Discriminating complement‐mediated acute transfusion reaction for type O+ red blood cells transfused into a B+ recipient with the complement hemolysis using human erythrocytes (CHUHE) assay

Abstract

These results indicate that hemolytic complement testing with the CHUHE assay can be used to assess the risk of antibody-initiated, complement-mediated hemolysis from a transfusion beyond what can be achieved with antibody titers alone.

Challenges in the treatment and prevention of delayed hemolytic transfusion reactions with hyperhemolysis in sickle cell disease patients

“…Consistent with this, prior observations suggest that many incompatible RBC transfusions fail to result in a hemolytic transfusion reaction, highlighting that the outcome of incompatible RBC transfusion even when the target antigen is known can be quite varied . Recent tools have been developed, including the monocyte monolayer assay, to aid in the prediction of adverse events following RBC transfusion . Unfortunately, many of these tests do not lend themselves to rapid turnaround time and/or do not accurately predict in vivo hemolytic potential, reducing their utility in the management of patients at risk for or acutely experiencing hemolytic events.…”

“…43,44 Recent tools have been developed, including the monocyte monolayer assay, to aid in the prediction of adverse events following RBC transfusion. [45][46][47] Unfortunately, many of these tests do not lend themselves to rapid turnaround time and/or do not accurately predict in vivo hemolytic potential, reducing their utility in the management of patients at risk for or acutely experiencing hemolytic events. Ultimately, the varied nature of RBC antigens coupled with incompletely understood recipient factors that likely influence the outcome of DHTRs make it difficult to predict what approach, if any, may be optimal in a given patient.…”

Seasonal variability is not observed in the rates of high anti‐A and anti‐B titers in plasma, apheresis platelet, and whole blood units tested by different methods

“…While a significant number of units have a titer greater than 50, the proportion of high‐titer units is higher than the reported rates of hemolysis . Perhaps other antibody tests, such as in vitro tests that attempt to identify antibodies with a high hemolytic potential through complement binding, could also be employed in addition to performing titers when deciding on which units to issue to patients of unknown ABO group . Thus, higher titer cutoffs may be acceptable, and given the recent recommendation to adopt a titer threshold of less than 256 for potentially incompatible plasma‐containing products centers that transfuse products containing ABO‐incompatible plasma may consider screening all potentially incompatible units to help prevent hemolysis, with the understanding that the method and definition of high titer may impact product availability.…”

Who's afraid of incompatible plasma? A balanced approach to the safe transfusion of blood products containing ABO‐incompatible plasma

“…The monocyte monolayer assay shows some promise in distinguishing between clinically significant and insignificant alloantibodies of IgG type . Other in vitro assays, such as the recently described complement hemolysis using human erythrocytes (CHUHE) test, might also be useful in predicting the hemolytic potential of group A plasma . However, until more clinical correlations between the results of these assays and actual recipient outcomes can be made, antibody titration is the most accepted method available for predicting the risk of an HTR from ABO‐incompatible plasma transfusions.…”

“…37 Other in vitro assays, such as the recently described complement hemolysis using human erythrocytes (CHUHE) test, might also be useful in predicting the hemolytic potential of group A plasma. 38,39 However, until more clinical correlations between the results of these assays and actual recipient outcomes can be made, antibody titration is the most 41 Gel 64, 256 Cooling et al 6 Gel NT, 128 Quillen et al 42 Gel 250, NT Karafin et al 19 Gel 512 Pittsburgh, PA 16 Tube 100, NT UK national guidance 43 Automated Tube 34 Tube 50, NT accepted method available for predicting the risk of an HTR from ABO-incompatible plasma transfusions. Apart from the titer technique, selection of a titer threshold requires some cognizance of the potential impact that the threshold will have on the available donor pool; the lower the selected titer threshold, the fewer donors that are likely to be suitable.…”