Polyagglutination in Hospitalized Patients: A Prospective Study

Abstract

A hospital population at high risk for red cell polyagglutination was studied prospectively in search for cryptantigen exposure. The patients included in this study suffered from: malignancies, sepsis, direct antiglobulin test (DAT) negative anemias and various combinations of these three. 238 patients were examined, and 18 of these (7.6%) were found to have exposed cryptantigens on their erythrocytes. This is an unexpectedly high percentage. Our findings suggest that cryptantigen exposure on the red cells is a more common phenomenon than previously described, especially when looked for in a carefully chosen population. The red cells of these patients are potentially polyagglutinable, and screening with lectins will ensure their pretransfusion identification and evaluation.

Pneumococcus-induced T-antigen activation in hemolytic uremic syndrome and anemia

“…Modern blood banking techniques have undergone methodological changes and the red cell T-activated agglutination-induced discrepancies are no longer detected during routine ABO/Rh red cell typing [50]. It is now necessary for the alert clinician to stage a deliberate effort to establish a diagnosis of red cell T-activation once it is suspected.…”

RBC T activation and hemolysis: implications for pediatric transfusion management

“…In vitro studies in patients with T activation do not support a role in which anti‐T causes fixation of complement that leads to hemolysis. Anti‐T reacts best at room temperature rather than at 37°C, and it does not appear to activate complement 28,37,42,43 . Except for a few early reports, the DAT has usually been negative in patients with T‐activated RBCs.…”

“…Because most of the reports in the literature use only peanut lectin to identify T activation, for clinical purposes it would seem appropriate to consider the related types together as one group. Classical T activation probably accounts for most of these reported cases 28 …”

“…This approach would not allow screening of plasma in advance of storage, and it requires that patient cells be polyagglutinable with normal sera. 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 …”

Pneumococcal Induced T-activation with Resultant Thrombotic Microangiopathy

“…2). 8,13,16 T-activation can be identified by the red cells’ reactions with the lectins derived from peanuts, Arachis hypogaea and their reactions with soybean lectin, Glycine soja 13,17,18. (Table 2).…”