Transfusion management in a pediatric patient with febrile neutropenia with red blood cell autoantibodies: a case report
DOI:
https://doi.org/10.18203/2320-6012.ijrms20214722Keywords:
Febrile neutropenia, Autoantibodies, Red cell transfusion, Granulocyte transfusionAbstract
Febrile neutropenia is a common complication of chemotherapy especially in hematological malignancies associated with sepsis or severe infection. We report a case where a seven-year-old girl with T – cell acute lymphoblastic leukemia (ALL) developed febrile neutropenia (absolute neutrophil count - ANC <500/µL). Patient developed transient red blood cell (RBC) autoantibodies which interfered with compatibility testing and posed a challenge in donor selection for granulocyte transfusion. Direct antiglobulin test (DAT) and compatibility testing were done by column agglutination technique (CAT) using polyspecific anti-human globulin gel cards. Antibody screen was also done by CAT using 3-cell panel. Granulocyte concentrate was collected from eligible donors after taking an informed consent using a cell separator based on continuous flow principle. The patient’s blood group was AB RhD positive, however, the auto-control was positive (2+), DAT was positive (1+) but the antibody screen was negative. Monospecific DAT revealed the characteristic of antibody to be IgG (2+). The donor for granulocyte harvesting was selected on the basis of adopting a least incompatible donor approach. During her hospital stay she was transfused with four granulocyte concentrates, and other blood components without any adverse events. The patient’s blood culture was sterile on day 33 of hospital stay and subsequently she remained afebrile and finally discharged on day 41 in a hemodynamically stable state. The hemogram was- Hb:10.7g/dL, Total leucocyte count (TLC): 5610/µL, ANC: 4375/µL, PLT: 22000 /µL. This case draws a special attention to the importance of serological testing in selection of donor for granulocyte transfusion.
References
Teofili L, Giovanna C, Blasi R, Orlando N, Fianchi L, Zini G, et al. Dose-dependent effect of granulocyte transfusions in hematological Patients with Febrile Neutropenia. PLoS One. 2016;11(8):e0159569.
Talcott JA, Finberg R, Mayer RJ, Goldman L. The medical course of cancer patients with fever and neutropenia: clinical identification of a low risk subgroup at presentation. Arch Intern Med. 1988;148:2561-8.
Graw RG Jr, Herzig G, Perry S, Henderson ES. Normal granulocyte transfusion therapy: treatment of septicemia due to gram-negative bacteria. N Engl J Med. 1972;287:367-71.
Price TH, Boeckh M, Harrison RW, McCullough J, Ness PM, Strauss RG, et al. Efficacy of transfusion with granulocytes from G-CSF/dexamethasone-treated donors in neutropenic patients with infection. Blood. 2015;126:2153-61.
Lapierre Y, Rigal D, Adam J, Josef D, Meyer F, Greber S, et al. The gel test: A new way to detect red cell antigen- antibody reactions. Transfusion. 1990;30:109-13.
Urdahl SG. Cobe spectra® Apheresis system: Designs, Protocols and Results. Infusionstherapie 1989;16(2):30-43.
Agrawal A, Tiwari AK, Mehta N, Bhattacharya P, Wankhede R, Tulsiani S, et al. ABO and Rh (D) group distribution and gene frequency: the first multicentric study in India. Asian J Transfus Sci. 2014;8:121-5.
Strauss RG, Klein GH, Leitman FS, Price TH, Lichtiger B, Martinez F, et al. Preparation of granulocyte concentrates by apheresis: Collection modalities in the USA. Vox Sang. 2011;100:426-33.
Narvios AB, Reddy V, Lichtiger B. Method of removing incompatible red blood cells from granulocyte components. Transfus Apher Sci. 2006;35:179-80.
Sallah S, Wan JY, Hanrahan LR. Future Development of Lymphoproliferative Disorders in Patients with Autoimmune Hemolytic Anemia. Clin Cancer Res. 2001;7:791-4.
