title: Three episodes of delayed hemolytic transfusion reactions due to multiple red cell antibodies, anti-Di, anti-Jk and anti-E.
abstract: There is no report in which three episodes of delayed hemolytic transfusion reaction (DHTR) occurred from multiple antibodies to red cells (RBCs) in the course of treatment of a patient. This paper describes episodes of anemia and hyperbilirubinemia in concert with the development of three alloantibodies in a multiple transfused patient. The patient was a 71-year-old male suffering from valvular heart disease and hemophilia B with a history of transfusions. Although he received compatible RBCs from 14 donors as judged by a crossmatch test using the albumin-antiglobulin method, three episodes of DHTR occurred after surgery. The first hemolytic episode on day 7 after surgery was due to anti-Di(a) because of clinical and laboratory evidence which included jaundice, sudden increases in total bilirubin (T-Bil) and lactate dehydrogenase (LD) levels, and a decrease (2.2 g/dl) in hemoglobin (Hb) level. The second hemolytic episode on day 16 resulted from newly producted anti-Jk(b). The patient experienced fever, fatigue, nausea and anorexia, and laboratory data showed a second increase in T-Bil, a second decrease (3 g/dl) in Hb, and moderate elevations of blood urea nitrogen (BUN) and creatinine (CRE) levels. The third hemolytic episode on day 39 was due to anti-E. The patient complained of fever and fatigue and had a third unexplained drop (1.5 g/dl) in Hb despite no bleeding. This is the first reported case in which three episodes of DHTR occurred from different red cell antibodies.
authors.affiliation: Division of Blood Transfusion and Transplantation Immunology, School of Medicine, Fukushima Medical University, 1 Hikariga-oka, 963-8501 Fukushima, 150-0012, Tokyo, Japan. hyasuda@cc.fmu.ac.jp
authors.forename: H
authors.initials: H
authors.lastname: Yasuda
authors.forename: H
authors.initials: H
authors.lastname: Ohto
authors.forename: O
authors.initials: O
authors.lastname: Yamaguchi
authors.forename: S
authors.initials: S
authors.lastname: Sakuma
authors.forename: T
authors.initials: T
authors.lastname: Suzuki
authors.forename: M
authors.initials: M
authors.lastname: Mita
authors.forename: H
authors.initials: H
authors.lastname: Tsuneyama
authors.forename: M
authors.initials: M
authors.lastname: Uchikawa
mesh_terms: D000368:Aged; D000743:Anemia, Hemolytic / Q000209:etiology* / Q000276:immunology; D001022:Aortic Valve Insufficiency / Q000150:complications / Q000601:surgery; D001789:Blood Group Antigens / Q000276:immunology*; D001787:Blood Group Incompatibility / Q000276:immunology*; D001788:Blood Grouping and Crossmatching; D005221:Fatigue / Q000209:etiology; D005334:Fever / Q000209:etiology; D002836:Hemophilia B / Q000150:complications / Q000276:immunology / Q000628:therapy; D006801:Humans; D006932:Hyperbilirubinemia / Q000209:etiology; D007518:Isoantibodies / Q000276:immunology*; D007667:Kidd Blood-Group System / Q000276:immunology; D008297:Male; D011183:Postoperative Complications / Q000276:immunology; D012008:Recurrence; D012204:Rh-Hr Blood-Group System / Q000276:immunology; D013997:Time Factors; D065227:Transfusion Reaction
chemical_list: D001789:Blood Group Antigens; D007518:Isoantibodies; D007667:Kidd Blood-Group System; D012204:Rh-Hr Blood-Group System