Correlation Analysis of Hemolytic Transfusion Reaction Induced by Low Titer Antibody / 中国实验血液学杂志

OBJECTIVE@#To establish the diagnostic process of low titer blood group antibody in the occurrence of adverse reactions of hemolytic transfusion.@*METHODS@#Acid elusion test, enzyme method and PEG method were used for antibody identification. Combined with the patient's clinical symptoms and relevant inspection indexes, the irregular antibodies leading to hemolysis were detected.@*RESULTS@#The patient's irregular antibody screening was positive, and it was determined that there was anti-Lea antibody in the serum. After the transfusion reaction, the low titer anti-E antibody was detected by enhanced test. The patient's Rh typing was Ccee, while the transfused red blood cells were ccEE. The new and old samples of the patient were matched with the transfused red blood cells by PEG method, and the major were incompatible. The evidence of hemolytic transfusion reaction was found.@*CONCLUSION@#Antibodies with low titer in serum are not easy to be detected, which often lead to severe hemolytic transfusion reaction.

Identification of immune hemolytic transfusion reaction and exploration of transfusion compatibility testing / 中国输血杂志

【Objective】 To analyze the causes of immune hemolytic transfusion reaction in one case, identify related antibodies, and explore transfusion compatibility testing. 【Methods】 ABO/Rh blood group identification, unexpected antibody identification of serum and diffusion fluid, direct antiglobulin test(DAT) and cross matching were conducted by saline method and/or microcolumn gel method. 【Results】 The patient′s blood group was O, and Rh phenotype was identified as DCCee. The DAT was negative, with strong anti-E antibody and weak anti-c antibody detected. Acute hemolytic transfusion reaction occurred in the patient after the last transfusion. 【Conclusion】 Currently, immune hemolytic transfusion reaction in China are mainly caused by Rh blood group system antibodies. The absence of unexpected antibody screening before blood transfusion and the weak anti-c antibody which resulted in missed detection of non compatibility in cross matching led to acute hemolytic transfusion reaction. It is recommended to conduct unexpected antibody screening before blood transfusion, and to collect blood sample for testing as soon as possible to improve the accuracy of DAT when acute hemolytic transfusion reaction is suspected.

Distribution of RH and Kell (K) blood group antigens among blood donors in a tertiary care hospital of Jammu region, India

Background: Knowledge about the frequency of red cell antigen phenotype is very important for the creation of donor data bank and to minimize the risk of alloimmunization. This requires the determination of immunological characteristics of blood products and blood recipients by performing phenotyping of clinically significant blood group antigens. The aims and objectives were to study the distribution of Rh and Kell (K) antigen among blood donors of different ethnic groups in a tertiary care hospital.Methods: This was prospective observational cross sectional one-point analysis study which was carried out over a period of one year with effect from November 2015 to October 2016 in the Postgraduate Department of Immunohematology and Blood Transfusion Medicine, Shri Maharaja Gulab Singh (SMGS) Hospital, Government Medical College, Jammu and Kashmir, India. It comprised of voluntary and replacement donors and categorized into different ethnic groups i.e Dogras, Gujjar Muslims, Non-Gujjar Muslims, Kashmiri Pandits, Sikhs and Christian. Donors selection criteria was as per Drug and Cosmetic Act.Results: A total of 500 (Five hundred) blood samples from the donors of all blood groups were typed for the presence of Rh (D, C, E, c, e) and Kell (K) antigens. Out of these 500 samples, 420 were antigen typed by conventional tube technique and 80 samples were typed by column agglutination technique using glass beads. As per ethnicity, maximum donors were Dogras (74%) followed by Non-Gujjar Muslims (9.4%), Gujjar Muslims (9%), Sikhs (5.6%), Kashmiri Pandits (1.4%) and Christians were the least in frequency (0.6%). On phenotyping for Rh and Kell antigens ‘e’ antigen have the ubiquitous distribution and was found to have the highest frequency 486 (97.2%) followed by ‘D’ antigen 472 (94.4%), ‘C’ antigen 426 (85.2%), ‘c’ antigen 320 (64.0%) and ‘E’ antigen 103 (20.6%). Overall frequency of Kell (K) antigen was 2.6%.Conclusions: Knowledge of red cell antigen phenotype frequencies in a population with different ethnic groups can help in creating donor data bank and database for the distribution of blood groups for preparing inhouse cell panels and providing proper antigen compatible blood for patients with multiple alloantibodies and also reduce the risk of RBC antigen alloimmunization along with their complications.

