Dara Ravi C, Tiwari Aseem Kumar, Arora Dinesh, Mitra Subhasis, Acharya Devi Prasad, Aggarwal Geet, Sharma Jyoti
Department of Transfusion Medicine, Medanta-The Medicity, Sector-38, Gurgaon, Haryana, India.
Asian J Transfus Sci. 2017 Jan-Jun;11(1):53-57. doi: 10.4103/0973-6247.200782.
Patients of β-thalassemia major are dependent on regular blood transfusions for their entire lifetime. Development of antibodies against red blood cell (RBC) antigen which may be alloantibody or autoantibody, several times as a result of frequent red cell component transfusions, further complicates the subsequent transfusion therapy. Among the autoantibodies, warm-reactive autoantibodies are commoner and interfere in the pretransfusion testing. These RBC autoantibodies present in patient's serum potentially react with all the cells of antibody identification panel giving "pan-reactive" picture and making alloantibody identification complex. In this report, we present our approach in a thalassemia patient who presented with warm-type autoimmune hemolytic anemia, low hemoglobin of 5.8 g/dl, and three significant alloantibodies (anti-D, anti-S, and anti-Jk) which were masked by pan-reactive warm autoantibody(s). Differential adsorption was used to unmask underlying alloantibodies. We suggest that differential adsorption procedure is an effective and efficient method for autoantibody adsorption, detection, and identification of masked alloantibody(s), especially in patients with low hemoglobin and history of recent blood transfusion.
重型β地中海贫血患者一生都依赖定期输血。由于频繁输注红细胞成分，多次产生针对红细胞（RBC）抗原的抗体，这些抗体可能是同种抗体或自身抗体，这使得后续输血治疗更加复杂。在自身抗体中，温反应性自身抗体更为常见，并干扰输血前检测。患者血清中存在的这些RBC自身抗体可能会与抗体鉴定板上的所有细胞发生反应，呈现“泛反应性”现象，从而使同种抗体鉴定变得复杂。在本报告中，我们介绍了对一名地中海贫血患者的处理方法，该患者表现为温型自身免疫性溶血性贫血，血红蛋白低至5.8 g/dl，并且有三种重要的同种抗体（抗-D、抗-S和抗-Jk）被泛反应性温自身抗体掩盖。采用差异吸附法来揭示潜在的同种抗体。我们认为差异吸附程序是一种有效且高效的自身抗体吸附、检测和鉴定被掩盖同种抗体的方法，尤其适用于血红蛋白低且近期有输血史的患者。
