Study of HemolysinTitre in ‘O’ Group Donors

Summary: Antibodies are globulins which are produced in response to an antigenicstimulation. The antibody that activates complement leading to cell lysis is calledhemolysin antibody. Group “O’ donor’s plasma may contain potent anti A or anti-B, capable of reacting with the red cells ofgroup A, B or AB recipent and sometimescause a severe transfusion reaction. The anitbodies may take the form of high titre agglutinins or hemolysins. Patient’s blood group A, B or AB receiving “O” blood groupwith a high titre IgG anti-A or anti-B reacting at 37°C may experience a moderatetransfusion reaction resulting jaundice and progressive anaemia. Immune anti-A and antiB are sometimes responsible for transfusion reaction. Objective: To find out the haemolysintitre of “O” blood group female donor. Methods: This cross sectional study was done on 100 cases of “O’ blood group female inchild bearing age and 100 adult male was selected as control, in transfusion medicine department, BSMMU from June 2008 to May 2009. Detailed demographic and clinical findings of all subject were recorded in data collection sheet,all analysis was done using SPSS (statistical package for social science) Result: The mean age differences was found statistically significant (P<0.5) between female & male, 81(81.0%) had Rh + ve & 19% had in negative female subject. 94% hadhaemolytic test positive in female and 8% had haemolysin test positive in male subject.The mean haemolysin antibody with A cell was 2.13 ± 12.3 and with B cell was16.5±8.15. Conclusion: It is important to avoid transfusion of blood containing high titres ofimmune anti A and anti B antibodies to non O group recipients, strongly heamolytic samples have high titres of IgG, a simple screen for donor heamolysin is suggested which can decrease the risk of transfusion if platelets/plasma from donors with minor incompatibbility are used.


Introduction
Transfusion medicine deals with that part of health care system which undertakes the appropriate provision and use of human blood resources.It provides the essential scientific clinical information for transfusion practice and they link between the blood donor altruistic donation and recipients. 1 An antigen or certain substance present on red cell reacts with corresponding antibody present in the serum can cause harmful effect. 2Antibodies that are produced after exposure to foreign antigens are termed as alloantibodies, whereas those that are produced against self antigens are known as auto antibodies.
Antibodies are globulins which are produced in response to an antigenic stimulation There are five classes of immunoglobulin: IgM, IgG, IgA, IgD, and IgE, of which, only the first two are important in blood transfusion.Red cell antibodies of the IgA class appear rarely and then almost invariably together with IgM and IgG antibodies. 2 Naturally occurring red cell antibodies are found in a person who has never received blood or blood product, or vaccines of human origin or has never been pregnant nor undergone organ transplantation.This may arise through one of two mechanism.First it seems possible that some immunocompetent cells may be capable of producing a specific antibody in the absence of an antigenic stimulus, secondly the antibodies may be produced in response to substances present in the environment and antigenically similar to blood group antigens. 2mune antibodies arise as a result of exposure to an alloantigen by transfusion of blood products, pregnancy, vaccination with vaccines of human origin or transplantation.The antibody that activates complement leading to cell lysis is called hemolysin antibody.Group "O' donor's plasma may contain potent anti A or anti-B, capable of reacting with the red cells of a group A, B or AB recipent and sometimes cause a severe transfusion reaction.The anitbodies may take the form of high titre agglutinins or hemolysins.Patient's blood group A, B of AB receiving "01" blood with a high titreIgG anti-A or anti-B reacting at 37° C donated by a high risk universal donor may experience a moderate transfusion reaction resulting jaundice and progressive anemia.Immune anti-A and anti-B are sometimes responsible for transfusion reaction following administration oflarge amounts of blood products. 3molytic disease of the newborn is the results of red cell alloimmunization in which IgG anybodies passage from the maternal circulation across the placenta in the circulation of the fetus where they react with fetal red calls and lead to their destruction.Anit-D anibody is responsible for most cases of severe HDN although anti-C, anti-E anti-K & a wide range of other antibodies are found in occasional cases.Although antibodies against the ABO blood group system the most frequent causes of HDN this is usually mild.Within the UK, approximately 500 fetuses develop hemolytic disease each year & approximately 30 of these cases are fatal. 4eviously transfusion/donation/administration of blood group "0" to any patient, was considered to be of risk & a safer option.In the early years of the Second World War group "O' blood was use for all emergency transfusion in the European Countries, usually without any cross matching or other serological testing & adverse reactions were rare.
However, this perception has now recently come to a halt.It is now known that though the recipients serum may not react with the donor's red cells, group "O" donor's plasma may contain potent anti-A or anti-B, capable of reacting with the red cells of a group A, B or Ab recipient and some time can also causes severe transfusion reaction. 5e present study was undertaken to investigate the possible differences at various titer level between two sex groups.

Methods:
This cross sectional study was done on 100 cases of "O' blood group female inchild bearing age and 100 adult male was selected as control, in transfusion medicine department, BSMMU from June 2008 to May 2009.Detailed demographic and clinical finding of all subject were recorded in data collection sheet.All analysis was done using SPSS (statistical package for social science) using inclusion & exclusion criteria.The objectives of the study along with its procedure risk and benefits of the study were explained to the subjects in easily understandable local language and then informed consent was taken from each subject.Itwas assured that all information and records would be kept confidential and the procedure would be helpful for both the attending subjects in making rational approach of the case management.It was found that 45(45.0%)and only 2(2.0%) had history of blood transfusion in female and male subjects respectively.The difference was found statistically significant (p<o.05) between female and male in chi square test.

Table-VI
Nulliparity was predominant in the study subjects.

Table - I
Age distribution of the study subject (n=200)

Table - II
Sex distribution of the study subjects (n=200).This study was carried out in 200 subjects.They were divided into female and male groups.Out of which 50.0% were female and rest 50.0%were male subjects.It was found that 81(81.0%)had Rh+ve and 19(19.0%)had Rh-ve in female subjects, however in male subjects 98(98.0%)had Rh+ve and only 2(2.0%) had Rh-ve.The difference was found statistically significant (p<0.05) between female and male in chi squire test.

Table - VII
History of exchange transfusion of babies (n=20)No appearance was predominant in the female study subject.It was found that 94(94.0%)and 8(8.0%) had Hemolysin test (+) ve in female and male subject respectively.