Alloantibodies to High-Incidence Antigen: Review of Cases and Transfusion Experiences in Korea / 대한수혈학회지

Antibodies to high-incidence red blood cell antigens should be considered if panagglutination reactions are noted in all panel cells, and negative reactions to autologous red blood cells are detected on antibody screening and identification tests. In Korea, most of those antibodies are identified through international reference laboratories. To prevent a hemolytic transfusion reaction, antigen-negative red cells should be provided for those patients who have antibodies to red cell antigens. However, this is nearly impossible when the antibody has specificity to high-incidence red cell antigen. In those cases, transfusion of autologous blood, cryopreserved rare blood and the least incompatible blood components can be considered. In the case of surgery, acute normovolemic hemodilution or intraoperative blood salvage can also be considered. For the patients who have antibodies to high-incidence red cell antigens, it should be discussed to set up a national reference laboratory to quickly identify antibody specificities, and to consider establishing rare blood donor registry and frozen rare blood storage/supply system. This article reviews characteristics of antibodies to high-incidence antigens found in Koreans and also the transfusion experiences of those patients based on literature.

The evaluation of modified cell infusion method to reduce febrile non-hemolytic transfusion reaction in CD19 chimeric antigen receptor T cell threapy / 中华内科杂志

Objective@#To retrospectively analyze the efficacy and safety of modified cell infusion method in reducing the incidence of febrile non-hemolytic transfusion reaction (FNHTR).@*Methods@#A total of 69 patients were enrolled in the clinical trial of CD19 chimeric antigen receptor T (CAR-T) cell treatment from February 2017 to October 2018. Study group received the modified cell infusion method, that 1×106 CAR-T cells were re-suspended in 2 mg human serum albumin with total volume of 20 ml and injected intravenously. The control group was intravenously administrated with CAR-T cell in 100 ml normal saline. The incidence of FNHTR, cytokine releasing syndrome (CRS) grade, cytokine level and efficacy were compared.@*Results@#(1)The incidence of FNHTR in the study group was 21.1%, significantly lower than that in the control group (71%)(P=0.000). (2)There was no statistical difference in cell proliferation between the study group and the control group on day 4, 7, 14 and 21 after CAR-T cell infusion (P=10.223, 3.254, 5.551, 7.605). (3)There was no statistical difference in CRS grading between the study group and the control group (P=0.767). There was no statistical difference in the levels of interleukin 2 receptor (IL-2R), IL-6, tumor necrosis factor (TNF)-α between the two groups. (4)The C-reaction protein (CRP) level of the study group was lower than that of the control group on day 4 and 7 (P=0.026, 0.007). (5)There was no statistical difference of response rates in acute lymphocytic leukemia (ALL) and non-Hodgkin lymphoma (NHL) patients between the two groups (PALL=0.842; PNHL=0.866).@*Conclusion@#The modified cell infusion method in CD19 CAR-T cell treatment reduces the incidence of treatment-related FNHTR. It does not affect the proliferation of CAR-T cells in vivo, the grading of CRS and the response rates.

