title: Precautions surrounding blood transfusion in autoimmune haemolytic anaemias are overestimated.
abstract: BACKGROUND
  It is very evident that many precautions are taken regarding transfusion of red blood cells in patients with autoimmune haemolytic anaemia. Frequently, considerable efforts are made to examine the indication and serological compatibility prior to transfusion in such patients. However, at times, this may unnecessarily jeopardize patients who urgently require a red blood cell transfusion.
  
  
  METHODS
  Thirty-six patients with warm-type autoimmune haemolytic anaemia were included in this study. All patients had reactive serum autoantibodies and required blood transfusion. Standard serological assays were employed for the detection and characterization of antibodies to red blood cells.
  
  
  RESULTS
  A positive direct antiglobulin test was observed in all 36 patients, in addition to detectable antibodies in both the eluate and serum. Significant alloantibodies were detected in the serum samples of three patients (anti-c, anti-JK(a), and anti-E). In 32 patients, red blood cell transfusion was administered with no significant haemolytic transfusion reactions due to auto- and/or allo-antibodies. Due to overestimation of positive cross-matches three patients received no transfusion or delayed transfusion and died, and one patient died due to unrecognised blood loss and anaemia which was attributed to an ineffective red blood cell transfusion.
  
  
  CONCLUSIONS
  Many of the reported recommendations regarding transfusion of red blood cells in autoimmune haemolytic anaemia are highly questionable, and positive serological cross-matches should not result in a delay or refusal of necessary blood transfusions.
authors.affiliation: Institute for Transfusion Medicine, Charité-University Medical School of Berlin, Berlin, Germany.
authors.forename: Salih
authors.initials: S
authors.lastname: Yürek
authors.affiliation: Institute for Transfusion Medicine, Charité-University Medical School of Berlin, Berlin, Germany.
authors.forename: Beate
authors.initials: B
authors.lastname: Mayer
authors.affiliation: Institute for Transfusion Medicine, Charité-University Medical School of Berlin, Berlin, Germany.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Almahallawi
authors.affiliation: Institute for Transfusion Medicine, Charité-University Medical School of Berlin, Berlin, Germany.
authors.forename: Axel
authors.initials: A
authors.lastname: Pruss
authors.affiliation: Institute for Transfusion Medicine, Charité-University Medical School of Berlin, Berlin, Germany.
authors.forename: Abdulgabar
authors.initials: A
authors.lastname: Salama
mesh_terms: D000293:Adolescent; D000328:Adult; D000740:Anemia / Q000401:mortality / Q000628:therapy; D000744:Anemia, Hemolytic, Autoimmune / Q000097:blood / Q000276:immunology*; D001323:Autoantibodies / Q000097:blood; D001789:Blood Group Antigens / Q000276:immunology; D001787:Blood Group Incompatibility / Q000097:blood / Q000175:diagnosis* / Q000517:prevention & control; D001788:Blood Grouping and Crossmatching; D003298:Coombs Test; D004630:Emergencies; D017707:Erythrocyte Transfusion / Q000009:adverse effects; D004912:Erythrocytes / Q000276:immunology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016079:Refusal to Treat; D012769:Shock / Q000209:etiology
chemical_list: D001323:Autoantibodies; D001789:Blood Group Antigens