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Clinical Observation
January 22, 2001

Autoantibody Formation in the Alloimmunized Red Blood Cell RecipientClinical and Laboratory Implications

Author Affiliations

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).

Arch Intern Med. 2001;161(2):285-290. doi:10.1001/archinte.161.2.285

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.