The evaluation of modified cell infusion method to reduce febrile non?hemolytic transfusion reaction in CD19 chimeric antigen receptor T cell threapy / 中华内科杂志

To retrospectively analyze the efficacy and safety of modified cell infusion method in reducing the incidence of febrile non?hemolytic transfusion reaction (FNHTR). Methods A total of 69 patients were enrolled in the clinical trial of CD19 chimeric antigen receptor T (CAR?T) cell treatment from February 2017 to October 2018. Study group received the modified cell infusion method, that 1×106 CAR?T cells were re?suspended in 2 mg human serum albumin with total volume of 20 ml and injected intravenously. The control group was intravenously administrated with CAR?T cell in 100 ml normal saline. The incidence of FNHTR, cytokine releasing syndrome (CRS) grade, cytokine level and efficacy were compared. Results (1)The incidence of FNHTR in the study group was 21.1%, significantly lower than that in the control group (71%)(P=0.000). (2)There was no statistical difference in cell proliferation between the study group and the control group on day 4, 7, 14 and 21 after CAR?T cell infusion (P=10.223, 3.254, 5.551, 7.605). (3)There was no statistical difference in CRS grading between the study group and the control group (P=0.767). There was no statistical difference in the levels of interleukin 2 receptor (IL?2R), IL?6, tumor necrosis factor (TNF)?α between the two groups. (4)The C?reaction protein (CRP) level of the study group was lower than that of the control group on day 4 and 7 (P=0.026, 0.007). (5)There was no statistical difference of response rates in acute lymphocytic leukemia (ALL) and non?Hodgkin lymphoma (NHL) patients between the two groups (PALL=0.842; PNHL=0.866). Conclusion The modified cell infusion method in CD19 CAR?T cell treatment reduces the incidence of treatment?related FNHTR. It does not affect the proliferation of CAR?T cells in vivo, the grading of CRS and the response rates.

Bombay Blood Group– Detection And Study Of Prevalence Of This Rare Phenotype Along With The Transfusion Recommendations

Four main blood types routinely identified are A,B,AB and O. Bombay phenotype individuals are typed as group O on forward ABO typing. Their red cells lack A,B,H antigens and their sera contain anti-A, anti-B and anti-H. It is important to correctly type individuals who are Bombay phenotypes because these individuals require autologous blood donation or blood from another Bombay individual. The present prospective study was conducted over two years to study the prevalence of Bombay phenotype with transfusion recommendations to the blood recipients. All the donor and patient’s blood group were confirmed by tube method. All blood samples showing O blood group on froward grouping and agglutination with O cell in reverse grouping, were tested for Bombay blood group using anti-H.Out of 76,204 cases constituting 49,604 donors and 26,600 patients, Bombay phenotype was detected in 12 cases (0.015%) constituting 4 number of donors and 8 number of patients. All cases were further ruled out to be para Bombay phenotypes and were found to be non secretor by agglutination inhibition test. Four cases out of 12 patients requiring blood transfusion 3 could be issued Bombay blood group and but death occurred in one case due to delay in the surgery for the unavailability of this rare phenotype. Thus, it is recommended that all blood group donors and patients should be routinely screened by both forward and reverse grouping for screening of Bombay phenotype to reduce the risk of hemolytic transfusion reaction resulting from issue of O blood group to Bombay blood group recipients

Case of Acute Hemolytic Transfusion Reaction due to Anti-Fy(a) Alloantibody in a Patient with Autoimmune Hemolytic Anemia / 대한수혈학회지

A 72-year-old man with general weakness visited the outpatient clinic of the hematology department. The patient had been treated under the diagnosis of autoimmune hemolytic anemia for 2 years. His hemoglobin level at the time of the visit was 6.3 g/dL, and a blood transfusion was requested to treat his anemia. The patient's blood type was A, RhD positive. Antibody screening and identification test showed agglutination in all reagent cells with a positive reaction to autologous red blood cells (RBCs). He had a prior transfusion history with three least incompatible RBCs. The patient returned home after receiving one unit of leukoreduced filtered RBC, which was the least incompatible blood in the crossmatching test. After approximately five hours, however, fever, chills, dyspnea, abdominal pain, and hematuria appeared and the patient returned to the emergency room next day after the transfusion. The anti-Fy(a) antibody, which was masked by the autoantibody, was identified after autoadsorption using polyethylene glycol. He was diagnosed with an acute hemolytic transfusion reaction due to anti-Fy(a) that had not been detected before the transfusion. In this setting, it is necessary to consider the identification of coexisting alloantibodies in patients with autoantibodies and to become more familiar with the method of autoantibody adsorption.

