unrelated to the AB blood group system, have also been suspected after blood transfusions through routine crossmatch testing or as a result of hemolytic transfusion reactions. Hypothesis: Incompatible crossmatch results among AB compatible cats signify the presence of a naturally occurring alloantibody against a newly identified blood antigen in a group of previously never transfused blood donor cats. The associated alloantibody is clinically important based upon a hemolytic transfusion reaction after inadvertent transfusion of red cells expressing this red cell antigen in a feline renal transplant recipient that lacks this red cell antigen. Methods: Blood donor and nonblood donor cats were evaluated for the presence of auto- and alloantibodies using direct antiglobulin and crossmatch tests, respectively, and were blood typed for AB blood group status. Both standard tube and novel gel column techniques were used. Results: Plasma from 3 of 65 cats and 1 feline renal transplant recipient caused incompatible crossmatch test results with AB compatible erythrocytes indicating these cats formed an alloantibody against a red cell antigen they lack, termed Mik. The 3 donors and the renal transplant recipient were crossmatch-compatible with one another. Tube and gel column crossmatch test results were similar. Conclusions and Clinical Importance: The absence of this novel Mik red cell antigen can be associated with naturally occurring anti-Mik alloantibodies and can elicit an acute hemolytic transfusion reaction after an AB-matched blood transfusion. -
Blood Bank I D
The Osler Institute Blood Bank I D. Joe Chaffin, MD Bonfils Blood Center, Denver, CO The Fun Just Never Ends… A. Blood Bank I • Blood Groups B. Blood Bank II • Blood Donation and Autologous Blood • Pretransfusion Testing C. Blood Bank III • Component Therapy D. Blood Bank IV • Transfusion Complications * Noninfectious (Transfusion Reactions) * Infectious (Transfusion-transmitted Diseases) E. Blood Bank V (not discussed today but available at www.bbguy.org) • Hematopoietic Progenitor Cell Transplantation F. Blood Bank Practical • Management of specific clinical situations • Calculations, Antibody ID and no-pressure sample questions Blood Bank I Blood Groups I. Basic Antigen-Antibody Testing A. Basic Red Cell-Antibody Interactions 1. Agglutination a. Clumping of red cells due to antibody coating b. Main reaction we look for in Blood Banking c. Two stages: 1) Coating of cells (“sensitization”) a) Affected by antibody specificity, electrostatic RBC charge, temperature, amounts of antigen and antibody b) Low Ionic Strength Saline (LISS) decreases repulsive charges between RBCs; tends to enhance cold antibodies and autoantibodies c) Polyethylene glycol (PEG) excludes H2O, tends to enhance warm antibodies and autoantibodies. 2) Formation of bridges a) Lattice structure formed by antibodies and RBCs b) IgG isn’t good at this; one antibody arm must attach to one cell and other arm to the other cell. c) IgM is better because of its pentameric structure. P}Chaffin (12/28/11) Blood Bank I page 1 Pathology Review Course 2. Hemolysis a. Direct lysis of a red cell due to antibody coating b. Uncommon, but equal to agglutination. 1) Requires complement fixation 2) IgM antibodies do this better than IgG. -
Neonatal Isoerythrolysis Neonatal Isoerythrolysis Pathogenesis
Neonatal Isoerythrolysis Neonatal Isoerythrolysis Pathogenesis Immune mediated hemolytic anemia Mediated by maternal anti-RBC antibodies Colostrum Neonatal Isoerythrolysis Pathogenesis Foal inherits specific RBC Ag from the sire Dam does not have these Ag Dam previously sensitized Placental bleeding - previous pregnancies Previous whole blood transfusion Equine biologics Plasma contaminated with RBC Ag Neonatal Isoerythrolysis Pathogenesis Current pregnancy mare re-exposed Mounts antibody response Concentrates antibodies in colostrum Foal absorb the colostral Abs Hemolytic Anemia Neonatal Isoerythrolysis Pathogenesis 32 blood group antigens in horses Aa and Qa 90% of the reactions R and S groups most of the rest Based on gene frequencies TB, QH, Saddlebred, - Qa & Aa Standardbred, Morgan - Aa (not Qa) Arabian - Qa Neonatal Isoerythrolysis Clinical signs Onset 8-120 hours old Depends on amount of antibody absorbed Titer in colostrum Amount ingested More antibody absorbed More rapid the onset More severe the disease Neonatal Isoerythrolysis Peracute disease Severe, acute anemia (massive hemolysis) No hypoxemia Tissue hypoxia Metabolic acidosis MODS Neonatal Isoerythrolysis Peracute disease Normal at birth Sudden onset Weakness Tachycardia Tachypnea Collapse Neonatal Isoerythrolysis Peracute disease Neurologic derangement Fever or hypothermia Cardiovascular collapse Shock Death - often before icteric Neonatal Isoerythrolysis Acute disease Normal at birth Progressive weakness Icterus (may become -
