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 JLMESH 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
