Transfusion support with RBCs from an Mk homozygote in a case of autoimmune hemolytic anemia following diphtheria-pertussis-tetanus vaccination.
BACKGROUND
Autoimmune hemolytic anemia (AIHA) in children, although unusual, is often associated with recent infection. Several reports have identified the diphtheria-pertussis-tetanus (DPT) vaccination as a possible trigger for AIHA.


METHODS
Life-threatening AIHA was diagnosed in a 6-week-old infant 5 days after receiving a DPT vaccination. The patient required daily transfusion and/or exchange transfusion for 3 weeks. RBCs from an Mk homozygote were found compatible with the patient's autoantibody. Transfusion of RBCs from an Mk homozygote and later RBCs from an individual (K.T.) with a variant glycophorin, Mi.VII, were required to sustain the patient's Hb level until autoantibody production ceased, as evidenced by a fall in antibody titer and the patient's Hct returning to normal.


RESULTS
The DAT was positive (3+) with only anti-C3 on presentation. An IgM cold reactive autoantibody with probable anti-Pr specificity and high thermal amplitude (37 degrees C) was identified in the serum. The DAT was no longer positive after transfusion with compatible blood.


CONCLUSIONS
This case represents life-threatening AIHA in an infant, temporally related to a DPT injection and responsive to a combination of immunosuppression and transfusion of rare compatible blood.
Johnson
Susan T
ST
Immunohematology Reference Laboratory, The Blood Center of Southeastern Wisconsin, Children's Hospital of Wisconsin, and the Medical College of Wisconsin, Milwaukee, Wisconsin 53201-2178, USA.
McFarland
Janice G
JG
Kelly
Kevin J
KJ
Casper
James T
JT
Gottschall
Jerome L
JL
D000373:Agglutinins / Q000096:biosynthesis / Q000276:immunology*; D000744:Anemia, Hemolytic, Autoimmune / Q000209:etiology*; D000918:Antibody Specificity; D001323:Autoantibodies / Q000096:biosynthesis / Q000276:immunology*; D001324:Autoantigens / Q000235:genetics / Q000276:immunology*; D001803:Blood Transfusion; D003450:Cryoglobulins; D015721:Diphtheria-Tetanus-Pertussis Vaccine / Q000009:adverse effects*; D017707:Erythrocyte Transfusion; D005078:Exchange Transfusion, Whole Blood; D005260:Female; D006021:Glycophorins / Q000235:genetics / Q000276:immunology*; D006400:Hematocrit; D006720:Homozygote; D006801:Humans; D007075:Immunoglobulin M / Q000096:biosynthesis / Q000276:immunology*; D007231:Infant, Newborn; D008951:MNSs Blood-Group System / Q000235:genetics / Q000276:immunology*
D000373:Agglutinins; D001323:Autoantibodies; D001324:Autoantigens; D003450:Cryoglobulins; D015721:Diphtheria-Tetanus-Pertussis Vaccine; D006021:Glycophorins; D007075:Immunoglobulin M; D008951:MNSs Blood-Group System; C029443:cold agglutinins