Anti-Jk-b Antibodies and Hemolytic Disease of the Fetus and Newborn: Case-Based Learning.

The Kidd blood group is clinically significant as Kidd antibodies have the potential to trigger both acute and delayed transfusion reactions, along with hemolytic disease of the fetus and newborn (HDFN). Here, we have reported a case of HDFN due to Jk-b antibodies. A 31-year-old pregnant female was found to have Jk-b antibodies on screening with the Bio­Rad ID Dia 11-cell panel (Bio-Rad Laboratories, Inc., CA) after her cross-matching results were incompatible. Emergency lower segment caesarian section was done; the baby was non-hydropic at birth with an increase in bilirubin that required high-intensity phototherapy. HDFN resulting from anti-Jk-b incompatibility is rare and tends to present with mild clinical symptoms and a favorable prognosis. However, monitoring of antibody titers is essential to prevent potentially fatal complications. Additionally, antenatal antibody screening should be mandatory for all pregnant women, regardless of their Rh-(D) antigen status, to detect red cell alloimmunization to other clinically significant blood group antigens.

Hemolytic disease of the newborn due to anti-jkb: case report and review of the literature.

Although anti-Jkb is a well-defined cause of severe acute or delayed hemolytic transfusion reactions, it is rarely associated with severe Hemolytic Disease of the Newborn (HDN), even with high antibody titer. To date, only 13 cases have been reported, so the possible reasons for that still remain unclear. Most of HDN due to anti-Jkb are mild-to-moderate, and usually have a good prognosis. A 41-years-old woman, who had a positive antibody screening test in her 13th week of pregnancy, was sent to the blood bank for study before an amniocentesis. Antibody identification and red blood cell (RBC) phenotyping of the patient and his husband were performed, plus arrays study in the amniotic fluid. An anti-Jkb was identified in the patient's serum with a titer of 1:1, and her RBC phenotype was O Rh(D) positive, C(+), c(+), E(-), e(+), K(-), Jka(+), Jkb(-). The RBC genotype of the fetus was B Rh(D) positive, Jka(+), Jkb(+). Antibody titer remained stable and the pregnancy was uneventful. At birth, there was no need of phototherapy or exchange transfusion for the newborn and her Jk(b+) typing result was confirmed in a cord blood sample. Although most of HDN cases due to anti-Jkb have a good outcome, monitoring antibody titer should be done to prevent fatal complications. Furthermore, antenatal antibody screening should be performed in every pregnant woman irrespective of her Rh(D) antigen status in order to detect red cell alloimmunization to other clinically significant blood group antigens.

Anti-JK-a Antibody in a Case of SLE Patient with Plasmodium falciparum Malaria Infection.

A 58 year old lady presented with high grade fever, pallor, abdominal pain, loss of appetite and swelling of legs. She was subsequently diagnosed with SLE along with infection of Plasmodium falciparum malaria. She was clinically pale and advised for two units of packed red cell transfusion. One of the two units was incompatible, so only one unit was issued. Subsequently, DAT and auto control were positive. Later antibody specificity was identified, which came out to be anti JK-a. Because of recent transfusion 2 weeks back, her antigenic phenotype could not be elicited. Though we could not make out whether this antibody was the result of pregnancy or transfusion induced allo anti-JK-a or SLE induced auto anti JK-a, this antibody is highly clinically significant from transfusion point of view.

Hemolytic transfusion reaction with acute renal failure due to Anti-Jkb: a case study / 대한수혈학회지

We reported a case of hemolytic transfusion reaction producing acute renal failure due to Anti-Jkb in a 35-year-old man with septic hip in post-operative state. At first, he received 7 units of packed red blood cells one month before admission, 2 units for hematuria 7 days before, and with 2 units just one day before the admission. He complained of symptoms and signs accounting for acute hemolytic transfusion reaction with chilling, hematuria, and oliguria. In this case, it seems that the patient acquired unexpected antibody by the episode of transfusion one month ago. He received another transfusion with similar episode of transfusion reaction. His transfusion was repeated and even more severe hemolytic transfusion reaction was presented, leading to acute renal failure.

A case of Intravascular Hemolytic Transfusion Reaction due to Anti-Jkb / 대한수혈학회지

We report a hemolytic transfusion reaction with acute intravascular hemolysis due to anti-Jkb in a 49-year-old woman with uterine myoma. A patient experienced chills, fever, and red color urine following the transfusion of 1.25 units of packed red cells, shown to be compatible by the conventional cross-matching tube method. She had been received two units transfusion 3 weeks ago and there was no transfusion reaction at that time. One day after transfusion, her laboratory data showed total bilirubin 2.7 mg/dL, LDH 2,310 IU/L, and a trace positive direct antiglobulin test. Irregular antibody screening test was negative by the conventional tube methods but anti-Jkb was identified by column agglutination method. The presence of anti-Jkb provided an explanation for the acute hemolytic reaction. The hemolytic transfusion reaction was secondary responses following the previous transfusion. She showed severe hemoglobinuria, but renal failure did not develop and she was fully recovered with maintaining adequate renal output with IV diuretics.

Delayed Hemolytic Transfusion Reaction Caused by Anti-Jkb Antibody in a Renal Transplant Recipient / 대한신장학회잡지

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.

Two Cases of Severe Hemolytic Transfusion Reactions Caused by Anti-Jkb Antibody / 대한수혈학회지

We report two patients who suffered from hemolytic transfusion reactions due to anti-Jkb antibody: one showed acute- and the other showed delayed-type hemolysis. The first patient was a 40-year-old man who suffered from epilepsy after the operation for arteriovenous malformation 16 years ago. He received five units of red blood cells (RBC) after right temporal lobectomy. On the fifteenth postoperative day, fever and chill developed during transfusion of one unit of packed RBC, followed by dark urine and oliguria. The polyethylene glycol-Coombs test and enzyme test revealed anti-Jkb antibody which had not been detected on the pretransfusion specimen. The second patient was a 41-year-old man who was admitted for the reoperation of the prosthetic mitral valve. Because hemoglobin was 5.9g/dL at admission, he received five units of packed RBCs. Oliguria and laboratory findings consistent with hemolytic anemia were observed from the third day of transfusion. Anti-Jkb antibody was detected on antiglobulin phase. Both patients developed acute renal failure (ARF) and hemodialysis with conservative management were done. They finally recovered from ARF without any residual complications. Implementation of more sensitive pretransfusion tests should be considered to prevent rare, but serious hemolytic transfusion reactions.