P38An Acute Hemolytic Transfusion Reaction Due to Anti-Wra Antibodies.

The Wr^a antigen is found on the red blood cells of approximately 1 : 1000 caucasians. Anti-Wr^a antibodies have been reported to be present in 1 : 25 to 1 : 100 healthy blood donors and an even higher proportion of hospital patients. Wr^a incompatibilty might therefore be expected to occur in approximately one in 50,000 blood transfusions. Reports of hemolytic transfusion reactions (HTR) and hemolytic disease of the newborn (HDN) due to anti-Wr^a are however rare. We report an acute HTR due to anti- Wr^a in a 58 year old male with MDS associated with rigors, shortness of breath and a significant rise in serum bilirubin from 16 μmol L⁻¹ pre-transfusion to 110 μmol L⁻¹ immediately afterwards. This was accompanied by the appearance of bilirubin and urobilinogen in his urine and a fall in haemoglobin of nearly 2 g dL⁻¹ following the transfusion. Anti- Wr^a was the only antibody implicated. Wr^a antigen expressing reference panel cells and the unit being transfused during the gave 2–3+ reactions by IAT against the recipient's plasma. The donation typed as positive with Wr^a antisera. The recipient typed as Wr^a antigen negative. The reaction resulted in the patient being admitted to hospital for 2 days. The increasing use of electronic issue may result in more frequent reports of reactions due to anti-Wr^a as commonly used screening cells do not express this antigen.     

Hemolytic Transfusion Reaction Associated with Poorly Detectable Anti-Jka

A hemolytic transfusion reaction, probably attributable to anti-Jk^a, occurred in a patient whose serum, before transfusion, reacted only very weakly with Jk(a+) cells.     

Hemolytic Transfusion Reaction Due to Interdonor Incompatibility

A hemolytic transfusion reaction due to interdonor incompatibility is reported. In a Kell negative recipient without irregular antibodies, Kell positive erythrocytes from one transfusion reacted with high-titered anti-Kell antibodies present in a unit of blood transfused subsequently. It was possible to demonstrate in vitro sensitization of mixed populations of Kell positive and Kell negative red cells exposed to antibody dilutions analogous to those in the patient.     

Hemolytic Disease of the Newborn Due to Anti-Jsa

A case of hemolytic disease of the newborn caused by Js^a sensitization is reported. The antibody, the sixth example of anti-Js^a, was detected in the serum of the mother of a nine-day-old anemic infant who required supportive transfusion.     

Hemolytic Disease of the Newborn Due to Anti-Jsb

Js^bnegative antigen occurs in about 1 per cent of Negroes and has not been reported in Caucasians. This report presents what appears to be the first published case of hemolytic disease of the newborn due to anti-Js^b. The disease was mild and no exchange transfusions were required despite a fairly high maternal anti-Js^b titer. Potential transfusion problems are discussed.     

Delayed Transfusion Reaction Attributed to Anti-Jkb

A hemolytic transfusion reaction, attributed to anti-Jk^b, occurred in a multiparous woman four days posttransfusion. Anti-Jk^b was not detectable in the patient's serum prior to transfusion, but was readily demonstrable seven days following transfusion. The anti-Jk^b was not accompanied by any other atypical blood group antibody.     

Delayed Hemolytic Transfusion Reaction Due to Appearance of Multiple Antibodies Following Transfusion of Apparently Compatible Blood

A delayed hemolytic transfusion reaction, appearing seven days after transfusions, characterized by jaundice, hemolysis and hemoglobinuria accompanied by the appearance of multiple antibodies in the patient's serum (anti-hr" (c) anti-rh" (E) and anti-Jk^b) is explained as an anamnestic phenomenon. The original sensitizing antigens and those which precipitated the recall mechanism may be traced to her 20-year-old son and to the single-unit transfusion which she received five years previous to the last admission, and to the transfusions given with the operation from which she recovered.
The important fact is that these latent antibodies failed to be detected by standard crossmatching tests (saline, high protein and Coombs) and by a pool of cells containing most of the antigens. The triple enzyme method was the only test which detected the anti-rh" (E) antibody.
The direct Coombs test became positive at the height of the reaction and persisted for 48 hours. Blood tests after 31/2 and 41/2 months revealed that both the anti-Jk^b and anti-rh" (E) antibodies had vanished and only anti-hr' (c) of low titer was still present.     

Hemolytic transfusion reaction due to anti-Tca

BACKGROUND: Anti-Tc(a) detects a high-incidence antigen in the Cromer blood group system. Cromer system antibodies have not usually been associated with hemolytic transfusion reactions or hemolytic disease of the newborn. CASE REPORT: Anti-Tc(a) (initially identified in the patient's serum in 1982) was not detected when she was admitted to the hospital with upper gastrointestinal. bleeding. Three units of red cells were administered. The patient was discharged, but was readmitted to the hospital after her hemoglobin fell to 7.1 g per dL. Antibody detection tests remained negative and three additional units were transfused. Over the next 7 days, her hemoglobin steadily fell to 5.5 g per dL. The level of lactate dehydrogenase rose to 1257, the plasma hemoglobin rose to >16 mg per dL, and the haptoglobin decreased to <6 mg per dL. Five days after transfusion, her direct antiglobulin test was weakly reactive with complement-specific antiglobulin reagents. Eluates were nonreactive. Anti-Tc(a) was detected in her serum; no other antibodies were detected. Differential typing failed to detect any circulating Tc(a+) red cells. The antibody was strongly reactive in a monocyte monolayer assay. CONCLUSION: Although Cromer system antibodies have generally not been proven to be clinically significant in transfusion therapy, the destruction of red cells from six units of transfused Tc(a+) red cells in this patient indicates that anti-Tc(a) may have destructive potential in some patients.     

