Delayed Hemolytic Transfusion Reaction due to Anti-Jka

Abstract

Abstract: Delayed hemolytic transfusion reaction (DHTR) occur in patients who have been immunized to foreign antigen (Ag) by previous transfusion or pregnancy but in whom the concentration of antibody (Ab) is so low that it can not be detected before the transfusion. Usually about five to 10 days after transtusion of red cells containing the same foreian Ag, the concentration of Ab has risen sufficiently to cause rapid destruction of those transfused red cells which possess the offending Ag. The patient with DHTR usually developed anemia without or mild symptoms. We reported here a male patient with muliple transfusions who developed fever with chill after receiving approximately 100 ml of packed red cells. Results : Postransfusion reaction work up showed that the postransfusion blood sample gave 2+ reactions in IAT and repeat crossmatch (XM) with the suspected blood unit, while the pretransfusion blood sample gave negative results for both tests. The antibody identification of the patient serum revealed anti-Jk^a. The patient's red cell was Jk^a while the suspected blood unit was Jk^a. Two units of Ik were negative for XM and successfully transfused to the patient. Low level Ab or Abs that required complement in their reactions or Abs to those Ags which show dosage effect may yeild the negative results in LAT and XM leading to the occurrence of DHTR. Conclusion: The fresh blood sample should be used to ensure the sufficient level of complement, and antigiobulin serum with anticomplement should be used. In addition the results of IAT and Ab specificity of the patient should be noted in the patient's record to avoid the use of offending Ag blood.