Evidence mapPaperPMID 41652849Full record

ArticleTransfusion2026

IgG4 anti-CD47: Erythrophagocytosis and potential transfusion complications.

Kayluz Frias Boligan, Melika Loriamini, Mairead B Holton, Gurleen Sandhu, Beth Binnington, Randall Velliquette, Connie M Westhoff, Donald R Branch

Abstract read
In one paragraph

Article in Transfusion, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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field-weighted citation impact
1 · What the graph read from it

What it found

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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

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Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

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PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Kayluz Frias BoliganCanadian Blood Services, Centre for Innovation, Toronto, Ontario, Canada.
Melika LoriaminiCanadian Blood Services, Centre for Innovation, Toronto, Ontario, Canada.
Mairead B HoltonCanadian Blood Services, Centre for Innovation, Toronto, Ontario, Canada.
Gurleen SandhuCanadian Blood Services, Centre for Innovation, Toronto, Ontario, Canada.
Beth BinningtonCanadian Blood Services, Centre for Innovation, Toronto, Ontario, Canada.
Randall VelliquetteImmunohematology and Genomics Laboratory, New York Blood Center Enterprises (NYBCe), Rye, New York, USA.
Connie M WesthoffImmunohematology and Genomics Laboratory, New York Blood Center Enterprises (NYBCe), Rye, New York, USA.ORCID https://orcid.org/0000-0002-1929-4593
Donald R BranchCanadian Blood Services, Centre for Innovation, Toronto, Ontario, Canada.ORCID https://orcid.org/0000-0002-8974-2451

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundIgG4 monoclonal anti-CD47 for cancer immunotherapy resulted in anemia necessitating red cell (RBC) transfusions. Although the antibody readily binds to CD47 on RBCs, the mechanism underlying the anemia associated with IgG4 is poorly understood. We investigated samples from patients receiving Hu5F9-G4 (magrolimab) with positive reactivity in compatibility tests using a monocyte-monolayer assay (MMA). STUDY DESIGN AND

methodsFor RBC opsonization, patient plasma was diluted to avoid direct agglutination and to give a 4+ indirect antiglobulin test (IAT) and >10

resultsFive of six samples showed significant erythrophagocytosis (phagocytosis index [PI] = 20-60; PI > 5 clinically significant) with the exception having 30-fold lower MFI. Phagocytosis was not increased in the presence of complement. Fcγ receptor blocking showed FcγRI and FcγRIIa were involved but not FcγRIIIa, supported by negative results when tested for NK ADCC. IgG4 anti-K also showed significant erythrophagocytosis (PI = 30). Blocking of CD47 increased phagocytosis, 1.7 to 3.9-fold, respectively, of RBCs opsonized with IgG4 anti-K or polyclonal anti-D.

conclusionIgG4 RBC antibodies, generally not considered clinically significant for transfusion, can result in erythrophagocytosis providing an explanation for anemia related to anti-CD47 mediated by FcγRI and FcγRIIa. Enhanced phagocytosis of alloantibody-coated RBCs with concurrent blocking CD47 suggests potential for enhanced complications for patients who develop RBC alloantibodies while receiving cancer therapies targeting CD47.

Indexed as

Antibodies, Monoclonal, HumanizedCD47 AntigenErythrocytesErythrocyte TransfusionImmunoglobulin GPhagocytosisAnemiaAntibody-Dependent Cell CytotoxicityFemaleHumansKiller Cells, NaturalReceptors, IgGAntibodies, Monoclonal, HumanizedCD47 AntigenCD47 protein, humanImmunoglobulin GmagrolimabReceptors, IgGanti‐CD47anti‐K (KEL1)Fcγ receptors, FcγI and FcγIIaIgG4 antibodiesMMAmonocyte‐monolayer assayphagocytosis

Identifiers

PMID41652849
PMCPMC13049245

What Socratic holds

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LicenceCC BY-NC-ND
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.