title: Discriminating complement-mediated acute transfusion reaction for type O+ red blood cells transfused into a B+ recipient with the complement hemolysis using human erythrocytes (CHUHE) assay.
abstract: A patient with B+ sickle cell disease received 3 units of red blood cells (RBCs) from two O+ donors and developed fever and hypotension after the first unit, consistent with an acute transfusion reaction (ATR). Anti-B titers in plasma from each O+ donor were markedly elevated and nondiscriminatory. In order to evaluate the potential for the transfused units to produce complement-mediated hemolysis of B+ RBCs, hemolytic complement testing was performed.
  
  
  
  Plasma from each donor was diluted in veronal buffer and incubated with B+ RBCs, and free hemoglobin was measured by spectrophotometer in the complement hemolysis using human erythrocytes (CHUHE) assay. Peptide inhibitor of complement C1 (PIC1) was used to confirm antibody-initiated complement pathway activation.
  
  
  
  A 96-fold difference (p = 0.014) in hemolysis was measured between plasma samples from the two O+ donors using the CHUHE assay. The extremely high degree of hemolysis produced by the one plasma was inhibited by PIC1 in a dose-dependent manner.
  
  
  
  These results indicate that hemolytic complement testing with the CHUHE assay can be used to assess the risk of antibody-initiated, complement-mediated hemolysis from a transfusion beyond what can be achieved with antibody titers alone.
authors.affiliation: Department of Pediatrics, Eastern Virginia Medical School.|Children's Specialty Group.|Children's Hospital of the King's Daughters.|Department of Microbiology and Molecular Cell Biology, Eastern Virginia Medical School.
authors.forename: Kenji M
authors.initials: KM
authors.lastname: Cunnion
authors.affiliation: Department of Pediatrics, Eastern Virginia Medical School.
authors.forename: Pamela S
authors.initials: PS
authors.lastname: Hair
authors.affiliation: Department of Pediatrics, Eastern Virginia Medical School.|Department of Microbiology and Molecular Cell Biology, Eastern Virginia Medical School.
authors.forename: Neel K
authors.initials: NK
authors.lastname: Krishna
authors.affiliation: American Red Cross, Norfolk, Virginia.
authors.forename: Pamela H
authors.initials: PH
authors.lastname: Whitley
authors.affiliation: American Red Cross Blood Services, Durham, North Carolina.
authors.forename: Corinne L
authors.initials: CL
authors.lastname: Goldberg
authors.affiliation: Department of Pathology, Wake Forest School of Medicine, Winston-Salem, North Carolina.
authors.forename: Emmanuel A
authors.initials: EA
authors.lastname: Fadeyi
authors.affiliation: American Red Cross, Norfolk, Virginia.
authors.forename: Lanne Y
authors.initials: LY
authors.lastname: Maes
mesh_terms: D000017:ABO Blood-Group System / Q000276:immunology*; D000293:Adolescent; D000755:Anemia, Sickle Cell / Q000628:therapy; D000906:Antibodies; D001787:Blood Group Incompatibility; D003167:Complement Activation / Q000276:immunology*; D005260:Female; D006461:Hemolysis / Q000276:immunology*; D006801:Humans; D008875:Middle Aged; D018570:Risk Assessment; D065227:Transfusion Reaction / Q000276:immunology*
chemical_list: D000017:ABO Blood-Group System; D000906:Antibodies