Red cell transfusions in autoimmunized patients

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There are several different settings in which the transfusion pf red cells to patients who have auto-antibodies present in their serum may be necessary. Because the serological approach to the selection of blood varies in different clinical and immunohematologic situations, the various settings are described here.

Transfusion in “warm” antibody-induced (autoimmune) hemolytic anemia (AIHA)

Most investigators agree that transfusion is contraindicated for patients with this disease and elect to use alternative forms of therapy, until and unless transfusion becomes essential to prevent the patient’s death from progressive anemia or its consequences.1–6 There are several reasons for not giving these patients transfusions in other than life-threatening situations. First, AIHA is not simple anemia and is not corrected by the administration of red cells. In most instances, transfused red cells survive in vivo for no longer than the patient’s own cells, meaning that the effects of transfusion are palliative and short-lived. Second, it is seldom possible to find compatible blood for transfusion to these Patients, since most autoantibodies that cause AIHA have a specificity that results in their reacting with the red cells of almost all donor units.4,7–12 Third, there is anecdotal evidence that transfusion in patients with AIHA can cause the disease to become more severe. Some workers have observed that patients with AIHA who require transfusions because of life-threatening anemia have a more severe long-term course, and that the disease is more difficult to control with steroid or other therapy than when remission can be induced by steroid . . .



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