Correspondence DOUGLAS W . HUESTIS,Ediror Tucson,Arizona
Transfusion Reaction Presumably due to Anti-Bga To the Editor: Mrs. C. S., a white woman with hypoplastic anemia, had been given 32 units of blood prior to the appearance of an alloantibody in 1%5. It was reactive against 60 per cent of donor units but against reagent red blood cells from black donors only. During the next two months, eight units of compatible blood were given without incident. Two month later, transfusion of one unit of blood resulted in an intravascular hemolytic transfusion reaction with hemoglobinuria. There were no detectable surviving donor cells 18 hours post-transfusion. Following the hemolytic reaction, she received over 100 transfusions without experiencing another hemolytic reaction. She died of her disease in 1971. The patient’s cells and sera were studied repeatedly and in 1978 all remaining sera were reevaluated. The patient’s most likely red cell phenotypes were B, DCe/dce, kk, Fy(a+b+), Jk(a+b+), MsNs, PI, Le(a-b+), Lu(a+b+), Yt(a+b-), Yk(a-), Cs(a+), McC(a+), Ch(a+). The alloantibody or antibodies coated test red blood cells with IgG and reacted only with polyspecific or anti-IgG AHG-reagents. Three reference laboratories demonstrated anti-Bga in our patient’s sera. In tests done in 1978, serum was reactive against red blood cells from 77 per cent of black donors and against 39 per cent of white donors. All Bg(a+) red blood cells from black donors reacted as did 26 of 31 Bg(a+) cells from white donors. However 13 of 19 Bg(a-) cells from blacks and ten of 62 Bg(a-) cells from whites also reacted. Bg(b+) cells failed to react. C.S. serum contained anti-Bga but the specificity of the second alloantibody(ies) appears to have some relationship to the Yka through Kna antigens. The anti-Bga was unaffected by ficin treatment of cells but the second antibody(ies)reacted variably with ficinized cells. The blood resulting in the hemolytic reaction was either Bg(a+) and/or positive for the second antigen(s) since no other alloantibody has been demonstrated. Neither anti-Bga nor an antibody similar to C . S . ’ s second antibody(ies) has ever been implicated as a cause of intravascular
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hemolysis. No other cause for the intravascular hemolytic reaction was ever in evidence. The long delay in publishing this case is due to the legal implications. The need to report it and to have similar cases published is to alert physicians and technologists that Bg and other “leukocyte related” antibodies are not necessarily benign. -Lyndall Molthan, M.D., Medical Director, Miller Memorial Blood Center, Bethlehem, PA 18018. Serologic Test for Syphilis
To the Editor: The recently published ninth addition of the AABB Standards does not mention syphilis testing as a requirement of donor bloods. Although I am familiar with some of the arguments in favor of discontinuing routine syphilis testing, I am unaware of the specific rationale for this decision. For example, could you comment on the projected incidence of syphilis transmission to patients as a result of transfusion of platelets prepared from untested bloods. Has consideration been given to the likelihood of increased risk of syphilis transmission from specific donor groups? For example, young service recruits might have a higher incidence of syphilis than that found in a more stable community. We will appreciate this information to help make our own decision whether to discontinue syphilis testing.Thomas A. Lane, M.D., Chief, Blood Bank Section, Laboratory Service, Veterans Administration Hospital, San Diego, CA 92161. Dr. Oberman, Chairman, AABB Committee on Standards, offers the following reply: A serologic test for syphilis is no longer required by AABB. It is still in force in the Code of Federal Regulations, although it is my understanding that the FDA may also discontinue this requirement. The Standards of the AABB represent minimum requirements, and it is appropriate for any individual laboratory to exceed them. It has been known for many years that the spirochete loses its virulence rapidly upon storage in citrated blood at refrigerator temperatures (Bull J. Hopkins Hosp. 68412, 1941). Further-
Volume 19 Number 5
Transfusion Reaction Presumably due to Anti-Bga To the Editor: Mrs. C. S., a white woman with hypoplastic anemia, had been given 32 units of blood prior to the appearance of an alloantibody in 1%5. It was reactive against 60 per cent of donor units but against reagent red blood cells from black donors only. During the next two months, eight units of compatible blood were given without incident. Two month later, transfusion of one unit of blood resulted in an intravascular hemolytic transfusion reaction with hemoglobinuria. There were no detectable surviving donor cells 18 hours post-transfusion. Following the hemolytic reaction, she received over 100 transfusions without experiencing another hemolytic reaction. She died of her disease in 1971. The patient’s cells and sera were studied repeatedly and in 1978 all remaining sera were reevaluated. The patient’s most likely red cell phenotypes were B, DCe/dce, kk, Fy(a+b+), Jk(a+b+), MsNs, PI, Le(a-b+), Lu(a+b+), Yt(a+b-), Yk(a-), Cs(a+), McC(a+), Ch(a+). The alloantibody or antibodies coated test red blood cells with IgG and reacted only with polyspecific or anti-IgG AHG-reagents. Three reference laboratories demonstrated anti-Bga in our patient’s sera. In tests done in 1978, serum was reactive against red blood cells from 77 per cent of black donors and against 39 per cent of white donors. All Bg(a+) red blood cells from black donors reacted as did 26 of 31 Bg(a+) cells from white donors. However 13 of 19 Bg(a-) cells from blacks and ten of 62 Bg(a-) cells from whites also reacted. Bg(b+) cells failed to react. C.S. serum contained anti-Bga but the specificity of the second alloantibody(ies) appears to have some relationship to the Yka through Kna antigens. The anti-Bga was unaffected by ficin treatment of cells but the second antibody(ies)reacted variably with ficinized cells. The blood resulting in the hemolytic reaction was either Bg(a+) and/or positive for the second antigen(s) since no other alloantibody has been demonstrated. Neither anti-Bga nor an antibody similar to C . S . ’ s second antibody(ies) has ever been implicated as a cause of intravascular
Transfusion September-October 1979
609
hemolysis. No other cause for the intravascular hemolytic reaction was ever in evidence. The long delay in publishing this case is due to the legal implications. The need to report it and to have similar cases published is to alert physicians and technologists that Bg and other “leukocyte related” antibodies are not necessarily benign. -Lyndall Molthan, M.D., Medical Director, Miller Memorial Blood Center, Bethlehem, PA 18018. Serologic Test for Syphilis
To the Editor: The recently published ninth addition of the AABB Standards does not mention syphilis testing as a requirement of donor bloods. Although I am familiar with some of the arguments in favor of discontinuing routine syphilis testing, I am unaware of the specific rationale for this decision. For example, could you comment on the projected incidence of syphilis transmission to patients as a result of transfusion of platelets prepared from untested bloods. Has consideration been given to the likelihood of increased risk of syphilis transmission from specific donor groups? For example, young service recruits might have a higher incidence of syphilis than that found in a more stable community. We will appreciate this information to help make our own decision whether to discontinue syphilis testing.Thomas A. Lane, M.D., Chief, Blood Bank Section, Laboratory Service, Veterans Administration Hospital, San Diego, CA 92161. Dr. Oberman, Chairman, AABB Committee on Standards, offers the following reply: A serologic test for syphilis is no longer required by AABB. It is still in force in the Code of Federal Regulations, although it is my understanding that the FDA may also discontinue this requirement. The Standards of the AABB represent minimum requirements, and it is appropriate for any individual laboratory to exceed them. It has been known for many years that the spirochete loses its virulence rapidly upon storage in citrated blood at refrigerator temperatures (Bull J. Hopkins Hosp. 68412, 1941). Further-
Volume 19 Number 5
