Delayed hemolytic transfusion reaction with multiple alloantibody (Anti S, N, K) and a monospecific autoanti-JK ^b in intermediate β-thalassemia patient in Tabriz

Abstract

It appears that delayed hemolytic transfusion reactions may occur several days after the administration of donor red cells is true even though they have been shown to be compatible in cross match tests by the antiglobulin technique. A specific case was observed in our center, which confirms the fact. The patient was a 37-year-old male suffering from intermediate β-thalassemia. He had a history of two previous transfusions, with unknown transfusion reaction. In the last transfusion, laboratory data showed: Hb 7.8 g/dL and Hematocrit (Hct) 24.2%. The patient received two units of cross matched, compatible concentrated red blood cells (RBCs). After eight days a severe reaction was observed with clinical evidence of tachycardia, fatigue, fever, back pain, chest discomfort, jaundice, nausea and anorexia. Accordingly delayed hemolytic transfusion reaction was suspected, and anti-RBC antibodies were tested. Laboratory tests revealed the presence of three alloantibodies: Anti-N, anti-S, anti-K, and a monospecific autoanti-JKb.

Routine indirect antiglobulin testing of blood donors—a further step toward blood safety: an experience from a tertiary care center in northern India

“…In our study, 0.18 percent of donors were found to have unexpected alloantibodies in their serum, many of which are implicated in hemolytic transfusion reactions, both acute and delayed. [19][20][21][22][23][24] Passively transferred antibodies in plasma units can lead to hemolysis, especially in pediatric and multitransfused patients. 3 As per our departmental policy, IATpositive units were discarded.…”

Anti‐N and anti‐Doa immunoglobulin G alloantibody–mediated delayed hemolytic transfusion reaction with hyperhemolysis in sickle cell disease treated with eculizumab and HBOC‐201: case report and review of the literature

“…Acute chest syndrome can develop rapidly and progress to respiratory failure thus transfusion is recommended in cases of ACS with hypoxia (Grade 1B) . DHTR with hyperhemolysis is an uncommon but potentially fatal complication of transfusion in patients with SCD that typically occurs 5 to 30 days after transfusion . The clinical presentation mimics a severe vaso‐occlusive crisis and laboratory evidence confirms increased hemolysis and reticulocytopenia or reticulocytosis .…”

“…Acute hemolytic transfusion reactions have been reported in patients with anti‐Do a , which can be difficult to identify utilizing serologic methods . DHTR to anti‐N and anti‐Do a IgG alloantibodies is extremely rare with only a few reported cases, and finding compatible RBCs can be challenging.…”

Delayed Severe Hemolytic Transfusion Reaction During Pregnancy in a Woman with β-Thalassemia Intermediate: Successful Outcome After Eculizumab Administration

“…Delayed hemolytic transfusion reactions (DHTR) are rare. They are potentially life-threatening complications mostly triggered by red blood cell (RBC) transfusions in patients with sickle cell disease (SCD) [ 1 , 2 ], but have been occasionally described in patients with other hematological conditions [ 3 – 5 ] such as thalassemia [ 6 – 10 ]. The main cause is alloimmunization, but the pathogenic mechanisms are complex and evidence of alloimmunization is not always found [ 11 – 13 ].…”