Delayed hemolytic transfusion reaction due to anti-Go(a), an antibody against the low-prevalence Gonzales antigen.
Go(a) (D(Cor)) is a low-frequency antigen in the Rh system found on red cells lacking part of the D mosaic (category IVa). Anti-Go(a) has not been previously reported to cause hemolytic transfusion reactions. A 27-year-old African American male with sickle-cell disease, maintained on chronic transfusion, was noted to have dark plasma during an erythrocytapheresis, procedure, and the pretransfusion hemoglobin was noted to be 1 g/dl lower than 4 weeks before (with hyperbilirubinemia and a significantly increased LDH). Polyspecific direct antiglobulin test (DAT) was weakly positive (C3-weak, IgG-weak), and indirect antiglobulin tests (IATs) performed on the serum (pre- and posttransfusion reaction) and a red blood cell (RBC) eluate from the postreaction sample were negative. A segment from one of the four implicated units from the prior month's transfusion was strongly reactive at 37 degrees C and using anti-human globulin (AHG) when crossmatched with the postreaction serum and the eluate. The postreaction serum, screened with a panel of red cells positive for low-prevalence antigens, reacted with three Go(a+) cells. The implicated unit was reactive with a previously identified anti-Go(a) serum.
Larson
P J
PJ
Department of Pediatrics, University of Pennsylvania, Philadelphia, USA.
Lukas
M B
MB
Friedman
D F
DF
Manno
C S
CS
D000328:Adult; D000743:Anemia, Hemolytic / Q000209:etiology* / Q000276:immunology; D000755:Anemia, Sickle Cell / Q000150:complications / Q000276:immunology / Q000628:therapy; D001789:Blood Group Antigens / Q000276:immunology; D001787:Blood Group Incompatibility / Q000276:immunology*; D002561:Cerebrovascular Disorders / Q000209:etiology / Q000628:therapy; D006801:Humans; D007114:Immunization; D007518:Isoantibodies / Q000276:immunology; D008297:Male; D012204:Rh-Hr Blood-Group System / Q000276:immunology*; D065227:Transfusion Reaction
D001789:Blood Group Antigens; D007518:Isoantibodies; D012204:Rh-Hr Blood-Group System