Probiotic-associated high-titer anti-B in a group A platelet donor as a cause of severe hemolytic transfusion reactions.

TitleProbiotic-associated high-titer anti-B in a group A platelet donor as a cause of severe hemolytic transfusion reactions.
Publication TypeJournal Article
Year of Publication2009
AuthorsDaniel-Johnson J, Leitman S, Klein H, Alter H, Lee-Stroka A, Scheinberg P, Pantin J, Quillen K
Pagination1845 - 9
Date Published2009
ISBN Number1537-2995
Other Numberswdn, 0417360
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

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'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.

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