ABSTRACT
Delayed hemolytic transfusion reaction (DHTR) due to multiple red blood cell (RBC) alloantibodies has rarely been reported in Korea. We report a case of DHTR in a patient with anti-c, anti-E, and anti-Jk(b). A 45-year-old man visited the emergency room with flame burn injury over 61% of his entire body. He received six units of packed RBCs and three units of fresh frozen plasma during the operation for excision and glycerol-preserved allografting. His hemoglobin (Hb) level gradually decreased from 13.5 g/dL on the operation day to 7.8 g/dL on the 11th postoperative day in spite of receiving three and two additional units of packed RBCs on the 8th and 9th postoperative days, respectively. His laboratory data was total bilirubin/direct bilirubin 15.9/11.4 mg/dL, lactate dehydrogenase 983 IU/L, haptoglobin 5.93 mg/dL and plasma hemoglobin 8.0 mg/dL. The urinalysis revealed hemoglobinuria, and the peripheral blood film showed moderate spherocytosis. Both the direct and indirect antiglobulin tests were positive, and the follow-up antibody identification test showed anti-c, anti-E, and Jk(b). His Hb levels increased after he was transfused with two units of packed RBCs without c, E, and Jk(b) antigens. This is a case of DHTR due to alloimmunization, which developed within a short interval after the patient had received multiple transfusions.