A fatal case of acute hemolytic transfusion reaction caused by anti-Wr^a: case report and review of the literature

Abstract

The red blood cell (RBC) antigen Wr a is a low-prevalence antigen first described in 1953 by Holman and assigned to the Diego system in 1995. Because of its low prevalence, Wr a is usually absent on commercial screening RBCs and antibody identification panels. When Wr(a+) screening RBCs are available, the corresponding antibody, anti-Wr a , is often found in sera from healthy individuals, patients, and pregnant women. Anti-Wr a can cause both hemolytic transfusion reactions and hemolytic disease of the fetus and newborn. We describe a fatal acute hemolytic transfusion reaction caused by anti-Wr a in a patient with no other RBC alloantibodies. Serologic investigation showed that one of the RBC units the patient received was Wr(a+).

Haemolytic transfusion reactions caused by non‐ABO red cell antibodies reported to the Norwegian Haemovigilance System 2004–2020

“…A total of 113 red cell antibodies were involved in the HTRs, consisting of 82 alloantibodies, 6 autoantibodies and 25 cases where the antibody specificity could not be determined. Two fatalities occurred: one caused by anti-Wr a [4] and one caused by an unidentified red cell antibody.…”

“…These were four cases of anti‐Kp a , two cases of anti‐Wr a , three cases of anti‐Co b and two anti‐C w (Figure 3). Except for one case of anti‐Wr a leading to a fatal acute HTR [4], the antibodies against LIAs were identified together with other antibody specificities. In two cases, two antibodies against LIAs could be found in the same patient, in addition to other red cell antibodies.…”

“…In nine additional cases involving anti‐Jk a , anti‐C, anti‐c, anti‐Fy a , anti‐Fy b , one unidentified antibody, anti‐Jk b , autoantibodies and anti‐E, the patient experienced chest or back pain and/or signs of haemolysis during the HTR. In one fatal case of anti‐Wr a , the patient had severe renal failure [4].…”