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Pediatric Nephrology
Published in: Pediatric Nephrology 3/2004

01-03-2004 | Original Article

Pneumococcus-induced T-antigen activation in hemolytic uremic syndrome and anemia

Authors: Joel B. Cochran, Valerie M. Panzarino, Lanne Y. Maes, Frederick W. Tecklenburg

Published in: Pediatric Nephrology | Issue 3/2004

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Abstract

The hemolytic uremic syndrome (HUS) is most commonly associated with Escherichia coli, but has been associated with other infections such as Streptococcus pneumoniae. Pneumococcus-induced HUS carries an increased risk of mortality and renal morbidity compared with E. coli-induced HUS. The pneumococcal organism produces an enzyme, which can expose an antigen (T-antigen) present on erythrocytes, platelets, and glomeruli. Antibodies to the T-antigen, normally found in human serum, bind the exposed T-antigen, and the resultant antigen-antibody reaction (T-activation) can lead to HUS and anemia. Clinicians need to be aware to request specific testing when pneumococcus-induced HUS/anemia is suspected, as current blood banking techniques do not routinely test for the presence of the T-antigen. Once this association is documented, washing all blood products and avoiding plasma products, if possible, is recommended. Plasmapheresis can be considered for the more critically ill patient. The incidence of pneumococcus-induced HUS may be increasing. We report six cases of pneumococcus-induced HUS/anemia presenting at our hospital.
Literature
1.
Berstein JM (1992) Hemolytic-uremic syndrome. In: Behrman R, Kliegman R, Nelson W, Vaughn V (eds) Nelson textbook of pediatrics, 14th edn. Saunders, Philadelphia, p 1335
2.
Gasser C, Gautire E, Steck A, Siebenmann R, Oechslin R (1955) Haemolytisch-uraemische Syndrome: bilaterale Nierenrindennekrosen bei akuten erworbenen haemolytischen Anaemien. Schweiz Med Wochenschr 85:905–909PubMed
3.
Amorosi EL, Ultmann JE (1966) Thrombotic thrombocytopenic purpura: report of 16 cases and review of the literature. Medicine (Baltimore) 45:139
4.
Fackler J (1996) Renal disorders in pediatric intensive care. In: Rogers M (ed) Textbook of pediatric intensive care, 3rd edn. Williams and Wilkins, Baltimore, pp 1231–1232
5.
Jacob NM, Harris VJ (1979) Acute Haemophilus pneumonia in childhood. Am J Dis Child 133:603–605PubMed
6.
Alon U, Adler SP, Chan JCM (1984) Hemolytic-uremic syndrome associated with Streptococcus pneumoniae. Am J Dis Child 138:496–499PubMed
7.
Erickson LC, Smith WS, Biswas AK, Camarca MA, Waecker WJ (1984) Streptococcus pneumoniae-induced hemolytic uremic syndrome: a case for early diagnosis. Pediatr Nephrol 8:211–213
8.
McTaggart SJ, Burke JR (1998) Streptococcus pneumoniae-induced haemolytic uraemic syndrome. J Pediatr Child Health 34:192–195CrossRef
9.
Shirey RS, Boyd JS, Kronz JD, Ness PM, King KE (1999) Polyagglutination: clinician be aware. Transfusion 39:36S
10.
Seitz RC, Buschermohle G, Dubberke G, Herbrand R, Maiwald M, Hellwege HH (1993) The acute infection-associated hemolytic anemia of childhood: immunofluorescent detection of microbial antigens altering the erythrocyte membrane. Ann Hematol 67:191–196PubMed
11.
Fischer K, Poschmann A, Oster H (1971) Hämolyse bei schwerer Pneumonie infolge Neuraminidasewirkung. Monatsschr Kinderheilkd 119:2PubMed
12.