Incidence of Adverse Transfusion Reactions from an Institutional Hemovigilance System: A Single Center Study / 대한수혈학회지

BACKGROUND: A hemovigilance system is essential to detect and analyze adverse transfusion reactions to various blood components. A blood bank physician has the role of discriminating the adverse transfusion reactions based on the hemovigilance criteria. This study investigated the incidence of adverse transfusion reactions per transfused case and the incidence of adverse transfusion reactions according to the various blood components in recipients. METHODS: From January 2016 to February 2017, 38,689 blood component units were transfused into 3,768 patients. A total of 11,170 transfused cases were reported. The patients’ signs or symptoms were monitored and reported by nurses using an electronic reporting system. A blood bank physician classified the adverse transfusion reactions according to the Korean hemovigilance reporting definitions. RESULTS: The frequency of all transfusion-related events was 469 according to the nursing record. Out of 469 events, 175 (37.3%) were classified as adverse transfusion reactions. The incidence of a febrile nonhemolytic transfusion reaction according to the blood component was highest for red blood cells (1.3%), followed by a platelets (0.8%) and fresh frozen plasma (0.3%). The incidence of allergic reactions was 1.0% (platelets), 0.8% (fresh frozen plasma), and 0.3% (red blood cells). The incidence of febrile nonhemolytic transfusion reactions was lowered significantly by leukocyte-reduction. CONCLUSION: The incidence of adverse transfusion reactions was 37.3% of the transfusion-related events. Therefore, close monitoring by the blood bank physician is essential for safe transfusion. The use of leukocyte-reduced blood components could reduce the incidence of febrile nonhemolytic transfusion reactions.

Acute Hemolytic Transfusion Reaction due to ABO-Incompatible Blood Transfusion: A Fatal Case Report and Review of the Literature / 대한수혈학회지

A 77-year-old female patient who was suspected to have had an acute hemolytic transfusion reaction was admitted to the emergency room. She received one unit of type A red blood cells in a type B patient during a total knee arthroplasty operation at another medical institution. ABO-incompatible transfusion was carried out due to an identification error between the patient and blood product. At the time of admission, acute hemolytic reaction, lactic acidosis, and disseminated intravascular coagulation were observed. She was admitted to the intensive care unit and received continuous renal replacement therapy. She maintained renal function and was moved to the general ward on the 7th day. Complications such as pulmonary edema, gastrointestinal bleeding, and ischemic colitis persisted, and the patient died on the 111th after admission. This case is the first report of death due to an ABO-incompatible transfusion in Korea. Efforts to establish a safe transfusion environment are necessary not only at individual medical institutions but also at the national level.

Elimination of Causative Antibody by Plasma Exchange in a Patient with an Acute Hemolytic Transfusion Reaction / 대한수혈학회지

An ABO-incompatible transfusion is a very rare event but it can cause severe adverse effects, including death. The prognosis is affected by various factors, such as the volume of infusion, underlying diseases, and immunologic state. Until now, however, there has been no consensus regarding the treatment of an ABO-incompatible transfusion except for conservative treatment. A 57 year-old male patient visited the authors' emergency unit with multiple trauma due to a car accident. He had a deep laceration on his left neck accompanied by severe bleeding. Because of his low blood pressure and low hemoglobin level due to bleeding, an emergency transfusion was attempted. Unfortunately, one unit of RBC was transfused incorrectly into the patient due to a clerical error during the identification of the patient. The patient was typed as O, RhD positive; the RBC administered was A, RhD positive. After the transfusion, the patient showed an acute hemolytic transfusion reaction due to gross hematuria. Plasma exchange was attempted and medical treatment with high dose steroid with diuretics was done simultaneously. Two cycles of plasma exchange were done and the patient appeared to recover from the acute adverse effects of the transfusion. The plasma exchange was stopped and medical treatments for the transfusion reactions were maintained for ten days. The patient recovered fully and was discharged after one month. Based on this case, although more studies are necessary for approval as a standard therapy, this case suggests that immediate plasma exchange with medical treatment can be very helpful for eliminating the isoagglutinins in ABO-incompatible transfusions.

