The differentiation of delayed serologic and delayed hemolytic transfusion reactions: incidence, long‐term serologic findings, and clinical significance

Abstract

Delayed serologic transfusion reactions (DSTRs) and delayed hemolytic transfusion reactions (DHTRs) were studied in a large tertiary-care hospital. A DSTR was defined by the posttransfusion finding of a positive direct antiglobulin test (DAT) and a newly developed alloantibody specificity. A DHTR was defined as a DSTR case that showed clinical and/or laboratory evidence of hemolysis. Thirty-four cases of DSTR, 70 percent of which were due to anti-E and/or -Jka, were documented prospectively over a 20-month period. Retrospective review of the medical records found clinical evidence of hemolysis in only 6 (18%) of the 34. Thus, the incidence of DSTR was 1 (0.66%) of 151 recipients with posttransfusion samples available for testing, whereas the incidence of DHTR was only 1 (0.12%) of 854 patients tested. Fifteen of the 34 patients were followed for up to 174 days after reaction. Twelve of the 15 still demonstrated a positive DAT with anti-IgG only. Eluate studies indicated that the persistence of a positive DAT after DSTR or DHTR may involve several immunologic mechanisms, including the development of posttransfusion autoantibodies. This study indicates 1) that DSTRs are a frequent finding in multiply transfused patients, although most cases are benign and fail to meet rigid criteria for DHTR, and 2) that the persistence of a positive DAT after DSTR or DHTR is common.

Pretransfusion Testing without Serologic Crossmatch: Approaches to Ensure Patient Safety

“…There were 201 (0.57%) transfusion reactions, including 73 (0.18%) febrile, 65 (0.17%) allergic, 73 (0.18%) miscellaneous (cytokine or coincidental), and 3 (0.008%) delayed hemolytic reactions. The incidence of the various types of reaction was consistent with previous reports [2, 5]. Blood bank records of transfusion reactions for an additional 5 years (1989–1993) showed no acute hemolytic reactions.…”

Delayed Hemolytic Transfusion Reaction Due to Anti-Jsain an Alloimmunized Patient With a Sickle Cell Syndrome

“…Furthermore, the patient described in this report was clinically symptomatic with fever and severe back and left upper quadrant abdominal pain. Ness et al 16 have differentiated DHTRs from delayed serologic reactions. The positive DAT, eluate results, and supporting laboratory values are the key serologic tests that implicate a serologic reaction, while correlated clinical symptoms in the patient support a hemolytic reaction.…”

History and Hemolysis: Not an Easy Kidd’s Game and Review of Literature

“…The Kidd family of antigens (Jk a , Jk b , and Jk 3 ) was first described in 1951 (Allen et al, 1951), and is estimated to be responsible for more than one-third of DHTRs (Ness et al, 1990). The prevalence of Kidd antibody-induced DHTRs is likely underrepresented due to the transient Figure 1).…”