Use of red cells preserved in extended storage media for exchange transfusion in anti‐k haemolytic disease of the newborn

Abstract

Anti-k is a Kell-related antibody. There is little correlation between the maternal antibody titre and the severity of haemolytic disease of the foetus and newborn, and anaemia is usually associated with low bilirubin levels. Severe erythroblastosis has been reported with a low titre anti-k (IAT 8-16). We report a case of severe haemolytic disease of the newborn (HDN) due to anti-k. HDN was associated with a normal bilirubin level and reticulocytopenia. The foetus was monitored by ultrasound, and delivery by elective caesarean section (CS) was planned. The mother was admitted 1 week before the expected date of delivery, and the infant was delivered by urgent CS. The infant required exchange transfusion. As suitable plasma-reduced (k antigen(-)) red cell units were not readily available, k- SAGM red cell units (preserved in extended storage media: SAGM sodium chloride, adenine, glucose and mannitol) were provided. The post-transfusion Hb remained stable, and the infant did not require further transfusion support. Our findings (reticulocytopenia and normal bilirubin levels) support the hypothesis that the pathogenesis of anaemia and haemolysis in anti-k HDN may be similar to that in anti-K (suppression of erythropoesis and immune destruction of K+ erythroid progenitor cells by macrophages in the foetal liver). The ideal product for exchange transfusion is plasma-reduced RBC, less than 5-days old. We provided a 4-day-old SAGM red cell unit for exchange transfusion in a term infant, and this was uneventful. Caution should be taken, however, and renal function and electrolyte levels should be monitored closely. More information is required regarding the safety of SAGM units for exchange transfusion.

SAGM blood for neonatal large volume transfusion

“…No studies could be found assessing DE with SAGM versus CPD blood in LVT. A case report by Win et al 10 . did however note the use of SAGM blood for neonatal ET, without any adverse effects (although renal function was closely monitored).…”

A new preparation method for red blood cells for intrauterine transfusion enabling reduction of donor exposure

“…From 100‐ and 200‐mL donations, RBCs of approximately 40 and 80 mL with Hct levels of 0.80 to 0.88 L/L, respectively, were prepared with comparable or better in vitro storage properties than reference RBCs for IUT prepared from LR RBCs. The preparation process was further improved by avoiding the removal of adenine and mannitol (from SAGM) from the LR RBCs, substances that have possible renal toxicity in fetuses and preterm infants …”

“…The preparation process was further improved by avoiding the removal of adenine and mannitol (from SAGM) from the LR RBCs, substances that have possible renal toxicity in fetuses and preterm infants. 11 Variables of special attention were hemolysis, extracellular potassium, and anti-A/-B titers, which all should be as low as possible. Hemolysis was always well below the limit of international guidelines (<0.8% in Europe) during the 6-and 24-hour storage period.…”

Kell Blood Group System Polymorphism in an Urban Tunisian Population

“…The most important is the KEL1 (K, ''kell'') antigen; anti-KEL1 is a commonly encountered allospecificity capable of causing hemolytic transfusion reactions, hemolytic disease of the fetus and newborn, and neonatal anemia (Win et al 2005). Besides peripheral immunologic clearance of anti-KEL1 sensitized RBCs, it has been reported that these antibodies are able to induce myelosuppression, probably contributing to the anemia observed in anti-KEL1-mediated hemolytic disease of the fetus and newborn (Körmöczi et al 2009).…”