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LETTER TO EDITOR Table of Contents   
Year : 2010  |  Volume : 53  |  Issue : 3  |  Page : 574-575
Trauma patient with M-antibody


1 Blood Bank, Department of Laboratory Medicine, Jai Prakash Narayan Apex Trauma Centre, AIIMS, New Delhi, India
2 Department of Neurosurgery, Jai Prakash Narayan Apex Trauma Centre, AIIMS, New Delhi, India

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Date of Web Publication22-Oct-2010
 

How to cite this article:
Rangarajan K, Subramanian A, Agrawal D, Chatterjee K. Trauma patient with M-antibody. Indian J Pathol Microbiol 2010;53:574-5

How to cite this URL:
Rangarajan K, Subramanian A, Agrawal D, Chatterjee K. Trauma patient with M-antibody. Indian J Pathol Microbiol [serial online] 2010 [cited 2021 Sep 26];53:574-5. Available from: https://www.ijpmonline.org/text.asp?2010/53/3/574/68249


Sir,

Anti-M is frequently found in the sera of persons who have had no exposure to human red cells. Though a commonly occurring antibody, it may, occasionally, have immense clinical significance. The detection of unexpected antibodies may complicate the management of acute trauma and the transfusion management of such patients is even more perplexing.

A 42-year-old female patient presented with poly trauma in the emergency department and required blood transfusion prior to surgery. Sample grouping was done in blood bank, which showed the cell grouping to be B+ ve. However, serum grouping showed a positive reaction (3+ and 2+) in all the reagent red cells A-cell, B-cell and O-cells [Table 1]. The repeat tests with gel technique DiaMed-ID Micro Typing System (DiaMed, Cresier, Switzerland) showed similar reaction. The reverse tubes showed the same reaction at 22oC and 37oC but were negative at 4oC. The possibility of cold antibodies was ruled out since both auto control and direct antiglobulin test (DAT) with IgG and C3d were negative. Antibody screening using gel technique showed a positive (4+) reaction with the in house routine two cell panel [Table 2]. An expanded panel involving 18 antigens was utilized and M antibody was detected [Table 3].
Table 1: Serum grouping showing a positi ve reacti on (3+ and 2+) in all the reagent red cells A-cell, B-cell and O-cells


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Table 2: Anti body screening cells (Both R1R1 and R2R2 cells were positive)

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Table 3: In the expanded panel involving 18 anti gens, M-anti body was the only anti body to be detected (Blood group – B Positi ve; DAT with Poly specific AHG – negati ve)


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Though two units of antigen negative, compatible blood were arranged after cross matching sixty four units of blood, the patient developed sepsis. Her blood culture revealed Acinetobacter infection and she succumbed to her injuries on the tenth day of admission.

Anti-M antibody-+++y is a naturally occurring, predominantly IgM antibody, reacting optimally at 4 0 C though many examples of partly or wholly IgG are frequently found (cold reactive). [1] Most of the anti-M antibodies are usually inactive at 37oC and hence can be generally ignored in transfusion practice. However, rare examples active at 37oC or at the antiglobulin phase of testing should be considered potentially significant and cause problems in transfusion medicine. In the present case, they were strongly reactive under strictly prewarmed conditions, both at room temperature and at 37oC.

A spectrum of manifestations due to anti-M antibody has been reported in pregnant females including hemolytic disease of new born. [2] Only rarely, they have been implicated as a cause of immediate and delayed hemolytic transfusion reactions. [3] In certain occasions, anti-M reactivity is elicited only at an optimal pH of 6.5, being inactive at pH of 7.5. [1,4] pH dependency was not demonstrated in the present case since the antibody was otherwise reactive.

In a trauma setting, there are no set guidelines regarding the transfusion management of anti-M antibodies. The Working party of the British committee for standards in hematology blood transfusion task force suggests administering antigen negative, fully cross matched blood in a patient with unexpected anti-M antibodies. [5] In a massively bleeding patient with unexpected antibodies, the primary objective of a blood bank is to issue antigen-negative, fully cross matched blood to avoid any untoward transfusion reactions. The present case is reported to emphasize the need to implement transfusion protocols for managing bleeding patients with unexpected antibodies especially in a trauma setting.


   Acknowledgment Top


Sunita Srinivasan, Technical Officer of Blood Bank, JPNATC, AIIMS, Rajesh M Thapliyal, Technical Officer, Blood Bank, AIIMS

 
   References Top

1.Tondon R, Kataria R, Chaudhry R. Anti-M. Report of two cases and review of literature. Asian J Transf Sci 2008;2:81-3.  Back to cited text no. 1      
2.Wikman A, Edner A, Gryfelt G, Jonsson B, Henter J. Fetal hemolytic anemia and intrauterine death caused by anti-M immunization. Transfusion 2007;47:911-7.  Back to cited text no. 2      
3.Parry-Jones N, Gore ME, Taylor J, Treleaven JG. Delayed haemolytic transfusion reaction caused by anti-M antibody in a patient receiving interleukin-2 and interferon for metastatic renal cell cancer. Clin Lab Haematol 1999;21:407-8.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]  
4.Beattie KM, Zuelzer WW. The frequency and properties of pH dependent anti-M. Transfusion 1965;5:322.  Back to cited text no. 4  [PUBMED]    
5.Chapman JF, Elliott C, Knowles SM, Milkins CE, Poole GD; Working Party of the British Committee for Standards in Haematology Blood Transfusion Task Force. Guidelines for compatibility procedures in blood transfusion laboratories. Transfus Med 2004;14:59-73.  Back to cited text no. 5  [PUBMED]  [FULLTEXT]  

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Correspondence Address:
Arulselvi Subramanian
Laboratory Medicine, Jai Prakash Narayan Apex Trauma Centre (JPNATC), AIIMS, New Delhi-110 022
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.68249

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