title: Severe immune haemolysis in a group A recipient of a group O red blood cell unit.
abstract: Haemolysis caused by passive ABO antibodies is a rare transfusional complication. We report a case of severe haemolytic reaction in a 38-year-old man (blood group A) with lymphoma who had received one red blood cell (RBC) unit group O. After transfusion of 270 mL, the patient experienced fever, dyspnoea, chills and back pain. On the following morning he was icteric and pale. Haptoglobin was inferior to 5.8 mgdL(-1), haemoglobin was not increased and lactate dehydrogenase was elevated. Haemolysis was evident on observation of the patient's post-transfusion samples. The recipient's red cells developed a positive direct antiglobulin test and Lui elution showed anti-A coated the cells. Fresh donor serum had an anti-A titre of 1024, which was not reduced by treating the serum with dithiothreitol. Donor isoagglutinin screening has been determined by microplate automated analyser and showed titre higher than 100. Physicians should be aware of the risk of haemolysis associated with ABO-passive antibodies. There is generally no agreement justifying the isoagglutinin investigation prior to transfusion. However, automated quantitative isoagglutinin determination could be part of the modern donor testing process, mainly in blood banks where identical ABO group units (platelets or phenotyped RBCs) are not available owing to limited supply.
authors.affiliation: Haematology and Transfusion Centre, State University of Campinas, Campinas, Sao Paulo, Brazil. maluz@unicamp.br
authors.forename: M L
authors.initials: ML
authors.lastname: Barjas-Castro
authors.forename: M F
authors.initials: MF
authors.lastname: Locatelli
authors.forename: M A
authors.initials: MA
authors.lastname: Carvalho
authors.forename: S O
authors.initials: SO
authors.lastname: Gilli
authors.forename: V
authors.initials: V
authors.lastname: Castro
mesh_terms: D000017:ABO Blood-Group System / Q000276:immunology*; D000328:Adult; D000740:Anemia / Q000139:chemically induced / Q000628:therapy; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D001782:Blood Donors; D001787:Blood Group Incompatibility / Q000276:immunology*; D002945:Cisplatin / Q000008:administration & dosage / Q000009:adverse effects; D003561:Cytarabine / Q000008:administration & dosage / Q000009:adverse effects; D003907:Dexamethasone / Q000008:administration & dosage / Q000009:adverse effects; D017707:Erythrocyte Transfusion / Q000009:adverse effects*; D005334:Fever / Q000209:etiology; D006461:Hemolysis; D006801:Humans; D007116:Immunization, Passive; D007518:Isoantibodies / Q000009:adverse effects* / Q000276:immunology; D007565:Jaundice / Q000209:etiology; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy; D008297:Male; D009844:Oligosaccharides / Q000276:immunology; D025942:Oligosaccharides, Branched-Chain; D010146:Pain / Q000209:etiology
chemical_list: D000017:ABO Blood-Group System; D007518:Isoantibodies; D009844:Oligosaccharides; D025942:Oligosaccharides, Branched-Chain; C101335:blood group A trisaccharide; D003561:Cytarabine; D003907:Dexamethasone; D002945:Cisplatin