© American Society for Clinical Pathology S105 Am J Clin Pathol 2021;156:S21-S165 DOI: 10.1093/ajcp/aqab191 AJCP / Meeting AbstrActs age for females was 50 and for males, 57. Overall, B2GA was present more than ACA (102/81) in females, and ACA was present slightly more than B2GA (20/17) in males. IgM APAs were much more common than IgG APAs; IgM B2GA/IgG B2GA: 87/32 (p<0.01) and IgM ACA/IgG ACA: 81/20 (p<0.01). Most APAs were at the low-intermediate titer range and increased APAs titer correlated with decreased positive rate: APAs titer at 20-40, 41-80 and >80 with positive results at 115, 61 and 44 respectively. In addition to documented autoimmune disorders, pregnancy miscarriage was a common clinical condition (24/66) in females at age <45. But for females at age >45, vascular thrombosis became more common (18/70). Vascular thrombosis was a common clinical di- sease in males (16/31) followed by autoimmune disorders (10/31). Most patients with vascular thrombosis received antithrombotic therapies. Conclusion: Female patients positive for APAs was sig- nifcantly more and younger than males in this study. IgM B2GA was the most common type of APAs followed by IgM ACA. IgG B2GA and IgG ACA were much less common. In younger female patients autoimmune dis- orders and abortion were the most common clinical conditions. In older female and male patients, autoim- mune disorders and vascular thrombosis were the most common clinical conditions. The titer of APAs detected was at low-intermediate range in most patients. The rela- tionship between the titer of APAs and clinical conditions needs further study. Hyperhemolysis Syndrome Following Pre-Operative Red Blood Cell Exchange D. Allison, 1 S.S. Karimi, 1 S. Campbell-Lee 1 ; 1 Pathology, University of Illinois Chicago, Chicago, Illinois, UNITED STATES Introduction/Objective: Pre-operative red blood cell ex- change (RBCX) for patients with Sickle Cell Disease (SCD) is a category III indication. In our institution, RBCX is routinely performed pre-operatively when ge- neral anesthesia is necessary with the goal of HbS%<30 and reduction in adverse events related to general anes- thesia. In the context of elective surgery, the risks and benefts of both the operation and any pre-operative transfusion must be discussed with the patient. Herein, we present an extreme case of Hyperhemolysis Syndrome resulting from a pre-operative RBCX. Methods/Case Report: A 23-year-old transgender fe- male with SCD (Hb S Lepore) treated with Hydroxyurea presented for elective breast augmentation for gender- affrmation. Her pre-operative plan included a RBCX. Her pre-exchange hemoglobin (Hb) and hematocrit (Hct) were 10.3 g/dL and 29.3%, respectively. Hb electropho- resis revealed HbS 52%, HbF 41.4%, HbA2 7.4%, and HbA was not detected. Type and Screen (T&S) demon- strated O + blood group, with a negative antibody screen, and with no known historical alloantibodies. RBCX was performed using the Spectra Optia (TerumoBCT, Lakewood, CO, USA) with exchange volume of 1.9 L of group O+ RBCs, phenotypically matched for C, E, and K, an end Hct of 30% and an FCR of 30%. Her post-exchange Hb and Hct were 10.2g/dL and 29.5%, respectively. Hemoglobin fractionation re- vealed HbS 12% and HbA 73%. She underwent surgery without intraoperative complica- tions. Two weeks post RBCX, her Hb had decreased to 5.3 g/dl, and her LDH and Total Bilirubin had increased to 253 ul and 1.8 mg/dl, respectively. A repeat T&S drawn 8 days after RBCX revealed a positive antibody screen and direct antiglobulin test (DAT). Three new alloantibodies were identifed: anti-Fya (present in plasma and eluate); anti-Jkb (present in plasma); anti-S (eluate). She was treated with IVIG, 0.4 g/Kg/day for 5 consecutive days and 2 doses of subcutaneous darbepoetin 100 mcg and subsequently discharged with close outpatient follow up. Her Hb returned to baseline at 11 g/dL, 48 days post RBCX. Results (if a Case Study enter NA): N/A Conclusion: Pre-operative RBCX decreases morbidity in sickle cell patients undergoing general anesthesia. In the setting of elective surgery, patients must be counseled on the benefts and risks of surgery as well as the requi- site RBCX. In our case, the patient developed multiple alloantibodies, with lifelong implications should she ever need future blood transfusions. Anemia prevalence in mothers with children under fve years of age in Dodi Papase, Volta region of Ghana and preventive practices. A. Sanyaolu, 1 G. Dzando, 2 C. Okorie, 3 U. Jaferi, 4 A. Marinkovic, 5 S. Prakash, 5 R. Patidar, 5 P. Desai, 6 K. Younis 7 ; 1 Communicable Diseases, AMOOF Healthcare Consulting, Calgary, Alberta, CANADA; 2 University of Cape Coast, Cape Coast, GHANA; 3 Union County College, Plainfeld Campus, New Jersey, UNITED STATES; 4 All Saints University School of Medicine, Roseau, DOMINICA; 5 Saint James School of Medicine, The Quarter, ANGUILLA; 6 American University of Saint Vincent School of Medicine, Leeward Hwy, SAINT VINCENT AND THE GRENADINES; 7 Mount Royal University, Calgary, Alberta, CANADA Introduction/Objective: Sociodemographic factors infu- ence the prevalence of anemia in endemic areas. The pur- pose of this study is to establish the prevalence and causes of anemia and to determine anemia preventive practices carried out by mothers with children under fve years of age in the Kadjebi District of the Volta region of Ghana. 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