Martinot A, Hue V, Leclerc F, Chenoud M (1989) Haemolytic-uremic syndrome associated Streptococcus pneumoniae meningitis. Eur J Pediatr 148:648–649PubMed
13.
Hubener G (1926) Untersuchungen über Isoagglutination mit besonderer Berücksichtigung scheinbarer Abweichungen vom Gruppenschema. Zeitschrift für Immunitate. Forschung 45:223–226
14.
Thomsen OZ (1927) Ein vermehrungsfähiges Agens als Veränderer des isoagglutinatorischen Verhaltens der roten Blutkörperchen, eine bisher unbekannte Quelle der Fehlbestimmungen. Zeitschrift für Immunitate. Forschung 52:85–90
15.
Friedenreich V (1930) The Thomsen hemagglutination phenomenon. Production of a specific receptor quality in red corpuscles by bacterial activity. Levin and Munksgaard, Copenhagen
16.
Seger RA, Kenny A, Bird GW, Wingham J, Baals H, Stauffer UG (1981) Pediatric surgical patients with severe anaerobic infection: report of 16 T-antigen positive cases and possible hazards of blood transfusion. J Pediatr Surg 16:905–910PubMed
17.
Williams RA, Brown EF, Hurst D, Franklin LC (1989) Transfusion of infants with activation of erythrocyte T antigen. J Pediatr 115:949–953PubMed
18.
19.
20.
Obeid D, Bird GW, Wingham J (1977) Prolonged erythrocyte T-polyagglutination in two children with bowel disorders. J Clin Pathol 30:953–955PubMed
21.
Klein PJ, Bulla M, Newman RA, Muller P, Uhlenbruck G, Schaefer HE, Kruger G, Fisher R (1977) Thomsen-Friedenreich antigen in haemolytic-syndrome. Lancet I:1024–1025CrossRef
22.
Moores P, Pudifin D, Patel PL (1975) Severe hemolytic anemia in an adult associated with anti-T. Transfusion 15:329–333PubMed
23.
Lenz G, Goes U, Baron D, Sugg U, Heller W (1987) Red blood cell T-activation and hemolysis in surgical intensive care patients with severe infections. Blut 54:89–96PubMed
24.
Crookston KP, Reiner AP, Cooper LJN, Sacher RA, Blajchman MA, Heddle NM (2000) RBC T activation and hemolysis: implications for pediatric transfusion management. Transfusion 40:801–812CrossRefPubMed
25.
Cabrera GR, Fortenberry JD, Warshaw BL, Chambliss CR, Butler JC, Cooperstone BG (1998) Hemolytic uremic syndrome associated with invasive Streptococcus pneumoniae infection. Pediatrics101:699–703
26.
Issitt PD, Anstee DJ (eds) (1998) Applied blood group serology, 4th edn. Montgomery Scientific Publications, Durham, N.C., pp 1097–1121
27.
Osborn DA, Lui K, Pussell P, Jana AK, Desai AS, Cole M (1999) T and Tk antigen activation in necrotizing enterocolitis: manifestations, severity of illness and effectiveness of testing. Arch Dis Child Fetal Neonatal Ed 80:192F–197F
28.
Judd WJ (1992) Review: polyagglutination. Immunohematology 8:58–69
29.
Brecher ME (ed) (2002) AABB technical manual, 14th edn. American Association of Blood Banks, Bethesda, Maryland, pp 680–681
30.
Brecher ME (ed) (2002) AABB technical manual, 14th edn. American Association of Blood Banks, Bethesda, Maryland, pp 421–445
31.
Nathanson S, Deschenes G (2001) Prognosis of Streptococcus pneumoniae-induced hemolytic uremic syndrome. Pediatr Nephrol 16:362–365
32.
McGraw ME, Lendon M, Stevens RF, Postlethwaite RJ, Taylor CM (1989) Haemolytic uremic syndrome and the Thomsen Friedenreich antigen. Pediatr Nephrol 3:135–139PubMed
33.
Novak RW, Martin MR, Orsini EN (1983) Hemolytic-uremic syndrome and t-crypantigen exposure by neuraminidase-producing pneumococci: an emerging problem. Pediatr Pathol 1:409–413PubMed
34.
