Prevention and diagnosis of delayed haemolytic transfusion reactions

Anti-Fya-mediated delayed hemolytic transfusion reaction following emergency-release red blood cell transfusion: possible involvement of HLA-DRB1*04:03 in the Japanese population

A 43-year-old Japanese male, who had undergone open liver surgery for tumor resection, presented with decreased hemoglobin levels on Day 13 post-emergency-release transfusion of 16 units of Fy(a +) red blood cells. As the anemia was accompanied by increased lactate dehydrogenase, indirect bilirubin, and reticulocytes, as well as decreased haptoglobin, it was attributed to hemolysis. In the diagnostic workup for hemolytic reaction, the direct antiglobulin test result for IgG was positive and the antibody dissociated from the patient's peripheral red blood cells was identified as anti-Fy^a (titer, 4). The hemolytic reaction was transient (approximately 10 days), of moderate severity, and did not result in any obvious organ damage. However, a single compatible red blood cell transfusion of 2 units was required on Day 17 after the causative transfusion. Notably, HLA typing revealed that the patient carried the HLA-DRB1*04:03 allele, which has been implicated in immunogenicity and induction of anti-Fy^a response in Caucasian populations. In summary, this is the first documented case of definitive anti-Fy^a-mediated delayed hemolytic transfusion reaction associated with HLA-DRB1*04:03 in the Japanese population.

Delayed haemolytic transfusion reaction due to anti-Jkb in a patient with non-Hodgkin's lymphoma-transient nature of anti-Jkb and the importance of early serological diagnosis

Delayed haemolytic transfusion reactions (DHTRs) are relatively common following blood transfusions. In the UK, DHTRs were responsible for 10.2% of all serious transfusion-related hazards between 1996 and 2003. In most cases, there is minor or no morbidity, and the reaction may go unnoticed. However, in some cases, a large fall in haemoglobin level and major morbidity may occur. Even in such serious cases, the true cause of the patient's clinical deterioration may be unrecognized if serological investigation is not carried out immediately because of the often transient nature of the antibodies involved. Failure to make the correct diagnosis will lead to inappropriate treatment and expose the patient to risk of further serious transfusion reactions. We describe a case of DHTR caused by anti-Jk(b) antibodies, which illustrates the difficulty in diagnosing this common but under-recognized reaction and shows the transient nature of the antibody involved, which became undetectable within 4 weeks.