Delayed Haemolytic Transfusion Reactions due to Anti-C

Abstract

In 5 patients of phenotype ccDEe or ccDEE, the transfusion of 2-14 U of C-positive blood was followed 5-9 days later by haemoglobinuria lasting 2-4 days. Anti-C was the only antibody present in all 5 cases but was always of low titre; with CC cells the maximum titre recorded with the indirect antiglobulin test was 8 and with the agglutination of enzymetreated cells, 128. The discordance between the weakness of the antibody in vivo and the amount of haemoglobin released intravascularly is surprising but may be related to the type of IgG molecule of which anti-C is composed.

An Immediate Hemolytic Transfusion Reaction Due to Anti-C and a Delayed Hemolytic Transfusion Reaction Due to Anti-Ce+e: Hemoglobinemia, Hemoglobinuria and Transient Impaired Renal Function

“…Antibody re sponse to the incompatible transfusions was minimal and/or transient in three cases. The strength of all four antibodies was compara ble to those reported by Pickles et al [9].…”

“…This and the DHTR due to anti-Ce+e add two cases of HTR due to these antibodies to the nine already reported [5,8,9], and they add two cases with hemoglobinuria to the five re ported [9], The cases reported herein also add one DHTR with hemoglobinuria to the 24 reported cases due to all alloantibodies [6][7][8][9][10][11] and they add two examples of HTR due to Rh antibodies complicated by renal other examples of these specificities. None of the antibodies could be subclassed, and all four were normal on RBC-MPA.…”

“…5 patients with DHTR oc curring over a 14-year period, all presenting with hemoglobinuria at 5-9 days, and all due to anti-C, were reported by Pickles et al [9] in 1978. In 1980 Moore et al reported 2 patients with DHTR due to anti-C and 1 due to anti-C, E. These patients did not have hemoglobinuria.…”

“…In 1980 Moore et al reported 2 patients with DHTR due to anti-C and 1 due to anti-C, E. These patients did not have hemoglobinuria. DHTR in which hemoglo binuria is observed are of rare occurrence [6][7][8][9][10][11]. Of the 24 cases reported, 9 were due This report will present the first imme diate HTR due to anti-C, a case which ex hibited hemoglobinemia, hemoglobinuria and transient renal impairment; a second patient with DHTR due to anti-Ce+e who had hemoglobinemia, hemoglobinuria and transient renal impairment; and 2 matching cases in whom neither signs nor symptoms of HTR occurred.…”

Control of the antigen‐antibody ratio in antibody detection/compatibility tests

“…Although the literature contains many cases of antibody-mediated delayed hemolytic transfusion reaction (DHTR) in which subsequent retesting of pretransfusion specimens showed no antibody by "usual" or "standard" techniques, no information about what serum: cell ratio was employed is provided.4, 8-11, [14][15][16][17]20,21,[24][25][26][27]32 In order to minimize errors in in vitro tests for detection of clinically significant antigens and antibodies, it is important to I) standardize pretransfusion test methodology by adopting an optimum serum:cell ratio, 2) test the drop delivery volume of dropper pipettes used in antibody detection! compatibility tests as part of the quality control of equipment, 3) promote standardization of the concentration of commercial reagent red blood cells and the drop delivery volume of their vial droppers, and 4) save pretransfusion samples for 14 days after the patient's transfusion.…”