Transfusion support with RBCs from an Mk homozygote in a case of autoimmune hemolytic anemia following diphtheria-pertussis-tetanus vaccination. Transfusion 2002 May;42(5):567-71
Date
06/27/2002Pubmed ID
12084164DOI
10.1046/j.1537-2995.2002.00093.xScopus ID
2-s2.0-0036562666 (requires institutional sign-in at Scopus site) 21 CitationsAbstract
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 Mk homozygote were found compatible with the patient's autoantibody. Transfusion of RBCs from an Mk 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 degrees 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.
Author List
Johnson ST, McFarland JG, Kelly KJ, Casper JT, Gottschall JLAuthor
James Casper MD Emeritus Professor in the Pediatrics department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AgglutininsAnemia, Hemolytic, Autoimmune
Antibody Specificity
Autoantibodies
Autoantigens
Blood Transfusion
Cryoglobulins
Diphtheria-Tetanus-Pertussis Vaccine
Erythrocyte Transfusion
Exchange Transfusion, Whole Blood
Female
Hematocrit
Homozygote
Humans
Immunoglobulin M
Infant, Newborn
MNSs Blood-Group System
