title: Anti-i causing acute hemolysis following a negative immediate-spin crossmatch.
abstract: A unique case of acute hemolysis following transfusion of red cells (RBCs) that were found compatible by immediate-spin (IS) crossmatch technique is reported. Screening tests for unexpected antibodies, using low-ionic-strength saline (LISS), 10 minutes' incubation at 37 degrees C, and anti-IgG, were nonreactive; however, 1 transfused unit was found crossmatch incompatible by indirect antiglobulin technique (IAT). An anti-i (titer 512 at 4 degrees C) that was not an autoantibody was identified in the patient's serum. Unlike the incriminated donor RBCs, most I+ RBCs did not react by LISS-IAT. Variable reactivity was seen with ficin-treated I+ RBCs, and there was marked hemolysis of iadult and icord RBCs. In marked contrast, dominant Lu(a-b-) RBCs, with reduced expression of i, did not react by any test method; nor did autologous I+, Lu(b+) RBCs. The in vivo clinical significance of this anti-i was confirmed by monocyte monolayer assay and RBC survival studies. The patient's i antigen may have been altered, by either chemotherapy or disease, and lacked part of the i antigen-mosaic. Her antibody was directed at epitopes of i that were absent from her RBCs. Those i epitopes missing from her RBCs are also absent on dominant Lu(a-b-) RBCs. This anti-i represents a unique cause of an acute hemolytic transfusion reaction. It also represents a case of acute immune-mediated hemolysis following transfusion of IS crossmatch-compatible blood when screening tests for unexpected antibodies are nonreactive. Because of the rarity of such cases (less than 1/200,000 RBC units transfused), modifications to pretransfusion testing protocols are not proposed.
authors.affiliation: Department of Pathology, University of Michigan Medical Center, Ann Arbor.
authors.forename: W J
authors.initials: WJ
authors.lastname: Judd
authors.forename: E A
authors.initials: EA
authors.lastname: Steiner
authors.forename: L V
authors.initials: LV
authors.lastname: Abruzzo
authors.forename: R D
authors.initials: RD
authors.lastname: Davenport
authors.forename: H A
authors.initials: HA
authors.lastname: Oberman
authors.forename: J C
authors.initials: JC
authors.lastname: Pehta
authors.forename: S J
authors.initials: SJ
authors.lastname: Nance
mesh_terms: D001788:Blood Grouping and Crossmatching / Q000379:methods*; D005260:Female; D006461:Hemolysis / Q000276:immunology; D006801:Humans; D007048:I Blood-Group System / Q000276:immunology*; D007518:Isoantibodies / Q000502:physiology; D008875:Middle Aged; D065227:Transfusion Reaction
chemical_list: D007048:I Blood-Group System; D007518:Isoantibodies