Delayed Hemolytic Transfusion Reaction Associated with Rh Antibody Anti-f: First Reported Case

A delayed hemolytic transfusion reaction (DHTR) occurring in a 30-year-old Caucasian man is described. His blood groups were B, CDe/cDE (R1R2, f-) K-, S-s+, Fy (a + b-), and Jk (a + b +). Eight days after receiving two units of packed red blood cells, his urine was strongly positive for hemoglobin; serum-free hemoglobin was 125 mg/dl. Serum contained a clearly reactive Rh antibody of anti-f specificity and a weakly reactive anti-Kell. The DHTR was probably caused by an anti-f alloantibody appearing as an anamnestic response to transfusion of seemingly compatible, but f-positive blood.     

Delayed Hemolytic Transfusion Reaction Caused by Anti-LebH Antibody

A major delayed hemolytic transfusion reaction produced by an antibody to Lewisb is reported. Delayed hemolysis following transfusion with Leb-positive red cells was not reported to the blood bank. Severe hemolysis recurred following a second transfusion with Leb-positive cells, but was avoided thereafter with Leb-negative red cells. This is the first reported case of a serious delayed hemolytic transfusion reaction caused by anti-Leb.     

Intravascular Hemolytic Transfusion Reaction due to Anti-Vw+Mia with Fatal Outcome

Because of the increasing use of type, screen and hold protocols and minimal surgical blood order protocols in transfusion services, a number of patients are receiving un-cross-matched blood in elective situations. There are many low-frequency red blood cell antigens which are lacking on reagent cells used for antibody screening procedures, and alloantibodies directed against these antigens are relatively common and occur in either natural or immune forms. A case of an intravascular hemolytic transfusion reaction resulting in death is reported. The patients had a naturally occurring anti-Vw+Mia and received 1 U of Vw+Mia-positive donor red cells. It is the 1st documented case of a hemolytic transfusion reaction due to this incompatibility. The potential threat of transfusion reactions due to low-frequency antigens must be recognized by the physicians who design type, screen and hold protocols and it has particular reference to the selection of possible recipients for whom the protocols are applied.     

First Case of Hemolytic Disease of the Newborn due to Anti-Ula Antibodies

The first case of hemolytic disease of the newborn (HDN) due to anti-Ul^a antibodies is described. The infant had severe anemia with a positive direct antiglobulin test with anti-IgG that required blood transfusion. But jaundice was not severe enough for exchange transfusion or phototherapy.     

Haemolytic Transfusion Reaction Caused by Anti-Lea

A severe hemolytic transfusion reaction due to the presence of a potent anti-Le^a in the patient's serum is described. The antibody was markedly hemolytic in vitro, especially against enzyme treated red cells. With carefully supervised therapy and restriction of fluids the patient recovered without any apparent kidney damage. The results of red cell and saliva studies on the patient's family are given.

Résumé

Les auteur décrivent une réaction transfusionnelle grave due à la présence d'un anti-Le^a puissant dans le sérum d'une patiente. Cet anticorps était très fortement hémolytique in vitro et plus spécialement à l'égard d'érythrocytes traités par des enzymes protéolytiques.
Grâce à une étroite surveillance du traitement et à la diète hydrique, la patiente a pu se remettre sans lésions rénales apparentes irréversibles. Les auteurs présentent les résultats des examens pratiqués sur la salive et les érythrocytes des membres de la fade de la patiente.

Zusammenfassung

Eine schwere hämolytische Transfusionsreaktion, bedingt durch die Anwesenheit eines kräftigen Anti-Le^a-Antikörpers im Patientenserum, wird beschrieben. Der Antikörper wirkte in vitro als Hämolysin; die Lyse enzymbehandelter Erythrozyten war besonders ausgepragt. Unter sorgfältiger Therapie mit Flüssigkeitsbeschränkung genas der Patient ohne erkennbaren Nierenschaden. Die Ergebnisse der serologischen Erythrozyten- und Speichelanalyse der Familie des Patienten werden mitgeteilt.     

Immediate Haemolytic Transfusion Reaction Due to Anti-Inb

An immediate haemolytic transfusion reaction was investigated in a patient with intestinal cancer. The causative antibody was directed against a high-frequency antigen Inb that was presumably produced as a result of pregnancies. This is the first case of a severe transfusion reaction due to this alloantibody.     

An Example of Anti-Jra Causing Hemolytic Disease of the Newborn and Frequency of Jra Antigen in the Japanese Population

An example of anti-Jra which caused hemolytic disease of the newborn is reported. Two other examples of the antibody were detected in random screening of Japanese donors. In testing 19, 298 unrelated Japanese, 5 Jr(a-) individuals were found, i.e. an incidence of 0.0003 (0.03%); the corresponding gene frequencies were Jra 0.984 and Jr 0.016.     

A Hemolytic Reaction Implicating Sda Antibody Missed by Immediate Spin Crossmatch

Anti-Sda, an antibody not usually considered to cause of hemolytic transfusion reactions, possibly was related to hemolysis following transfusion of red blood cells expressing strong Sda antigen. Prior to transfusion, the antiglobulin antibody screen performed in LISS and an immediate spin crossmatch were negative. Retrospectively, after hemolysis was detected, an antiglobulin crossmatch with red cells from the transfused unit revealed microscopic incompatibility. The transfused unit proved to have strong expression of Sda antigen-facilitating identification of a weak Sda antibody in our patient. In addition, this case represents an unusual instance in which an antibody screen plus an immediate spin crossmatch failed to detect an incompatibility that would have been apparent had an antiglobulin crossmatch been performed.     