Revisiting the Pre-transfusion Test: A Case of Acute Hemolytic Transfusion Reaction due to Multiple Alloantibodies of Anti-E, Anti-c, Anti-Jk(b) / 대한수혈학회지

We report a case of acute hemolytic transfusion reaction due to multiple alloantibodies. A 41-year-old male with multiple histories of transfusion was admitted for jaundice and oliguria after receiving two units of red blood cells in a local clinic. He showed acute renal failure and disseminated intravascular coagulation. Direct Coombs test was negative and antibody screening test showed strong positive results. Anti-E, anti-c, and anti-Jk(b) antibodies were identified in two panels of unexpected antibody assays. Acute hemolytic transfusion was diagnosed, and he was discharged after 1 month of supportive treatment. Unexpected antibody detection tests, including the antiglobulin phase, should be performed to prevent adverse transfusion reactions by unexpected antibodies. Better precision and quality control are necessary when performing pre-transfusion tests.

Fenotipagem eritrocitária em doadores de sangue no HEMOPI - PI (Teresina - Picos) e no hemocentro regional do Crato - CE

Em razão da melhor expectativa de vida e do envelhecimento da população,consequentemente, a melhora dos avanços técnicos e diagnósticos na Medicina, aliados anovas modalidades terapêuticas para doenças, cresce no mundo inteiro a transfusão deconcentrados de hemácias, plaquetas e plasma fresco congelado. Assim, a fenotipagemeritrocitária, tanto em receptores quanto em doadores de sangue, tem como finalidade reduziro número de reações transfusionais, prevenindo o aparecimento de anticorpos de forma maistardia, principalmente naqueles receptores candidatos a politransfusão. Além disso, afenotipagem eritrocitária é essencial na confirmação dos aloanticorpos formados, além defacilitar a identificação de anticorpos que poderão ser constituídos no futuro. O estudo tevecomo objetivo analisar as frequências dos principais antígenos de grupos sanguíneospertencentes aos sistemas ABO, Rh, Duffy, Kidd, MNS, e o antígeno K do sistema Kell, bemcomo estudar a associação entre esses grupos e a distribuição quanto à procedência e o gruporacial autorreferido, por serem esses os principais sistemas envolvidos em reaçãotransfusional hemolítica e causarem a doença hemolítica perinatal em todo o mundo. Foramanalisadas 532 amostras de doadores de sangue do Hemocentro do Estado do Ceará, regionaldo Crato, e Hemocentro do Estado do Piauí (Teresina e Picos)...

Due to better life expectancy and the aging of population, consequently the improvement oftechnical advances and diagnostics in medicine, combined with new therapeutic modalitiesfor different diseases, it is growing worldwide the transfusion of packed red blood cells,platelets and fresh frozen plasma. So, the erythrocyte phenotyping as in receptors as in blooddonors aims to reduce the number of transfusion reactions, preventing the appearance ofantibodies in a later way, mainly in those receptors candidates to poly-transfusion. Besidesthis the erythrocyte phenotyping is essential for confirmation of formed alloantibodies aswell as facilitating the identification of antibodies that can be formed in the future. This studyaimed to analyze the frequencies of the main antibodies of blood groups belonging to thesystems ABO, Rh, Duffy, Kidd, MNS, and K antigen of Kell system and to study theassociation between these groups and the distribution concerning the origin and the racialgroup self-referred. Being these, the main systems involved in hemolytic disease worldwide.532 samples of blood donors of hemocenter of Ceará State, regional of Crato and hemocenterof Piaui State (Teresina and Picos)...

