FNHTR and Bg antibodies

[RL0121]

Patient had multiple transfusions 2 mos ago (open heart) but had a reaction (febrile) last night after second RBC transfusion. I'm reviewing the path report, our doc recommended use of washed RBC's. We only use leureduced RBC . I'm not sure if the patient can actually benefit from washed RBC's other than leukopoor RBC's shes getting from us. Patient is not know to be Ig A deficient.

This patient also has strong rouleaux at IS and at 37 C. Saline replacement was recommended by our Ref. lab.

If a patient developed an HLA type antibody, is washing of red cells going to eliminate the problem?

Like in the case of Bga antibody?

He also asked if short date units would be beneficial for our patient ??

[David Saikin]

I don't think washed cells are the answer . . . even with leukoreduced rbcs we still will have a rare febrile rx (1 every 2 yrs). . . I'd wait it out and see if your pt has further rxs of this type in the future. I's sure this was a great deal of help in answering your question. Short dated units would probably NOT be the best thing - too much residual wbc (and other) "junk".

[RL0121]

He realized that afterwards but suggested hopefully in the future leukofree and not lekoreduced only rbc will be available .

[David Saikin]

If you run those leukoreduced through another leukoreduction filter they will be almost leukofree (personal observation)

[Yanxia]

Patient had multiple transfusions 2 mos ago (open heart) but had a reaction (febrile) last night after second RBC transfusion. I'm reviewing the path report, our doc recommended use of washed RBC's. We only use leureduced RBC . I'm not sure if the patient can actually benefit from washed RBC's other than leukopoor RBC's shes getting from us. Patient is not know to be Ig A deficient.

This patient also has strong rouleaux at IS and at 37 C. Saline replacement was recommended by our Ref. lab.

If a patient developed an HLA type antibody, is washing of red cells going to eliminate the problem?

Like in the case of Bga antibody?

He also asked if short date units would be beneficial for our patient ??

The fever can be anti-HLA , anti-HNA , anti-RBC antigen or anti-plasma protein, washed RBCS can reduce the reaction to plasma protein, as you say, the transfused RBC has been leukoreduced , so your doc maybe want to reduce the plama protein reaction.

But if the reaction is against RBC antigen, such as Bga , wash will not successful, the only way is to find it out ,and transfuse antigen neg cells.

[Malcolm Needs ☆]

Bg(a) is not a RBC antigen, but may be adsorbed onto the red cell surface from the plasma. I think that the physician may want washed RBCs to try to get rid of the Bg(a) in the plasma, but it will not get rid of the Bg(a) antigen adsorbed from the plasma (see Bg(a+) RBC on washed screening and panel cells), and so would be a rather expensive waste of time.

[DOGLOVER]

Iwould not wash for one reaction. If pre-meding (new word) doesn't work and the patient continues to have febrile reactions then maybe washing could be worth a try. Is your doc that requested it, an experienced Blood Banker or was he/she just covering? In 35+ years of Blood Banking I have only seen two or three patients that required washing. One was IgA deficient and the other had febrile reactions and most everyone thought that the resutls were mostly in her head anyway. Kind of like the A pos patient who said she got reactions to A neg blood and that God tole her not to get any more A neg units. Who were we to argue? Made sure she always got A pos.

[Abdulhameed Al-Attas]

It is now clear that FNHTRs are commonly caused by cytokines, such as interleukin (IL)-1, IL-8, and tumor necrosis factor-alpha (TNFa). These cytokines are generated and accumulate during the storage of blood components.

It has been proposed that an interaction between donor leukocytes and recipient antibody leads to interleukin-1 (IL-1) release from donor leukocytes or recipient monocytes. IL-1 can then cause fever by stimulating prostaglandin E2 production in the hypothalamus.

Cytokine accumulation is reduced by prestorage leukocyte reduction,but bcause prestorage leukoreduction cannot prevent the accumulation of some biological response mediators in cellular components such as IL-8, C3a, and C4a, an additional approach to preventing FNHTR associated with cellular components may be to remove the plasma just prior to transfusion. Currently this strategy is not routinely used, although it has been shown to be effective in preventing severe reactions to cellular component,we have tried successfully several times.

[Mabel Adams]

Wouldn't there be a lot of variability in the amount of cytokines present between donor units? Then it seems like you couldn't predict whether the patient will react to just one donor or to several. Washing seems pretty extreme if it was just a response to one odd donor. Of course, we have to get washed cells from our supplier several hours away and they will expire in 24 hrs so it is a bigger deal for us than it might be for a big place with the ability to wash cells themselves.

[tbostock]

We would also not request washed cells for just one febrile reaction. In our case, most of our "febrile" reactions are just coincidental. Patient was sporadically febrile, and just happened to have another one during or after a transfusion.

With repeated febrile reactions, we would try washed.