Sir.—We would like to suggest that the hemolysis observed by Warren et al1 in their patients with necrotizing enterocolitis (NEC) and Clostridium perfringens infection is an example of a phenomenon that we and others have previously described.2,3Clostridium can produce a neuraminidase that strips N-acetyl-neuraminic acid from RBC surfaces, revealing the T-crypt-antigen. Normal adult plasma contains naturally acquired IgM antibody to the T-cryptantigen and can cause rapid hemolysis of T-cryptantigen-bearing RBCs when it is infused.4 Results of routine immunohematologic evaluation of hemolysis are often negative in hemolysis associated with T-cryptantigen exposure; minor crossmatch testing with fresh plasma or peanutlectin testing is often necessary to demonstrate the phenomenon.4
Both of the patients in the report by Warren et al1 had received plasma before hemolysis was detected. Although Coombs testing and antibody screens were apparently performed, no mention of minor crossmatching or lectin testing was made.
NOVAK RW, KLEIN RL, NOVAK PE. Necrotizing Enterocolitis, Hemolysis, and Clostridium perfringens. Am J Dis Child. 1985;139(2):114-115. doi:10.1001/archpedi.1985.02140040012010