Autoimmune Hemolytic Anemia in COVID-19 Patients, the « Transmissible » Direct Coombs Test
J H C R JOURNAL OF HEMATOLOGY 2640-2823 AND CLINICAL RESEARCH Research Article More Information *Address for Correspondence: Alice Brochier, Hematology Department of Laboratory Medicine, Autoimmune hemolytic anemia in Saint-Luc University Hospital, Avenue Hippocrate 10, 1200 Brussels, Belgium, Tel: +322764 6814; COVID-19 patients, the « transmissible » Email: [email protected]; Véronique Deneys, Hematology Department of Laboratory Medicine, Saint-Luc University direct Coombs test Hospital, Avenue Hippocrate 10, 1200 Brussels, Belgium, Email: [email protected] Alice Brochier1*, Julien Cabo1, Claudine Guerrieri1, Leïla Belkhir2, Submitted: March 24, 2021 3 1 Pierre-François Laterre and Véronique Deneys * Approved: April 06, 2021 Published: April 07, 2021 1Hematology Department of Laboratory Medicine, Saint-Luc University Hospital, Brussels, Belgium 2Department of Internal Medicine and Infectious Diseases, Saint-Luc University Hospital, Brussels, How to cite this article: Brochier A, Cabo J, Guerrieri C, Belkhir L, Laterre PF, Deneys V. Belgium Autoimmune hemolytic anemia in COVID-19 3 Department of Intensive Care Medicine, Saint-Luc University Hospital, Brussels, Belgium patients, the « transmissible » direct Coombs test. J Hematol Clin Res. 2021; 5: 004-008. Abstract DOI: 10.29328/journal.jhcr.1001016 Copyright: © 2021 Brochier A, et al. This Background: Like other viruses, the SARS-CoV-2 (severe acute respiratory syndrome is an open access article distributed under coronavirus 2) appears to be responsible for several autoimmune complications. The occurrence the Creative Commons Attribution License, of autoimmune hemolytic anemia has been described in several case reports. This AIHA was also which permits unrestricted use, distribution, noticeable by the important number of blood transfusions required for COVID-19 (coronavirus and reproduction in any medium, provided the disease 2019) patients. -
Occurrence, Hematologic and Serum Biochemical Characteristics of Neonatal Isoerythrolysis in Arabian Horses of Iran
Archive of SID Original Paper DOI: 10.22067/veterinary.v1-2i10-11.71821 Received: 2018-Mar-27 Accepted after revision: 2018-Aug-07 Published online: 2018-Sep-26 Occurrence, hematologic and serum biochemical characteristics of neonatal isoerythrolysis in Arabian horses of Iran a a a Seyedeh Missagh Jalali, Mohammad Razi-Jalali, Alireza Ghadrdan-Mashhadi, b Maryam Motamed-Zargar a Department of Clinical Sciences, Faculty of Veterinary Medicine, Shahid Chamran University of Ahvaz, Ahvaz, Iran b Graduated student of Veterinary Medicine, Faculty of Veterinary Medicine, Shahid Chamran University of Ahvaz, Ahvaz, Iran Keywords assessment, the foal with hemolytic anemia showed neonatal isoerythrolysis, hemolytic anemia, Arabian horses, a major decline in hematocrit, hemoglobin concen- Khouzestan tration and erythrocyte count along with considerable leukocytosis and neutrophilia. Serum total and direct Abstract bilirubin concentrations in the NI case was about ten times higher than in the rest of the foals. This study Neonatal isoerythrolysis is a major cause of ane- revealed that neonatal isoerythrolysis can occur in Arabian mia in newborn foals. However, there are no docu- foals of Khouzestan and is associated with severe anemia mented data regarding the occurrence of neonatal and icterus which may lead to death. These findings can be isoerythrolysis in Arabian horses of Iran, which are beneficial in the establishment of preventive measures in mostly raised in Khouzestan province. Hence, this Arabian horse breeding industry in the region, as well as study was carried out to investigate the occurrence of improving therapeutic methods. neonatal isoerythrolysis in Arabian horses of Khou- zestan and assess the hematologic and serum bio- chemical profile of affected foals. -
