Acute hemolytic transfusion reaction secondary to anti-Fy3

Abstract

A hemolytic transfusion reaction due to anti-Fy3 is reported in an African American patient with no history of sickle cell disease. This 82-year-old African American woman received two units of RBCs for anemia (Hb 7g/dL) on admission for a left hip fracture. On hospital Day 7, the patient underwent left hip endoprosthesis surgery; she received two units of RBCs on the second postoperative day due to Hb of 6.1g/dL. Her urine was dark during surgery and postoperatively. Her posttransfusion plasma was red. Her Hb dropped from 8.4 to 6.4 g/dL over 24 hours after the transfusion. Her total bilirubin rose to 4.0 mg/dL, with an LDH value of 1558 U/L and a haptoglobin of 10.9 mg/dL. Both the antibody detection test and the DAT were positive. An anti-Fy3 was identified in the serum and in the eluate. To the best of our knowledge, this is the first case of acute intravascular hemolysis due to anti-Fy3 in a patient without sickle cell disease. Immunohematology 2005;21:48-52.

Hyperhemolysis in a patient with sickle cell disease and recent SARS‐CoV‐2 infection, with complex auto‐ and alloantibody work‐up, successfully treated with tocilizumab

“…Anti‐N is a rarer entity, with only one HHS patient developing an anti‐N in the 26‐year look‐back study by Merrill et al 4 In addition to the anti‐N and a previously identified anti‐Fy a , our patient also developed cold agglutinins, anti‐Le antibodies, presumed anti‐Fy3/Fy5, and HTLA‐like antibody with KN specificity. It should be noted that patients of African ancestry with the canonical FY GATA mutation can still make alloanti‐Fy3/Fy5 if exposed to Fy b antigen‐positive RBC, as with our patient 30,31 . This complex auto‐ and alloimmunization event necessitated multiple work‐ups and send‐out to two different immunohematology reference labs, including our blood supplier's national reference lab.…”

“…It should be noted that patients of African ancestry with the canonical FY GATA mutation can still make alloanti‐Fy3/Fy5 if exposed to Fy b antigen‐positive RBC, as with our patient. 30 , 31 This complex auto‐ and alloimmunization event necessitated multiple work‐ups and send‐out to two different immunohematology reference labs, including our blood supplier's national reference lab.…”

Complex Transfusion Management in a Sickle Cell Patient With Anti-Fy3 Alloimmunization: A Case Report

“…In our case, the Fy null phenotype and the emergence of anti-Fy3 could be attributed to the presence of the erythroid-specific GATA-1-binding motif mutation. However, unlike most cases, the anti-Fy3 alloantibodies were here unaccompanied by concurrent or existing anti-Fy a alloimmunization, rendering this an atypical case of anti-Fy3 development [ 12 - 17 ].…”