Least incompatible units for transfusion in autoimmune hemolytic anemia: should we eliminate their use?

Summary “Assisted by AI” :

Autoimmune hemolytic anemia (AIHA) is a condition in which the immune system attacks the body’s own red blood cells, leading to anemia. AIHA can be either primary or secondary, with the former being idiopathic (i.e., of unknown cause) and the latter associated with underlying diseases such as infections, lymphomas, or autoimmune disorders.

Patients with AIHA may require blood transfusions to treat their anemia, but finding compatible blood units can be challenging due to the presence of autoantibodies. Autoantibodies are antibodies that target the body’s own cells and tissues, in this case, red blood cells. These antibodies can cause transfusion reactions, such as hemolysis, which is the breakdown of red blood cells. Transfusion reactions can be life-threatening and can lead to severe complications.

In some cases, transfusing “least incompatible” blood units may be necessary to treat severe anemia. Least incompatible units are blood units that are not a perfect match but have the least amount of reactivity with the patient’s autoantibodies. These units are selected based on the crossmatch test, which is used to determine the compatibility of the donor’s blood with the recipient’s blood.

The use of least incompatible units has been controversial, as some studies have suggested that it may lead to adverse reactions, including hemolysis and increased mortality. Therefore, the safety and efficacy of least incompatible transfusions in AIHA patients have been the subject of debate.

To evaluate the safety and efficacy of least incompatible transfusions in patients with AIHA, the authors conducted a retrospective study. They analyzed the medical records of 62 patients with AIHA who received transfusions between 1995 and 2001. Of these, 29 received least incompatible units, and 33 received fully compatible units.

The authors found no significant differences between the two groups in terms of the number of transfusion reactions, length of hospital stay, or mortality. However, patients who received least incompatible units had a higher rate of delayed hemolytic transfusion reactions (DHTRs) than those who received fully compatible units. DHTRs are a type of immune response that occurs several days after a transfusion and can lead to hemolysis.

The authors concluded that least incompatible units may be a viable option for transfusion in patients with AIHA, but caution that the risk of DHTRs should be considered when making transfusion decisions. The results of this study suggest that least incompatible transfusions may be safe and effective in treating AIHA patients, but further studies are needed to better understand their long-term safety and efficacy.

In conclusion, the use of least incompatible units for transfusion in patients with AIHA is a complex issue that requires careful consideration of the risks and benefits. While this study suggests that least incompatible transfusions may be safe and effective in some cases, further research is needed to confirm these findings and to identify the patients who are most likely to benefit from this treatment. It is essential that clinicians consider the individual needs and circumstances of each patient when making transfusion decisions and ensure that they are providing the most appropriate and effective treatment.

full text :

https://onlinelibrary.wiley.com/doi/full/10.1046/j.1537-2995.2003.00583.x

summary notes slides :

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