Feld LG, Springate JE, Darragh R, Fildes RD (1987) Pneumococcal pneumonia and hemolytic uremic syndrome. Pediatr Infect Dis J 6:693–694PubMed
35.
Brandt J, Wong C, Mihm S, Roberts J, Smith J, Brewer E, Thiagarajan R, Warady B (2002) Invasive pneumococcal disease and hemolytic uremic syndrome. Pediatrics 110:371–376PubMed
36.
Boccardi V, Attina D, Bigliocchi S, Girelli G (1974) Anti-T agglutinin in cirrhosis of the liver. Vox Sang 26:83–85PubMed
37.
Boccardi V, Attina D, Girelli G (1974) Influence of orally administered antibiotics on anti-T agglutinin of normal subjects and of cirrhotic patients. Vox Sang 27:268PubMed
38.
Springer GF, Tegtmeyer H (1981) Origin of anti-Thomsen-Friedenreich (T) and Tn agglutinins in man and in White Leghorn chicks. Br J Haematol 47:453–460PubMed
39.
Klein PJ, Novak RW, Novak PE (1986) T-cryptantigen exposure in neonatal necrotizing enterocolitis. J Pediatr Surg 21:1155–1158PubMed
40.
Novak RW (1990) The pathobiology of red cell cryptantigen exposure. Pediatr Pathol 10:867–875
41.
Kim YD (1980) Immunochemical characteristics of human anti-T antibodies. Vox Sang 39:162PubMed
42.
Novak RW, Abbott AE, Klein RI (1993) T-cryptantigen determination affects mortality in necrotizing enterocolitis. Surg Gynecol Obstet 176:368–370PubMed
43.
Engelfriet CP, Reesink HW (1999) Blood transfusion in premature or young infants with polyagglutination and activation of the T antigen. Vox Sang 76:128–132CrossRefPubMed
44.
Hamilton DV, Black AJ, Darnborough J, Bird GW (1983) Haemolytic-uraemic syndrome and T-activation of red blood cells. Clin Lab Haematol 5:109–112PubMed
45.
Havens PL, O’Rouke PP, Hahn J, Higgins J, Walker AM (1988) Laboratory and clinical variables to predict outcome in hemolytic-uremic syndrome. Am J Dis Child 142:961PubMed
46.
Cleary TG, Lopez EL (1989) The shiga-like toxin-producing Escherichia coli and hemolytic uremic syndrome. Pediatr Infect Dis J 8:720–724PubMed
47.
Milford DV, Taylor CM, Guttridge B, Hall SM, Rowe B, Kleanthous H (1990) Haemolytic uraemic syndromes in the British Isles 1985–8: association with verocytotoxin producing Escherichia coli. I. Clinical and epidemiological aspects. Arch Dis Child 65:716–721PubMed
48.
Bird GWG (1978) Plenary Session Lectures. 27th Congress ISH, 15th Congress ISBT. Arnette, Paris, p 97
49.
Beck ML (1983) Blood group antigens and disease. American Association of Blood Banks, Arlington, Va., p 45
50.
Buskila D, Levene C, Bird GWG (1987) Polyagglutination in hospitalized patients: a prospective study. Vox Sang 52:99–102PubMed
51.
Seeger R, Joller P, Baerlocher K, Kenny A, Dulake C, Leumann E, Spierig M, Hitzig W (1980) Hemolytic-uremic syndrome associated with neuraminidase-producing microorganisms: treatment by exchange transfusion. Helv Paediatr Acta 35:359–367PubMed
52.
Beattie KM, Lewis PE, Briski JE (1985) Detection of circulating t-activating enzyme in the serum of a patient having hemolytic-uremic syndrome and disseminated intravascular coagulation. Am J Clin Pathol 84:244–248PubMed
Metadata
Title
Pneumococcus-induced T-antigen activation in hemolytic uremic syndrome and anemia
Authors
Joel B. Cochran
Valerie M. Panzarino
Lanne Y. Maes
Frederick W. Tecklenburg
Publication date
01-03-2004
Publisher
Springer-Verlag
Published in
Pediatric Nephrology / Issue 3/2004
Print ISSN: 0931-041X
Electronic ISSN: 1432-198X
DOI
https://doi.org/10.1007/s00467-003-1382-z

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