RBC T activation and hemolysis: implications for pediatric transfusion management

Crookston, Kendall P.; Reiner, Alex P.; Cooper, Laurence J.N.; Sacher, Ronald A.; Blajchman, Morris A.; Heddle, Nancy M.

doi:10.1046/j.1537-2995.2000.40070801.x

Cited by 60 publications

(116 citation statements)

References 80 publications

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“…Pneumococcus-derived neuraminidase removes neuraminic acid residues from surfaces of red blood cells, platelets, and glomeruli, and then exposes the hidden T antigen. Binding of anti-T antibodies to the T antigen leads to the characteristic features of HUS: hemolytic anemia, thrombocytopenia and renal failure [6,9,21]. T-antigen exposure was proved in our patients.…”

Section: Discussionmentioning

confidence: 54%

Hemolytic uremic syndrome associated with pneumococcal pneumonia in Taiwan

et al. 2006

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Streptococcus pneumoniae ( S. pneumoniae ) has been associated with hemolytic uremic syndrome (HUS), which is an unusual but serious disease in childhood. We conducted a retrospective review of children aged less than 18 years with S. pneumoniae -associated HUS in northern Taiwan from January 2000 to June 2005. The demographic characters, clinical courses, and outcomes were analyzed. Seven children (three girls, four boys) with S. pneumoniae -associated HUS were studied. The median age at onset of HUS was 40 months (range: 25-60 months). The median duration of hospital stay was 36 days (range: 15-50 days). The interval between the onset of illness attributable to S. pneumoniae and the development of HUS was around 1-2 weeks. The onset of oliguria developed within 2 weeks after illness. Six patients required dialysis with median duration of 16 days. Three patients had leukopenia as the initial presentation. All seven patients had pneumococcal pneumonia complicating with empyema, and two of them received decortication via video-assisted thoracoscopic surgery. Between patients who needed dialysis or not, there was no significant difference in age, sex, duration of thrombocytopenia, incidence of extra-renal complications, such as hepatitis, pancreatitis, and hypertension, and length of hospital stay. The seven patients survived with normal renal function. HUS is a potentially fatal complication of S. pneumoniae infection. Clinicians managing patients with pneumococcal pneumonia with empyema accompanied by leukopenia should beware of the development of HUS. The long-term prognosis for recovery of renal function appears to be good in these patients in northern Taiwan.

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Section: Discussionmentioning

confidence: 54%

Hemolytic uremic syndrome associated with pneumococcal pneumonia in Taiwan

et al. 2006

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“…It is unclear why these two children with Tactivation and hemolytic anemia did not develop thrombocytopenia or renal dysfunction. However, other reports have linked T-activation and hemolytic anemia without HUS [21,22,23,24]. A recent report by Cabrera et al [25] described an increased association of S. pneumonia and HUS.…”

Section: Discussionmentioning

confidence: 98%

“…The polyagglutination phenomenon associated with microbial enzymatic action is usually transient, clearing once the bacterial infection is controlled, and only rarely persisting for months [20]. Bacterial infection and T-antigen activation have been strongly associated with the characteristic features of HUS [21] and isolated hemolytic anemia [22,23,24].…”

Section: Introductionmentioning

confidence: 99%

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

Cochran

Panzarino

Maes

et al. 2004

Pediatric Nephrology

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The hemolytic uremic syndrome (HUS) is most commonly associated with Escherichia coli, but has been associated with other infections such as Streptococcus pneumoniae. Pneumococcus-induced HUS carries an increased risk of mortality and renal morbidity compared with E. coli-induced HUS. The pneumococcal organism produces an enzyme, which can expose an antigen (T-antigen) present on erythrocytes, platelets, and glomeruli. Antibodies to the T-antigen, normally found in human serum, bind the exposed T-antigen, and the resultant antigen-antibody reaction (T-activation) can lead to HUS and anemia. Clinicians need to be aware to request specific testing when pneumococcus-induced HUS/anemia is suspected, as current blood banking techniques do not routinely test for the presence of the T-antigen. Once this association is documented, washing all blood products and avoiding plasma products, if possible, is recommended. Plasmapheresis can be considered for the more critically ill patient. The incidence of pneumococcus-induced HUS may be increasing. We report six cases of pneumococcus-induced HUS/anemia presenting at our hospital.

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“…Bacteremia might not always be necessary for causing hemolysis, perhaps because of diffusion of the toxins from other sites, but it might also be that bacteria could not be found because antibiotic treatment had already been started. In the literature, it is discussed controversely whether or not transfusion of anti-T-containing blood products might cause hemolysis in patients with T-antigen activation [12][13][14]18]. Arguments against such a causative relationship are: i) anti-T belongs to the IgM class and will not react well at body temperature, and ii) causative bacteria can produce other potent hemolysing toxins (e.g.…”

Section: Discussionmentioning

confidence: 99%

“…As there are anti-T antibodies in the sera of virtually all adults, an antigen-antibody reaction in the case of T-antigen activation might cause damage to RBCs and to vascular endothelial cells, followed by disseminated intravascular coagulation and renal impairment [11]. However, the clinical relevance of T-antigen activation as a cause of intravascular hemolysis has been called into question in the last time [12][13][14]. Nevertheless, it is important to recognize T-antigen activation as it may be an interesting diagnostic marker for the differential diagnosis of acute hemolysis in critically ill patients.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic Importance and Difficulties in Testing of T-Antigen Activation

Strobel¹

2002

Transfus Med Hemother

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Background: In vivo T-antigen activation is a rare phenomenon caused by the effect of microbial sialidase on red blood cells (RBCs). Its pathogenetical relevance for acute hemolysis is discussed controversely. Patients and Methods: Two of the 3 patients were neonates that suffered from necrotizing enterocolitis. At the time when they were transferred to our hospital, one showed massive hemolysis, the other significant hyperbilirubinemia. The 3rd patient was an polytraumatized adult who showed sepsis and massive hemolysis 1.5 days after the accident. T antigen was tested in all these patients using Arachis hypogea lectins from two manufacturers and a Glycine soja lectin. Results : RBCs of both neonates showed positive reactions with the Arachis hypogea lectins from both manufacturers and with the Glycine soja lectin, whereas RBCs of the polytrauma patient had a positive reaction only with one of the Arachis hypogea lectin reagents (that with the higher titer) and did not react with the Glycine soja lectin. Bacteriological examinations revealed Clostridium butyricum in an intraoperative abdominal swab from one of the neonates. In the polytrauma patient, Clostridium perfringens could be isolated from three intraoperative swabs taken from different wounds. Conclusions: Hemolysis in critically ill patients may be caused by bacterial toxins, especially in cases of necrotizing enterocolitis or anaerobic wound infection. Detection of T-antigen activation on red blood cells may sometimes be helpful to draw attention to life-threatening infections in such patients and to distinguish them from other causes of acute hemolysis.

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RBC T activation and hemolysis: implications for pediatric transfusion management

Cited by 60 publications

References 80 publications

Hemolytic uremic syndrome associated with pneumococcal pneumonia in Taiwan

Hemolytic uremic syndrome associated with pneumococcal pneumonia in Taiwan

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

Diagnostic Importance and Difficulties in Testing of T-Antigen Activation

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