Basophil activation test for allergic and febrile non‐haemolytic transfusion reactions among paediatric patients with haematological or oncological disease

Abstract

Background and Objectives: Allergic transfusion reactions (ATRs) and febrile nonhaemolytic transfusion reactions (FNHTRs) are common, although their mechanisms remain unclear. Immunoglobulin E (IgE)-mediated type I hypersensitivity may be involved in the pathogenesis of ATR. A basophil activation test (BAT) may help elucidate this process. Materials and Methods:The BAT was based on peripheral blood samples from paediatric patients with a haematological or oncological disease and on samples of residual blood products transfused in each case. Dasatinib was used to evaluate whether basophil activation was mediated by an IgE-dependent pathway.Results: Twenty-seven patients with and 19 patients without ATR/FNHTR were included in this study, respectively. The median BAT values associated with ATR-(n = 41) and FNHTR-causing (n = 5) blood products were 22.1% (range = 6.1%-77.0%) and 27.8% (range = 15.2%-47.8%), respectively, which were higher than the median value of 8.5% (range = 1.1%-40.9%) observed in blood products without a transfusion reaction.Dasatinib suppressed basophil activity. BAT values were comparable in patients with ATR regardless of severity. Meanwhile, BAT values analysed with blood products non-causal for ATR/FNHTR were higher in patients with ATR/FNHTR than in those without. Conclusion:The IgE-mediated type I hypersensitivity may be involved in the pathogenesis of ATR and FNHTR. BAT analyses may help elucidate the underlying mechanisms and identify patients at risk.

Fever accompanied by basophil activation in response to transfused blood products in an adult patient

“…Although BAT is generally used to diagnose common forms of type 1 immunoglobulin E (IgE)-mediated allergy, a few studies have recently examined its utility in detecting ATRs. 3 In the present case, BAT was performed by incubating the patient's peripheral blood with the relevant RBC products to induce a febrile reaction, which confirmed basophil activation (Figure 1B). Although multiple blood products were transfused for this patient during surgery, no TR developed, and results of BAT for these products were negative (Figure 1C-F).…”

“…2 Meanwhile, a previous study also reported that basophil activation was observed even in FNHTR cases. 3 Therefore, fever caused by blood products might be related to allergic mechanisms even in cases of suspected FNHTR, such as the present case. This may also be one of the reasons for the high incidence of FNHTR even after the standardization of prevention strategies employing prestorage leukocyte reduction.…”

“…The method has been described in detail in a previous paper. 3 A cursor was set at 5% positive of CD203c on the histogram of the negative control (in the histogram depicting each condition, the lightest gray (dotted line) denotes the negative control, which was prepared by adding phosphate-buffered saline instead of blood products). The blood products used in assays shown in B-F are the blood product residues that were transfused to the same patient.…”

“…BAT might be a useful tool even in posttransfusion fever diagnosis, despite the challenges of analysis in patients with low white blood cell counts. 3 However, the usefulness of BAT in blood transfusion and its role in the overall TR should continue to be carefully evaluated.…”

Pilot study on the use of basophil activation tests and skin tests for the prevention of allergic transfusion reactions

“…Previous studies set forth the utility of BAT as a functional test in transfusion medicine by using healthy individuals and patients with a history of ATR ( Table 3 ) ( 2 , 5 , 13 – 20 ). It was used to assess the causal relationship between transfusion and ATR and to examine the mechanisms of the reaction ( 2 , 5 , 13 , 21 ).…”