International Forum on Blood Transfusion in Premature or Young Infants with Polyagglutination and Activation of the T Antigen

It is known from the literature that severe haemolytic transfusion reactions may occur in premature infants or young children with an activated T antigen when they are transfused with blood or plasma-containing blood components from donors with strong anti-T. It has come to our attention that in some transfusion centres, the provision of blood or blood components for such infants or children is considered to be a transfusion problem. It seemed worthwhile to obtain information on the subject via a short International Forum. The following questions were submitted to 18 colleagues who might have experience with this problem. Unfortunately, we have been able to obtain only 8 answers. (1) Do you screen infected infants for polyagglutination and T activation or only infants with necrotizing enterocolitis or none at all? (2) Do you think that there is a need for blood banks/transfusion centres to screen for donors with anti-T in low titres? (3) Do you think that blood banks/transfusion centres should be able to provide blood or plasma-containing components with anti-T in low titre? Question 1:In two centres, children with necrotizing enterocolitis are routinely screened for polyagglutination and T activation (Martin-Vega, Gibson). In two other centres, infants are screened in selected cases: either because an infant with sepsis or necrotizing enterocolitis has symptoms of increased haemolysis (Strauss) or because, after a transfusion with plasma-containing components, an infant has symptoms of increased haemolysis or there is failure to achieve the expected posttransfusion haemoglobin level (Luban). In the other centres, no screening is done at all because no cases of haemolysis after transfusion due to T activation have been seen in years. Question 2:A stock of fresh frozen plasma with anti-T in low titre is available in one centre and children with T activation are only transfused with washed red cells. However, for platelet transfusions donors are not selected (Gibson). No stock of fresh frozen plasma or a special panel of donors with anti-T in low titre are available in any of the other centres, but the formation of such a stock or panel is advocated by one contributor (MartinVega). In two centres, donors with low-titre anti-T are selected ad hoc prior to transfusion of infants with activated T (Strauss, Luban). Incidentally, there does not seem to be a clear definition of low-titre anti-T, but in one centre anti-T with a titre not greater than 1 in saline is considered suitable [Strauss, pers. commun.]. Question 3:As can be concluded from the answers to question 2, those contributors to the Forum who see cases of increased haemolysis due to T activation are of the opinion that this should indeed be the case, although it is mostly felt that such donors can be selected when transfusion is in fact needed. In conclusion, although not many contributions to the Forum were obtained, it seems clear that problems in infants or young children due to T activation are rare. The provision of blood or plasma-containing components for such children is considered a transfusion problem in only a few centres. Routine screening for T activation is not done anywhere, but selected cases are screened in three centres. A problem in selecting cases for screening, when no transfusion problems have occurred, seems to us the absence of anti-T in infants and very young children who therefore may have strong T activation without any symptoms of increased haemolysis. No panels of fresh frozen plasma or donors with anti-T in low titre are available, such donors rather being selected ad hoc. One reason is that it is not known whether the titre of anti-T is stable over time.