A Fatal Hemolytic Transfusion Reaction with Acute Autohemolysis

A fatal hemolytic transfusion reaction due to anti-Kidd (Jk^a) is described in a woman with aplastic anemia associated with acute leukemia. Radioactive chromium studies, which were in progress at the time, made it possible to demonstrate that a severe autohemolytic crisis was a part of the reaction. The relationship between a hemolytic transfusion reaction and the initiation or intensification of autohemolysis is discussed. The difficulties of serologic diagnosis and selection of blood for transfusion in patients with nonspecific antibodies are reviewed. This case again illustrates that nonspecific agglutinins can mask the presence of specific anti-red cell antibodies.     

免疫性溶血性输血反应100例分析

目的 近年来,临床样本的检测中,免疫性溶血性输血反应(IHTR)样本检出率不断增加.同时,毛细管离心技术、PEG增强技术、微柱凝集卡技术等逐渐普及应用,这些技术上的变化可能影响IHTR检出率.为了减少IHTR漏检,有必要对以往IHTR样本特点进行总结,分析造成临床漏检的可能原因,以及实验室及时发现IHTR的检测技术关键...     

Autoimmune Hemolytic Anemia in Hodgkin's Disease Associated with Anti-IT

In this study, three cases of Hodgkin's disease with autoimmune hemolytic anemia are described. The IgG autoantibodies in each case were shown to have I^T specificity. There is only one other case of an IgG anti-I^T described in the literature and that also was present in a patient with Hodgkin's disease. No other examples of anti-I^T were found in studies which included 50 cases of Hodgkin's disease with negative direct antiglobulin tests, three cases with positive direct antiglobulin test but no hemolysis, and 70 cases of autoimmune hemolytic anemia, either idiopathic or secondary to other diseases of the reticuloendothelial system. Fetal, cord and adult cells were tested with anti-IT, anti-I and anti-i in an attempt to show the development of I^T relative to i and I.     

Hemolytic Disease of the Newborn Apparently Caused by Anti-Lua

Report of the first example of pure anti-Lu^a associated with hemolytic disease of the newborn. Of special interest is the fact that this serum demonstrated a marked prozone reaction in saline, papain and indirect Coombs titrations, and is the first anti-Lu^a serum to react well by the indirect Coombs technic.     

Severe Acute Hemolytic Transfusion Reaction Treated with Ruxolitinib and Plasma Exchange

IntroductionAcute hemolytic transfusion reaction is a rare but extremely mortal condition. Even small quantities of ABO-incompatible erythrocytes, as much as 50 mL, can lead to fatality. Since there is no successful standard therapy, preventive measures are very important. In this case report, we presented a 29-year-old woman who was transfused with 2 units of AB Rh-positive instead of 0 Rh-positive red blood cells following a cesarean section. As far as we know, this is the first patient in the literature for whom ruxolitinib was used as a part of therapy.Case ReportThe patient was referred to our center 22 h after the ABO-mismatched transfusion. On admission, she had severe hemolysis, acute renal failure, and disseminated intravascular coagulation. Massive plasma exchange, hemodialysis, and pulse steroid therapy were commenced. The patient was refractory to first-line therapies. She was intubated on day 2 due to hypoxia, respiratory failure and changes in consciousness. Ruxolitinib, 2 × 10 mg/day, was started on day 3. The patient''s clinical status improved on day 6. Ruxolitinib was withdrawn on day 15, and the patient was discharged without any complications or sequels on day 26.ConclusionRuxolitinib may be life-saving in patients with ABO-incompatible transfusion reaction which follows a severe and catastrophic course.     

Delayed Hemolytic Reaction Caused by Anti-c Not Detectable Before Transfusion

A patient with the phenotype CCD^uEe was given ten pints of blood which were compatible on crossmatch. Five days later a moderately severe hemolytic reaction appeared. Recheck of the pretransfusion specimen revealed no antibodies but a sample taken on the ninth postoperative day contained anti-c.     

低频率抗体抗-Mur引起的溶血性输血反应

目的 :研究抗Mur抗体的血清学特异性及其在输血中的临床意义。方法 :患者的血清 ,与 3组试剂红细胞 (其中二组为Miltenberger抗原试剂红细胞组 )和 2 8个低频率血型抗原 ,在盐水介质、低离子强度介质和低离子间接抗球蛋白介质中反应 ,分析鉴定其抗体的特异性。结果 :患者血清与三组试剂红细胞在多种反应介质中的反应的结果显示患者血清中含有抗Mur抗体 ,患者血清与 2 8个低频率血型抗原的反应证实该例抗体只与Mur抗原反应。结论 :该例同种抗体为特异性抗Mur抗体 ,且引起溶血性输血反应。在亚洲人中Miltenberger血型系抗体筛选意义值得探讨。     

Anti-Lub and Mild Hemolytic Disease of the Newborn: A Case Report

The occurrence of anti-Lu^b is uncommon. A group O, Rh-negative woman developed atypical antibodies during her second pregnancy. The direct antiglobulin reaction on the cord blood was weakly positive and the infant developed mild jaundice. The mother's cells were determined to be Lu^b-negative and the antibody in the serum was identified as anti-Lu^b.     

Second Example of Hemolytic Disease of the Newborn Caused by Anti-Jkb

Mild hemolytic disease developed in the second child of a woman who gave no history of transfusions. The antibody was identified as anti-Jk^b. The antiglobulin method gave the strongest reactions but the antibody also agglutinated test cells in saline at room temperature and at 37 C. No difficulty was encountered in determining the presence of the Jk^b antigen in cord blood erythrocytes.