Package Insert
Anti-Human Globulin Anti-IgG IH-Card AHG Anti-IgG (Rabbit)(Green)_____________________________________________________________________ English, B186359, Version 07, 2016.07 FOR IN VITRO DIAGNOSTIC USE Gel card for use with the IH-System MEETS FDA POTENCY REQUIREMENTS U.S. LICENSE NUMBER: 1845 Product-Identification: 74020 IH-Card AHG Anti-IgG: VOL 12 cards per box............ REF 813 420 100 VOL 48 cards per box............ REF 813 421 100 VOL 288cards per box........... REF 813 422 100 INTENDED USE The IH-Card AHG Anti-IgG is intended for the detection of antibodies on human red blood cells using the Direct and Indirect Antiglobulin Tests. SUMMARY Moreschi first described the use of Anti-Human Globulin in 1908.1 Coombs rediscovered the test in 1945.2,3 By injecting rabbits with human IgG, they were able to produce a protein (Anti-IgG) that reacted with ˝incomplete˝ antibodies (IgG). Most ˝incomplete˝ antibodies (IgG) fail to agglutinate red blood cells suspended in saline.4 Most clinically significant antibodies in red blood cell serology are of the IgG class and can only be detected by the use of Anti-IgG. The IH-Card AHG Anti-IgG is suitable for the Direct and Indirect Antiglobulin Tests. The Direct Antiglobulin Test allows the detection of in vivo sensitization of human red blood cells with immunoglobulins. The Indirect Antiglobulin Tests allows the detection of in vitro sensitization of human red blood cells with clinically significant antibodies. The Indirect Antiglobulin Test may be used for antibody detection, identification, IAT crossmatching , and D variant testing. An optional autocontrol may help to distinguish autoantibodies and alloantibodies. -
Giant Cell Hepatitis with Autoimmune Hemolytic Anemia; a Case Report
Iran J Pediatr Case Report Dec 2009; Vol 19 (No 4), Pp:421-424 Giant Cell Hepatitis with Autoimmune Hemolytic Anemia; a Case Report Mehri Najafi1, MD; Vajiheh Modarresi*1, MD; Kambiz Eftekhari1, MD; Fatemeh Mahjoub2, MD; Mina Izadyar1, MD 1. Department of Pediatrics, Children’s Medical Center, Pediatrics Center of Excellence, Tehran University of Medical Sciences, Tehran, IR Iran 2. Department of Pathology, Tehran University of Medical Sciences, Tehran, IR Iran Received: Jan 30, 2009; Final Revision: Apr 25, 2009; Accepted: May 22, 2009 Abstract Background: Giant cell hepatitis (GCH) is a histological finding in infants with neonatal cholestasis and rarely can be seen after this period. Autoimmune hemolytic anemia (AIHA) which is characterized by massive and acute red blood cell destruction due to antibody production, responds favorably to corticosteroid therapy. The combination of GCH and AIHA is a rare distinct entity that carries poor response to immunosuppressive therapy and often progresses to fatal liver disease. Case Presentation: A 13‐month‐old boy was referred to us with anemia and icterus. Investigations confirmed the diagnosis of GCH which was associated with AIHA. Treatment with steroids and azathioprin failed. We changed to cyclosporine. The anemia improved by steroid and IVIG at the beginning, but few months later anemia relapsed. Finally he recovered with rituximab and now he is 6 years old in suitable condition. Conclusion: The association of AIHA with GCH is an uncommon condition that can be life threatening. Most patients initially respond to immunosuppressive agents, but usually recur and have an aggressive course. In this case liver disease responded to steroid and immunosuppressive therapy, but the AIHA was refractory to immunosuppressive therapy. -
Dr* Robert Hillman Cares for a Newborn with Assistance from Judy Chapman
Dr* Robert Hillman cares for a newborn with assistance from Judy Chapman. DO YOU HAVE A 'PREEMIE1? The perinatal period for the equine has been defined as the period from Day 300 of gestation, generally considered to be the lowest By Pamela Livesay-Wilkins '86 limit of viability, to 96 hours post-partum, "ith Special Thanks to Dr. Diane Craig when the foal is considered to have reached a steady state of body functions, recovering from the stresses of birth. Events in the fetus and in the mother need to be closely coordinated so There are times when the mother and the that the mother will give birth to a full-term, ^ tus are prepared for birth at different stages mature foal that is capable of survival outside ?f