A Case of Hemolytic Transfusion Reaction Attributable to Anti-Jk(b) Abolished in the Enzyme Phase Reaction / 대한수혈학회지

We report a case of an intravascular hemolytic reaction attributable to anti-Jk(b) antibodies that were not detected using an enzyme phase antibody identification test. A 61-year-old male who had received two units of red blood cells was admitted to the emergency room because his urine was dark. LISS/Coombs gel column agglutination tests suggested the presence of anti-Jk(b) and anti-E antibodies. However, his serum was negative for the Jk(b) antigen when an enzyme phase test was performed. A positive reaction was evident, however, when EDTA-treated plasma was tested; this excluded any possible complement-mediated reaction. The patient was diagnosed with an intravascular hemolytic transfusion reaction, caused by anti-Jk(b), and was later discharged without specific complications after receiving antigen-negative blood transfusions.

Frequency and Pattern of Noninfectious Adverse Transfusion Reactions at a Tertiary Care Hospital in Korea

BACKGROUND: Although transfusion is a paramount life-saving therapy, there are multiple potential significant risks. Therefore, all adverse transfusion reaction (ATR) episodes require close monitoring. Using the computerized reporting system, we assessed the frequency and pattern of non-infectious ATRs. METHODS: We analyzed two-year transfusion data from electronic medical records retrospectively. From March 2013 to February 2015, 364,569 units of blood were transfused. Of them, 334,582 (91.8%) records were identified from electronic nursing records. For the confirmation of ATRs by blood bank physicians, patients' electronic medical records were further evaluated. RESULTS: According to the nursing records, the frequency of all possible transfusion-related events was 3.1%. After the blood bank physicians' review, the frequency was found to be 1.2%. The overall frequency of febrile non-hemolytic transfusion reactions (FNHTRs) to red blood cells (RBCs), platelet (PLT) components, and fresh frozen plasmas (FFPs) were 0.9%, 0.3%, and 0.2%, respectively, and allergic reactions represented 0.3% (RBCs), 0.9% (PLTs), and 0.9% (FFPs), respectively. The pre-storage leukocyte reduction significantly decreased the frequency of FNHTRs during the transfusion of RBCs (P<0.01) or PLTs (Pfalling dots0.01). CONCLUSIONS: The frequency of FNHTRs, allergic reactions, and "no reactions" were 22.0%, 17.0%, and 60.7%, respectively. Leukocyte-reduction was associated with a lower rate of FNHTRs, but not with that of allergic reactions. The development of an effective electronic reporting system of ATRs is important in quantifying transfusion-related adverse events. This type of reporting system can also accurately identify the underlying problems and risk factors to further the quality of transfusion care for patients.

Universal Leukoreduction Decreases the Incidence of Febrile Nonhemolytic Transfusion Reactions to Cellular Blood Components: A 5 Year Study.

Background: Febrile nonhemolytic transfusion reactions (FNHTRs) are common complications associated with allogenic transfusion and it is caused by the leucocytes and cytokines released by leucocytes during storage of blood/ blood components. These reactions are generally not life threatening, but they are expensive in their management, evaluation, and associated blood-product wastage. 1st log prestorage universal leukoreduction (ULR) i.e. removal of Buffy coat is a useful and effective procedure in developing countries to control FNHTRs significantly. Aims and Objects: To know the efficacy of pre-storage 1st log universal leuckoreduction in controlling febrile nonhemolytic transfusion reactions (FNHTRs). Place and Duration of Study: Study was carried out at Blood Bank, Department of Pathology, G. R. Medical College, Gwalior from January 2009 to December 2013 (5years). Materials and Methods: Study was divided into control group (Year: 2009) and study group (Years: 2010-13). 14,292 recipients in control group and 45,064 in study group were transfused with non-leukoreduced and prestorage 1st log leukoreduced blood/ blood components respectively. Usefulness of prestorage 1st log ULR over non-leukoreduced blood/ blood components was observed, compared and discussed. Result: In the control group 610 (4.26%) out of 14,292 (p=0.0003) and in study group 381(0.84%) out of 45,064 (p=0.0003) recipients were reported to have FNHTRs. The comparative study showed significant reduction in FNHTRs from 4.26% to 0.84% (↓ 3.42%) (p=0.000001). Conclusion: 1st log Universal Leukoreduction (ULR) is a better option over Selective Leukoreduction (SLR) to prevent FNHTRs and it also helps the transfusion services of under-resourced developing countries in many ways.

