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Erythrocyte T‐antigen activation in children: Patient characteristics and the hemolytic risk of transfusion
Author(s) -
Jacquot Cyril,
Pary Philippe P.,
Babu Varshini,
Belay Ezana,
Mo Yunchuan D.,
Webb Jennifer L.,
Luban Naomi L. C.,
Delaney Meghan
Publication year - 2021
Publication title -
pediatric blood and cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.116
H-Index - 105
eISSN - 1545-5017
pISSN - 1545-5009
DOI - 10.1002/pbc.29082
Subject(s) - medicine , hemolysis , hemolytic anemia , schistocyte , immunology , anemia , agglutination (biology) , platelet , hemoglobin , antigen , gastroenterology , thrombotic thrombocytopenic purpura
Background T‐antigen activation usually occurs upon red blood cell (RBC) membrane cryptantigen exposure due to bacterial enzymes. Although uncommon, the condition is probably underrecognized. There is concern about hemolysis after plasma and plasma‐containing platelet transfusions due to naturally occurring anti‐T antibody in healthy blood donors. However, experts have debated the extent and severity of clinical hemolysis due to anti‐T. Procedure We retrospectively identified patients who tested positive for polyagglutination with Arachis hypogea and Glycine max lectins from 2008 to 2019. The records of the patients were reviewed to determine clinical symptoms, laboratory evidence of hemolysis, need for transfusion, and clinical outcomes. Results Ten patients were identified. At diagnosis, all were anemic and four had thrombocytopenia. Severe Streptococcus pneumoniae infection affected seven patients; one died. Seven of 10 patients (70%) had laboratory evidence of hemolysis. Peripheral blood smear findings in six patients included RBC agglutination and changes suggesting hemolysis (spherocytes and schistocytes), but three had unremarkable RBC morphology. Four patients required plasma or platelet transfusions; all survived to discharge. Conclusions T‐antigen activation is a rare entity. Most patients diagnosed at our hospital had hemolytic anemia and severe pneumococcal infection. Hemoglobin decreased after plasma and platelet transfusions in all patients assessed, but these transfusions were necessary to support treatment. RBCs were given to maintain appropriate hemoglobin levels.