Diagnosis of Cryptantigen Exposure and Polyagglutinability: Management of Transfusion Therapy in a Patient with Sepsis and Colitis

Abstract

The diagnosis of microbial-induced T (Thomsen-Freidenreich) red blood cell (RBC) cryptantigen exposure and polyagglutinability and management of transfusion therapy for such patients poses a potential clinical problem. These phenomena are often not detectable by standard cross-matching techniques and may go unrecognized unless specific testing prompted by the clinical setting is performed. Infusion of standard plasma-containing blood products (a rich source of IgM anti-T) may cause intravascular haemolysis, renal failure and death in some cases l. \ or be uneventfuP. Thus there is debate regarding the need for transfusion precautions 6 ,7. The lack of tests to predict those who will react adversely to plasma products further complicates this tissue. We report a case and discuss these findings and their impact on the management of a patient with complex medical and surgical problems. CASE REPORT A 69-year-old female was transferred to the intensive care unit from another institution with complications arising from cardiac surgery performed 45 days previously. Clinical examination and subsequent investigations revealed a sternal wound infected

RBC T activation and hemolysis: implications for pediatric transfusion management

“…Purified albumin concentrates and highly purified coagulation factor concentrates contain essentially no IgM 70 . Similarly, only trace amounts of IgM are present in preparations of IVIG 76 . Thus, exposure to anti‐T with these products is usually not an issue.…”

“…Some investigators have suggested that T‐activated RBCs that do not show in vitro polyagglutination with normal adult sera may not pose a hemolytic threat to the patient 28 . Screening plasma in advance with T‐activated reagent RBCs has also been proposed, 76 but human sera may show discordant anti‐T titers when tested with RBCs transformed with different microbes 1,79 …”