Résumé
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.
Sujets)
Humains , Adulte d'âge moyen , Bilirubine , Incompatibilité sanguine , Brûlures , Test de Coombs , Urgences , Érythrocytes , Études de suivi , Haptoglobines , Hémoglobines , Hémoglobinurie , Alloanticorps , Corée , L-Lactate dehydrogenase , Plasma sanguin , Transplantation homologue , Examen des urinesRésumé
BACKGROUND: Alloantibodies to red cell antigens may cause acute or delayed hemolytic transfusion reactions (DHTRs). In most cases, however, anamnestic antibody production causes only a delayed serological transfusion reaction (DSTR). According to the previous reports, alloimmunization occured with a risk of 1-2.6%, however, no prospective studies on a DSTR have been performed in Korea. The purpose of this study was to evaluate prospectively the frequency of alloimmunization and its clinical significance in Korean population. METHODS: Antibody screening tests were performed for a total of 1,903 patients who were transfused with packed RBCs from May 2003 through July 2004. One blood sample from each patient was collected within 7-10 day after transfusion and screened for serological evidence of alloimmunization. If any antibody was detected the patient's post-transfusion sample was screened for biochemical evidence of hemolysis and the patients' medical records were reviewed for documentation of clinical signs of a transfusion reaction. RESULTS: Overall, 17/1,903 patients became alloimmunized for a frequency of 0.89%. Only one of 1,903 patients had clinical evidence of hemolysis, and the frequency of DHTR was 0.053%. Interestingly, anti-Dia which was characteristic antibody in Asian-Mongoloid populations was detected in three patients, and anti-Mia was found in one patient. CONCLUSION: This study showed lower frequency of DSTR and DHTR, compared with previous studies in Caucasian. However, it is noteworthy that the incidence of anti-Dia was relatively higher in Korean population.
Sujets)
Humains , Production d'anticorps , Incompatibilité sanguine , Hémolyse , Incidence , Alloanticorps , Corée , Dépistage de masse , Dossiers médicaux , Études prospectivesRésumé
As a minor blood antigen, the Duffy blood group has 5 antigens which are Fya, Fyb, Fy3, Fy4 and Fy5. When the Duffy group is implicated in delayed transfusion reactions, one expects to find anti-Fya rather than Fyb. We experienced a case of delayed hemolytic transfusion reaction caused by anti-Fyb antibody. A 69 year-old woman was referred having had hematuria, fever, chill and jaundice 9 days after transfusion. The hemoglobin was 9.5mg/dl, reticulocyte count 1.4%, liver function test showed total bilirubin 10.8mg/dL, LDH 5,225IU/L, alkaline phosphatase 26IU/L. Indirect antiglobulin test was positive, while the direct one was negative. A delayed hemolytic transfusion reaction was suspected as patient's serum was reacted with panel cells for the antibody identification test and the anti-Fyb was finally identified. The patient recovered without specific treatment. There were no severe complication and sequele.It appears to be the first reported case of hemolytic transfusion reaction caused by anti-Fyb in Korea.
Sujets)
Sujet âgé , Femelle , Humains , Phosphatase alcaline , Bilirubine , Incompatibilité sanguine , Test de Coombs , Fièvre , Hématurie , Ictère , Corée , Tests de la fonction hépatique , Numération des réticulocytesRésumé
A delayed hemolytic transfusion reaction (DHTR) is the result of delayed anamnestic alloantibody response four to fourteen days after transfusion of apparently compatible blood. Most DHTRs are very mild and may not be recognized clinically. Some are manifested only by anemia. Only a few cases are severe enough to induce a massive hemolytic reaction followed by frank renal failure. Recently, we experienced a case of DHTR with acute renal failure (ARF) due to anti-E. A 21-year-old woman received compatible four units of packed red cells after right artificial total hip replacement arthroplasty due to juvenile rheumatoid arthritis. She had a history of transfusion 4 years ago. Fourteen days after the transfusion, she showed a fall in hematocrit, hemoglobinuria and a positive indirect antiglobulin test, and accompanied by ARF. Anti-E was identified in the patient's serum by antibody screening and identification test at that time. She recovered from ARF after hemodialysis with conservative management. However, eventually, she died due to disseminated intravascular coagulopathy.
Sujets)
Femelle , Humains , Jeune adulte , Atteinte rénale aigüe , Anémie , Arthrite juvénile , Arthroplastie , Arthroplastie prothétique de hanche , Incompatibilité sanguine , Test de Coombs , Hématocrite , Hémoglobinurie , Dépistage de masse , Dialyse rénale , Insuffisance rénaleRésumé
We report a case of delayed hemolytic transfusion reaction due to anti-Jka antibody. The patient was a 68-year-old women who was admitted for general weakness after subtotal thyroidectomy. She received two units of packed red cells because of anemia. On the fifteenth post-transfusion day, she developed a marked fall in hemoglobin and mild hyperbilirubinemia. Direct antiglobulin test was positive. Anti-Jka antibody was identified in her serum, and her phenotype of Kidd blood group was Jk(a-b+). Therefore the anti-Jka antibody was thought to be the possible offending antibody in this delayed hemolytic transfusion reaction.
Sujets)
Sujet âgé , Femelle , Humains , Anémie , Incompatibilité sanguine , Test de Coombs , Hyperbilirubinémie , Phénotype , ThyroïdectomieRésumé
We report a case of 46-year-old women who suffered from delayed transfusion hemolytic anemia due to anti-Jkb antibody after renal transplantation. The patient had been treated with hemodialysis and had a past history of multiple transfusion. On the second postoperative day, she received 2 units of packed red cell. During transfusion, she complained of mild chest tightness only, but 10 days later, anemia of unknown origin developed. Irregular antibody was found in her serum and identified as anti- Jkb antibody. Together with other serologic findings, she was diagnosed as delayed hemolytic transfusion reaction due to anti -Jkb antibody. We thought that this reaction might be the amnestic response to previous exposure during delivery or remote multiple transfusion. Our patient responded to steroid and plasmapheresis and recovered without severe hemolytic transfusion reaction. In conclusion, antibody screening tests and identification test might be considered as a routine pretransfusion test for all renal recipients for safe transfusion practices.