Hematopoietic Stem Cell

Abbreviated “HSC” and often somewhat inaccurately used interchangeably with

hematopoietic progenitor cell (HPC), this term describes very early cells present normally in
small quantities in the bone marrow and even smaller quantities in the peripheral blood. HSCs
are totipotent, meaning that they can develop into and populate any of the three cell lines
(erythroid, myeloid, or megaloblastic). HPCs, on the other hand, are committed to a single cell
line.

Hematuria
Hematuria is simply “defined as the presence of red blood cells in the urine.” Often,
when evaluating someone for a transfusion reaction, people mistake this word for
“hemoglobinuria,” which sounds really similar but means something completely different
(further, the CDC Hemovigilance Module from the National Healthcare Safety Network includes
hematuria in the list of signs of a transfusion reaction, which I personally find somewhat
confusing). The take-home message here is that the presence of red blood cells in the urine
(hematuria) means nothing to us in the blood bank, while hemoglobin in the urine
(hemoglobinuria) is very important and may be consistent with a hemolytic transfusion reaction.

Hemolysis
A general term for the destruction of red blood cells (RBCs). Hemolysis can occur for
many reasons, including incompatible antibodies (as in hemolytic transfusion reactions and
autoimmune hemolytic anemias), mechanical reasons (damaged heart valves or thrombotic
microangiopathies), infections (malaria, babesiosis), enzyme deficiencies (G6PD), drugs
(penicillins, cephalosporins), hemoglobin abnormalities (sickle cell disease), or RBC membrane
defects (hereditary spherocytosis, McLeod syndrome), just to name a few! We commonly divide
hemolysis into intravascular and extravascular categories for ease of understanding.

Hemolytic Uremic Syndrome

Commonly abbreviated “HUS,” this is one of the two thrombotic microangiopathies,
along with thrombotic thrombocytopenic purpura (TTP). Like TTP, HUS is associated with
thrombocytopenia and changes of microangiopathic hemolytic anemia, but it is characterized by
prominent acute renal failure. In contrast to TTP, most patients with HUS do not have
abnormalities of the von Willebrand Factor cleaving enzyme ADAMTS13. The vast majority of
patients are children below age 5 who have a recent gastrointestinal infection (especially with E.
coli O157:H17); this is so-called “typical” or “diarrhea-associated” HUS (D+HUS). 10% or so of
patients with HUS, however, are adults who either have a disease or infection (including
Streptococcus pneumoniae, HIV, cancer), are pregnant, are taking a mediation (including oral
contraceptives and quinine), or have a defect in the inhibition of the complement system. All of
the adult patients with HUS (no matter the cause) are grouped into the general category of
“atypical HUS.” Treatment for D+HUS is simply supportive, but as many as half of the children
affected must undergo dialysis. On the other hand, treatment for atypical HUS is controversial,
with many if not most patients receiving therapeutic plasma exchange (TPE) despite the fact that
it may not help in most cases.
HEMPAS
Acronym for a rare inherited anemia known as “Hereditary Erythroblastic
Multinuclearity with a Positive Acidified Serum lysis test,” or congenital dyserythropoietic
anemia, type II (CDA II). HEMPAS is important in blood banking due to the finding of
polyagglutination when red cells from these patients are exposed to human serum in a minority
of cases. Like other forms of polyagglutination, HEMPAS is associated with incomplete
glycosylation of surface red cell antigens, leading to exposure of an underlying antigen that is not
normally visible (cryptantigen). Antibodies against the cryptantigen are not as common as those
present in T activation, so polyagglutination is only seen with exposure to about one third of
non-self human sera. When present, however, the antibodies will lyse HEMPAS red cells when
incubated at 37C.

HLA Alloimmunization
Alloimmunization, as defined elsewhere, simply means formation of antibodies against
non-self antigens. When this occurs against antigens in the “Human Leukocyte Antigen” (or
HLA) system, the process is known as HLA alloimmunization. Anti-HLA antibodies are most
commonly induced by multiple pregnancies, though transfusion of blood products (especially
those given before the near-universal implementation of leukocyte reduction) may also be a
culprit. HLA antibodies are a big deal when a patient needs a hematopoietic progenitor cell
transplant, as well as in those needing solid organ transplants (though less so). In addition,
developing these antibodies may make a patient resistant, or “refractory” to the effect of platelet
transfusions due to the fact that HLA antibodies are present on the platelet surface.

Homologous
This antiquated term is sometimes used by blood bankers with a bit more “experience.”
The word itself roughly means “of the same species.” To blood bankers that use it, however, it
means exactly the same as “allogeneic“; that is, it refers to blood from a different person. The
problem is that the word really sounds like “autologous“, so many students confuse the two
phrases and think “homologous” means blood from the same person.