Ann Lab Med.  2015 Jul;35(4):436-444. 10.3343/alm.2015.35.4.436.

Red Blood Cell Transfusion in Patients With Autoantibodies: Is It Effective and Safe Without Increasing Hemolysis Risk?

• Park SH
• Choe WH
• Kwon SW

• KMID: 2045867
• DOI: http://doi.org/10.3343/alm.2015.35.4.436

Abstract

BACKGROUND
The therapeutic efficacy of red blood cell (RBC) transfusions in patients with autoimmune hemolytic anemia (AIHA) is highly debated because of speculations on the increased risk of transfusion reactions; yet it is a suggested adjuvant therapy in anemic patients with life-threatening hypoxemia. In this study, we evaluated the safety and efficacy of RBC transfusions in AIHA patients.
METHODS
Daily changes in hemoglobin, total bilirubin, and lactate dehydrogenase (LDH) were assessed in 161 AIHA patients without bleeding history who were transfused once with 1-5 units of the least-incompatible RBCs and monitored over a seven-day period. Post-transfusion patients positive for alloantibodies only or those without RBC-specific antibodies were considered as control groups (N=100 for both groups).
RESULTS
The three groups revealed similar increases in hemoglobin of 1.40-1.70 g/dL (autoantibodies), 1.20-1.60 g/dL (alloantibodies only), and 1.40-1.55 g/dL (no antibodies) for seven days following transfusion of 10 mL RBCs/kg. During follow-up, no significant changes in total bilirubin or LDH levels were detected in the AIHA group compared with controls. Influences due to autoantibody type, direct antiglobulin test (DAT) specificity and strength, and steroid therapy status on transfusion reactions were not evident in AIHA patients. In addition, changes in hemoglobin levels were significantly higher (P<0.001) in severe anemia (<5 g/dL) than in other patients.
CONCLUSIONS
Transfusion of the least-incompatible RBCs in AIHA patients is effective and safe without any associated increase in hemolysis risk when compared with post-transfusion patients positive for alloantibodies or those lacking RBC-specific antibodies.

Keyword

Autoantibodies; Effectiveness; Hemolysis; Red blood cell; Safety; Transfusion

MeSH Terms

Anemia
Anemia, Hemolytic, Autoimmune
Anoxia
Antibodies
Autoantibodies*
Bilirubin
Blood Group Incompatibility
Coombs Test
Erythrocyte Transfusion*
Erythrocytes
Follow-Up Studies
Hemolysis*
Hemorrhage
Humans
Isoantibodies
L-Lactate Dehydrogenase
Antibodies
Autoantibodies
Bilirubin
Isoantibodies
L-Lactate Dehydrogenase

Figure

• 

  Fig. 1 Comparison of hemoglobin changes (medians) at days 1 and 7 after transfusion of 10 mL RBCs/kg in the patients with autoantibodies with respect to (A) autoantibody type, (B) DAT specificity, (C) DAT strength in IgG, (D) DAT strength in C3d, (E) initial hemoglobin level, and (F) steroid therapy status.*P values were obtained from the Kruskal-Wallis test and †the Mann-Whitney U test.Abbreviations: RBC, red blood cell; DAT, direct antiglobulin test.

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