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Transfusion support with RBCs from an M k homozygote in a case of autoimmune hemolytic anemia following diphtheria‐pertussis‐tetanus vaccination
Author(s) -
Johnson Susan T.,
McFarland Janice G.,
Kelly Kevin J.,
Casper James T.,
Gottschall Jerome L.
Publication year - 2002
Publication title -
transfusion
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.045
H-Index - 132
eISSN - 1537-2995
pISSN - 0041-1132
DOI - 10.1046/j.1537-2995.2002.00093.x
Subject(s) - autoimmune hemolytic anemia , medicine , tetanus , immunology , vaccination , diphtheria , autoantibody , anemia , hemolytic anemia , blood transfusion , antibody
BACKGROUND : Autoimmune hemolytic anemia (AIHA) in children, although unusual, is often associated with recent infection. Several reports have identified the diphtheria‐pertussis‐tetanus (DPT) vaccination as a possible trigger for AIHA. STUDY DESIGN AND METHODS : Life‐threatening AIHA was diagnosed in a 6‐week‐old infant 5 days after receiving a DPT vaccination. The patient required daily transfusion and/or exchange transfusion for 3 weeks. RBCs from an M k homozygote were found compatible with the patient's autoantibody. Transfusion of RBCs from an M k homozygote and later RBCs from an individual (K.T.) with a variant glycophorin, Mi.VII, were required to sustain the patient's Hb level until autoantibody production ceased, as evidenced by a fall in antibody titer and the patient's Hct returning to normal. RESULTS : The DAT was positive (3+) with only anti‐C3 on presentation. An IgM cold reactive autoantibody with probable anti‐Pr specificity and high thermal amplitude (37°C) was identified in the serum. The DAT was no longer positive after transfusion with compatible blood. CONCLUSION : This case represents life‐threatening AIHA in an infant, temporally related to a DPT injection and responsive to a combination of immunosuppression and transfusion of rare compatible blood.