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Autoantibody Formation in the Alloimmunized Red Blood Cell Recipient
Clinical and Laboratory Implications
Marc S. Zumberg, MD;
Jo L. Procter, MEd;
Richard Lottenberg, MD;
Craig S. Kitchens, MD;
Harvey G. Klein, MD
Arch Intern Med. 2001;161:285-290.
Alloimmunization to erythrocyte antigens is a well-characterized complication
in heavily transfused patients. Less well recognized, however, is the frequency
of autoantibody formation in these previously alloimmunized patients. The
autoantibodies are heterogeneous and of variable clinical significance. We
describe the clinical history, laboratory evaluation, diagnosis, and treatment
in 4 patients who developed autoantibodies in temporal association with alloantibody
formation. In one case, the autoantibody found on routine screening had no
clinical significance. In another case, the autoantibody made accurate blood
typing and subsequent transfusion exceedingly difficult. Two patients experienced
hemolysis as a consequence of the autoantibody. The management of both patients
included supportive measures, while one patient required glucocorticosteroids
and red blood cell transfusion. We review the published literature concerning
autoimmunization in the transfused alloimmunized host. The spectrum of clinical
consequences is important for the general practitioner to recognize, as these
complications may occur during routine blood transfusions.
From the Division of Hematology/Oncology, Department of Medicine, University
of Florida, Gainesville (Drs Zumberg, Lottenberg, and Kitchens); and Department
of Transfusion Medicine, Warren G. Magnuson Clinical Center, National Institutes
of Health, Bethesda, Md (Ms Procter and Dr Klein).
Corresponding author: Marc S. Zumberg, MD, Division of Hematology/Oncology,
Dept of Medicine, University of Florida, Box 100277, Gainesville, FL 32610-0277
(e-mail: zumbems{at}medicine.ufl.edu).
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