[Pubmed] Detection of red cell alloantibody prior to overflow phenomenon in a case of warm AIHA secondary to Chronic Lym

[RSS-Bot]

Transfus Clin Biol. 2023 Sep 7:S1246-7820(23)00102-7. doi: 10.1016/j.tracli.2023.09.001. Online ahead of print.

ABSTRACT

INTRODUCTION: Defects in the lymphoid system have been linked to immune dysregulation, which might explain why lymphoid neoplasms and immunological disorders tend to occur concurrently. Chronic Lymphocytic Leukemia (CLL), characterized by the accumulation of dysfunctional lymphocytes, is associated with autoimmune cytopenias such as autoimmune haemolytic anemia (AIHA). Detection of underlying alloantibody in warm AIHA, is challenging for any transfusion medicine specialist. This report highlights the significance of overflow phenonmenon in detection of alloantibody in a case of warm AIHA secondary to CLL and myasthenia gravis.

CASE REPORT: A 56-year-old male with history of myasthenia gravis and thymoma progressed to B-cell CLL presented with severe anaemia and thrombocytopenia leading to multiple red blood cell (RBC) transfusions since last two months. Clinical profile and laboratory workup suggested features of AIHA, and subsequent immunohaematological workup hinted towards an impending overflow phenomenon due to differential reactivity pattern observed between serum and eluate with antibody screen/identification panel. The eluate was pan-reactive with antibody screen/ identification panel while the serum showed discrete anti-C alloantibody pattern. A compatible and antigen negative RBC unit was successfully transfused, followed by medical management.

DISCUSSION: The overflow phenomenon in AIHA is dependent on antibody titre and its affinity for RBC antigens. In the index case, the impending 'overflow or spillover' of autoantibodies into patient's serum, allowed us to detect underlying alloantibody without performing allogeneic adsorption and transfuse antigen negative and crossmatch compatible PRBC unit.

CONCLUSION: This case emphasizes the significance of understanding the overflow phenomenon in AIHA as it can guide a transfusion medicine specialist in early detection and identification of underlying alloantibodies which is crucial for appropriate transfusion management in AIHA. However, early presentation and timely workup along with high level of suspicion is crucial to identify this phenomenon.

PMID:37689387 | DOI:10.1016/j.tracli.2023.09.001


Source: https://pubmed.ncbi.nlm.nih.gov/3768938 ... t6+86293ac