gestation. When it happens that the mother the uterus. However, there are a variety of ls ready first, the foal may be born premature. conditions that can occur and indicate that the Approximately 1% of all Thoroughbreds are mother and fetus were not equally prepared for “orn prematurely, and the incidence approaches birth. Most forms of prematurity have a this value in most other breeds, so it isn't common cause with abortion and the distinction surprising that most active horse breeders have between them is rather arbitrary, based t° deal with the problem of a premature foal at primarily on the prospect for fetal survival and some point. In the last decade the value of gestational age of the fetus. Chronic placental horses, particularly Thoroughbreds, has insufficiency due to twinning, body pregnancy Increased tremendously, reflected by an (pregnancy located in the body of the uterus increased interest on the part of both the rather than in one of the uterine horns), veterinarian and the client in neonatal critical umbilical cord abnormalities, hydrops of the care and management techniques. -
D:\My Documents\Vet Alumnus
For Private Circulation Only Vol. XXXVIII (No. 2) December, 2016 Vet Alumnus Vol. XXXVII (No. 2) December, 2016 1 ISSN 2319-5762 Editor: Dr. Amarjit Singh Associate Editor: Dr. Jaswinder Singh Vet Alumnus Vol. XXXVII (No. 2) December, 2016 2 CONTENTS 1. SOME ANATOMICAL DIFFERENCES IN STIFLE 1 JOINT OF BUFFALO AND CATTLE VARINDER UPPAL, NEELAM BANSAL, ANURADHA GUPTA AND OPINDER SINGH 2. BUSINESS OPPORTUNITIES FOR VETERINARIANS IN INDIA 5 MK GUPTA AND HK VERMA 3. CLASSICAL SWINE FEVER-DREADLY DISEASE IN PIGS 11 V. MAHAJAN, G. FILIA, M. S. BAL AND AMARJIT SINGH 4. CRYSTALLOID PLUS COLLOID BASED FLUID THERAPY 14 FOR DYSTOCIA AFFECTED BUFFALO SARVPREET SINGH GHUMAN 5. HOW TO PREPARE YOUR DOG FOR A DOG SHOW 16 KIRTI DUA 6. ULTRASONOGRAPHY: A ROBUST TOOL TO IDENTIFY 21 SUB-FERTILITY IN BREEDING BULLS KHUSHPREET SINGH, AJEET KUMAR AND BILAWAL SINGH 7. LAMENESS IN YOUNG DOGS 24 VANDANA SANGWAN AND YASEEN MOHD SHEIKH JANI 8. PHYSICAL OCCUPATIONAL HEALTH HAZARDS IN VETERINARY 27 PRACTICE AND THEIR MANAGEMENT RAJESH KASRIJA AND SIMRANPREET KAUR 9. POLICY AND STRATEGY FOR GENETIC IMPROVEMENT OF 32 DAIRY ANIMALS IN PUNJAB SIMARJEET KAUR, P.K. SINGH* AND P.S. BRAR 10. A BRIEF INTRODUCTION ON BLOOD GROUPS IN EQUINES 41 AND NEONATAL ISOERYTHEOLYSIS. RABYIAJAVED, PH.D SCHOLAR Note : Authors are sole responsible for the contents given in articles Vet Alumnus Vol. XXXVII (No. 2) December, 2016 3 SOME ANATOMICAL DIFFERENCES IN STIFLE JOINT OF BUFFALO AND CATTLE VARINDER UPPAL, NEELAM BANSAL, ANURADHA GUPTA AND OPINDER SINGH Department of Anatomy, GADVASU, Ludhiana The stifle joint is the largest and most complex and modified hinge joint. -
Proposal for Crossmatch Project 18.10.12.Docx
Aus der Klinik für kleine Haustiere des Fachbereichs Veterinärmedizin der Freien Universität Berlin Studies in feline pre-transfusion testing: Evaluating a novel blood typing device and serial cross-matching in transfusion patients Inauguraldissertation zur Erlangung des Grades eines Doktors der Veterinärmedizin an der Freien Universität Berlin Vorgelegt von Layla Hourani Tierärztin aus Rostock Berlin 2017 Journal-Nr.: 3990 Gedruckt mit Genehmigung des Fachbereichs Veterinä rmedizin der Freien Universitä t Berlin Dekan: Univ.-Prof. Dr. Jürgen Zentek Erster Gutachter: Univ.-Prof. Dr. Barbara Kohn Zweiter Gutachter: Univ.-Prof. Dr. Heidrun Gehlen Dritter Gutachter: Univ.-Prof. Dr. Robert Klopfleisch Deskriptoren (nach CAB-Thesaurus): blood type, blood typing, cat, cross-matching, pre- transfusion testing, point-of-care, transfusion medicine, transfusion safety Tag der Promotion: 19.07.2017 2 To Friedolin, Krikri, Molly, Spotty and the old gibbon couple at Sababurg Zoo 3 Table of contents LIST OF ABBREVIATIONS.....................................................................................................................6 TABLES AND FIGURES .........................................................................................................................7 1 INTRODUCTION ...........................................................................................................................8 1.1 HISTORY OF TRANSFUSION MEDICINE AND TRANSFUSION SAFETY .......................................................9 1.2 PATIENT SAFETY IN