No Hemolytic Transfusion Reactions in a Patient with the Apparent Anti-e Autoantibody Following Transfusion of Packed Red Cells with CcDEe Phenotype / 대한수혈학회지

Patients with alloantibody should be transfused with specific antigen negative blood, and in the case of autoantibody, the least incompatible blood on crossmatching can be transfused. Yet any transfusion cases that possessed autoantibody with the apparent antigen specificity have been rarely reported. A 62 year-old-woman with chronic renal failure underwent tests showing that the direct antiglobulin test was positive (2+) for IgG, the autocontrol test was positive, and the Rh phenotype of her erythrocytes was typed as group CcDEe. One unit of the e-positive packed red cells (PRCs) was transfused before an antibody identification test identified this antibody as autoantibody with an apparent e antigen specificity, but the level of hemoglobin increased from 6.3 g/dL to 7.4 g/dL without a hemolytic reaction or other transfusion side-effects.

A Case of Autoimmune Hemolytic Anemia Induced by Autoanti-E / 대한수혈학회지

Autoimmune hemolytic anemia was diagnosed in a 60-year-old male without underlying disorder. He had complained of headache and exertional dyspnea. Laboratory studies revealed hemoglobin 4.9 g/dL, reticulocyte count 30%, total serum bilirubin 2.6 mg/dL, and haptoglobin 10 mg/dL. The peripheral blood smear showed marked spherocytosis. The bone marrow examination showed marked erythroid hyperplasia. The direct antiglobulin test was 2+ positive with anti-IgG and negative for C3d while indirect antiglobulin test was 1+ positive. The anti-E was identified in his serum and eluate from his red blood cells (RBCs). His blood group was group A, CcDEe. He had no transfusion history and autocontrol was positive. The adsorbed serum with ZZAP-treated RBCs did not react with a panel of reagent RBCs. These findings indicated that the antibody was autoanti-E. After transfusions of E-negative RBCs, the hemoglobin increased to 8.4 g/dL, and hemolytic transfusion reaction was not noted after transfusions. Treatment with prednisolone was effective in controlling the hemolytic anemia, but a splenectomy was performed to achieve permanent remission. After splenectomy the patient had normal hemoglobin and reticulocyte count lasting for three years without subsequent medical therapy.