Transfusion Premedication: A Single Center Study / 대한수혈학회지

BACKGROUND: Acute transfusion reaction occurs during or within a few hours of transfusion with 0.5~3% of blood transfusion. Febrile non-hemolytic transfusion reactions (FNHTRs) and allergic transfusion reactions (ATRs) are the most common transfusion reactions. Premedication with acetaminophen and diphenhydramine has been used to prevent these reactions in 50~80% of transfusions. The purpose of this study was to describe the frequency of premedication and FNHTRs and ATRs according to premedication in Korea. METHODS: Between January 1 and 31, 2013, analysis of the first transfusion was performed retrospectively with chart review. A total of 549 cases were analyzed with regard to product of blood, care area, premedication, and FNHTRs and ATRs. RESULTS: Premedication was administered in 88.2% (484/549) of transfusions; 4 mg chlorphenamine, a well-known antihistamine, was used as premedication in all cases. Occurrence of FNHTRs was 7.7% without premedication and 3.7% with premedication. Occurrence of ATRs was 0% without premedication and 0.8% with premedication. The frequency of premedication was related to care area but not blood products. CONCLUSION: Premedication use was more frequent than previously reported. However, the sample size in this study is small; therefore, conduct of further prospective multicenter studies is needed.

A case of acute hemolytic transfusion reaction due to anti-Di(a) antibody: A case report / 대한마취과학회지

Many medical institutions in Korea have recently been performing an antibody screening test as one of the essential elements of a pre-transfusion test. The Dia antigen is well known as one of the antigens with low incidence among Caucasians; however, it has been discovered with a relatively higher incidence among Mongoloid populations. The frequency of the Dia antigen among the Korean population is estimated to be 6.4-14.5%. But in Korea, a screening panel of cells from abroad without Dia positive cells has been commonly used when a patient has an unexpected antibody screening test. Here we report a case of acute hemolytic transfusion reaction due to Anti-Dia antibody. To prevent other transfusion reaction by anti-Dia antibody, addition of Dia positive cells as unexpected antibody screening test is recommended.

A Case of Delayed Hemolytic Transfusion Reaction in a Patient with Anti-c, Anti-E, and Anti-Jk(b) / 대한수혈학회지

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.

A Hemolytic Transfusion Reaction due to Anti-Ku Antibody in a Patient with Knull Phenotype: The First Case in Korea / 대한진단검사의학회지

Knull phenotype completely lacks all Kell system antigens. Anti-Ku antibody is seen in immunized persons with Knull phenotype by transfusion or pregnancy. It can cause a fatal hemolytic transfusion reaction. A 66-yr-old male patient with liver cirrhosis visited emergency center due to acute bleeding. The patient was at hypovolemic shock status: his blood pressure was 80/50 mmHg, pulse rate was 110/min and hemoglobin level was 4.4 g/dL. Because of the presence of antibody against high incidence antigen, we could not find any compatible blood for the patient. Nevertheless, 4 units of packed RBCs had to be transfused. Moderate hemolytic transfusion reaction was developed after transfusion. At endoscopic examination, blood was spurting from gastric cardiac varix. Endoscopic histoacryl injection was tried, and bleeding was successfully controlled. After bleeding stopped, he was managed for anemia using steroid and other medical therapy instead of transfusion. His hemoglobin level was improved to 7.7 g/dL at the time of discharge. Later he has been proved to have a Knull phenotype, which is very rare, and anti-Ku antibody. This report is the first case of anti-Ku in a Knull phenotype person in Korea, who experienced a moderate hemolytic transfusion reaction.