@article {4398,
	title = {Probiotic-associated high-titer anti-B in a group A platelet donor as a cause of severe hemolytic transfusion reactions.},
	journal = {Transfusion//Transfusion},
	volume = {49},
	year = {2009},
	month = {2009},
	pages = {1845 - 9},
	publisher = {Daniel-Johnson,Jennifer. Department of Transfusion Medicine, Warren G Magnuson Clinical Center, and the Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA.},
	address = {United States},
	abstract = {BACKGROUND: Hemolytic transfusion reactions (HTRs) can occur with transfusion of platelets (PLTs) containing ABO-incompatible plasma. Reported cases have involved group O donors. Two cases of PLT-mediated HTRs associated with the same group A plateletpheresis component, collected from a donor taking high doses of probiotics are reported., CASE REPORT: Case 1 was a 40-year-old 69-kg group B stem cell transplant patient who received one-half of a group A plateletpheresis component. Severe back pain occurred 10 minutes into the transfusion, accompanied by anemia and hyperbilirubinemia. Case 2 was a 5-year-old 26-kg group B male with aplastic anemia who received the other half of the same plateletpheresis component, volume reduced to 37 mL. Syncope occurred immediately after the transfusion, with laboratory evidence of hemolysis a few hours later., RESULTS: Serologic investigation of posttransfusion samples from both patients revealed positive direct antiglobulin tests: C3d only for Case 1 and immunoglobulin (Ig)G and C3d for Case 2; the eluates contained anti-B. The group A donor{\textquoteright}s anti-B titer was 16,384 at saline and IgG phases. Donor lookback revealed that the donor had donated 134 apheresis PLTs over many years. For 3 years, he had intermittently taken probiotics; 3 weeks before the index donation, he began taking three tablets of probiotics every day. Lookback of prior group B recipients uncovered a case of acute hemolysis that was not recognized at the time. The solubilized probiotic inhibited anti-B in vitro., CONCLUSION: Non-group O PLT donors can have high-titer anti-A or anti-B that might mediate HTRs, and probiotic ingestion in blood donors represents a novel mechanism of stimulating high-titer anti-B.},
	keywords = {*ABO Blood-Group System/im [Immunology], *Blood Donors, *Blood Group Incompatibility/im [Immunology], *Hemolysis/im [Immunology], *Platelet Transfusion/ae [Adverse Effects], *Probiotics, Adult, Aged, Child, Preschool, Female, Humans, Male, Middle Aged, Plateletpheresis},
	isbn = {1537-2995},
	author = {Daniel-Johnson, Jennifer and Leitman, Susan and Klein, Harvey and Alter, Harvey and Lee-Stroka, Agnes and Scheinberg, Phillip and Pantin, Jeremy and Quillen, Karen}
}
