Blood, 1956, Vol. 11, No. 5, pp. 403-422.
© 1956 American Society of Hematology, Inc.
Anti-A Agglutinins in Pooled Plasma as a Cause of
Hemolytic Anemia
JULIUS RUTZKY 1,
FLOSSIE COHEN 1, and
WOLF W. ZUELZER 1
1 Child Research Center of Michigan, the Department of Pediatrics, Wayne
University College of Medicine, and the Children’s Hospital of Michigan, Detroit.
Five sets of observations are presented showing the development of hemolytic
anemia in group A patients as the result of prolonged administration of relatively large amounts of pooled plasma. During the hemolytic episodes, spherocytosis, increase in osmotic fragility, rising bilirubin levels and sometimes
clinical jaundice and splenomegaly were observed. Antibody attached to the
recipients’ erythrocytes was demonstrated by means of the direct Coombs test,
and in several instances free antibody of anti-A specificity was found in the
recipient’s plasma during the hemolytic episode.
Random testing of commercial pooled plasma revealed a number of instances
of astonishingly high anti-A titers, indicating that neither dilution in the pool
nor neutralization by natural A substance in the component A plasmas can be
relied upon.
The pools implicated in the production of hemolytic reactions had anti-A1
titers of 1:64 in saline or higher, and with the usual technics showed no clear-cut
"immune" characteristics except in one instance. The administration of substantial amounts of plasma pools of low titer (1:16) was not followed by adverse
reactions in several instances. On the other hand, the administration of originally
high titered plasmas, neutralized in vitro to a saline titer of 1:16 resulted in
blood destruction, indicating that under conditions of prolonged massive administration, specific soluble substance, though effective in vitro, is inadequate
in vivo. Whether the adverse effects of the moderately high and high titered
plasma pools were the result of purely quantitative factors connected with the
introduction of large amounts of natural anti-A agglutinins or whether special
immune isoantibodies not detected by the methods used were responsible could
not be determined by the data at hand.
Prolonged administration of untitered pooled plasma to recipients of blood
groups A and probably B is potentially dangerous.
Submitted on August 3, 1955
Accepted on November 9, 1955