Transfusion Significance of LWa Allo-Antibodies

An example of anti-LWa, arising as a complication during a RhD immunization programme, has been studied for evidence of its likely in vivo haemolytic properties. In vitro testing of the anti-LWa showed it to be largely IgG1 acting by the antiglobulin technique. Results of antibody-dependent cellular cytotoxicity and macrophage phagocytic assays were both negative. However, 99mTc-labelled Lw(a+) donor cells showed a slight reduction in t1/2 (18 h) compared with the normal survival of autologous cells. Despite this observation, and bearing in mind the difficulties of interpreting apparently accelerated destruction of small serologically incompatible red cells, it was concluded that the presence of this example of anti-LWa should not be a bar to urgent transfusion.     

Post-Transfusion Purpura Associated with Anti-Baka and Anti-PlA2 Platelet Antibodies and Delayed Haemolytic Transfusion Reaction

The occurrence of post-transfusion purpura (PTP) in a 16-year-old girl with sickle/beta-thalassaemia is described. Clinically this was a typical case of PTP, but it was unusual serologically. Anti-Baka and anti-PIA2 platelet-specific antibodies were identified and the patient's platelets were typed as homozygous PIA1-positive and Baka-negative. The patient also developed red-cell, granulocyte and lymphocytotoxic antibodies in response to the blood transfusion and had a delayed haemolytic transfusion reaction.     

Enlargement of the Dombrock Blood Group System: the Finding of Anti-Dob

Abstract. The finding of anti-Do^a, the antibody antithetical to anti-Do^b in the Dombrock blood group system, is here reported; its existence promotes Dombrock to fifth place amongst red cell antigen systems in order of potential usefulness in discriminating between white people.     

The First Human Example of anti-Me

Abstract. Anti-M^e is an antibody which cross-reacts with the M and He antigens. It has previously only been found in rabbit serum; the first human example is described.
The Henshaw antigen is closely associated with the MNSs system and is found in about 3% of Negroes [1–3] but only rarely in Caucasoids [2]. The original anti-He was found in a rabbit anti-M serum by Ikin and Mourant [1] in 1951. Other examples were deliberately produced by the immunisation of rabbits with the blood of Mr. Henshaw [3].
The first example of anti-He in a human serum was found in 1967 by MacDonald et al. [4] in a Caucasoid mother. Although at the time it was not possible to ascertain the racial group of the father, it has since been established that he was a Negro. Other human anti-He sera have since been found [2].
In 1961 Wiener and Rosenfield [5] reported an immune rabbit serum which possessed inseparable anti-M and anti-He specificities which they designated anti-M^e. The rabbit which produced the anti-M^e had almost certainly not received Henshaw-positive cells. The rabbit serum was investigated as a result of a discrepancy found during M-typing of a Negro involved in a medicolegal case of disputed parentage.
The first human example of anti-M^e herein described was found in the serum of Mr. Richards, a 41-year-old Caucasoid male with no known transfusion history and has been used at this centre as an anti-M serum for many years.     

Delayed Haemolytic Transfusion Reaction Due to Simultaneous Appearance of Anti-Fya and Anti-Fy5

We report here the development of anti-Fy5 in a young Negro female with sickle cell disease. The antibody was responsible for a delayed hemolytic transfusion reaction. We believe this is the first report of such an antibody in Europe.     

The Serology of Sda Effects of Transfusion and Pregnancy

Abstract: Pre- and posttransfusion antibody titers were performed on 6 patients with anti-Sd^a transfused with incompatible blood. In 3 of these patients a significant rise in IgG antibody titer was found. The data suggest that in occasional patients the Sd^a antigen does evoke a secondary immune response. We evaluated 245 pregnant women for the presence of Sd^a and found that 30% were Sd(a-). This incidence was significantly higher than that found in normal blood donors (4%), but was lower than that described in previous reports. We found that 22% of pregnant women in their first trimester were Sd(a-) whereas at term 36% were Sd(a-). These significantly different incidences of antigen positivity suggest decreased antigen expression with progressing pregnancy, as seen in the Lewis system. No difference was found in the incidence of anti-Sd^a between pregnant women, either during their first trimester or at term, and normal donors.     

Severe Delayed Hemolytic Transfusion Reaction Complicating an ABO-Incompatible Bone Marrow Transplantation

A 26-year-old, blood group O bone marrow transplant recipient experienced a severe, delayed hemolytic transfusion reaction 6 days following transplantation of marrow from his HLA-mixed lymphocyte culture - identical, blood group AB sister. The patient's pretransplant serum contained both anti-A (IgG titer = 1:128; IgM = 1:32) and anti-B (IgG = 1:16; IgM = 1:64) which was reduced by a two-plasma volume plasma exchange followed by transfusion of four units of incompatible, donor type red cells. The patient experienced no immediate adverse reaction. On the 6th posttransplant day, he became acutely dyspneic. His hematocrit dropped to 18%; the direct antiglobulin test was positive for IgG and complement; anti-A and anti-B were eluted from his red cells. His peripheral blood smear demonstrated extensive agglutination resembling a mixed field reaction. This case demonstrates that significant morbidity may be associated with major ABO-incompatible bone marrow transplantation, that the transfusion of incompatible red cells should be undertaken with extreme caution, and that efforts should be continued to develop methods of pretransplant in vitro red cell removal from the infused bone marrow.