title: Mechanisms responsible for delayed and immediate hemolytic transfusion reactions in a patient with anti-E + Jk(b)+ Di(b) and anti-HLA alloantibodies.
abstract: Immediate hemolytic transfusion reactions (IHTR) occurred in the course of delayed hemolytic transfusion reactions (DHTR). An 84-year-old man had received a blood transfusion 20 years ago. Progressive anemia developed, because of continuous bleeding from a bladder tumor. He was transfused with concentrated red blood cells (CRC) which were Rh-E antigen negative, because he had anti-E antibodies (day 0). He received CRC on day 3, and underwent resection of bladder tumor on day 6. Although crossmatch-compatible CRCs were prepared for the operation, those were not required and were kept in a refrigerator in the ward. On day 9, when a CRC kept in the ward was transfused, he suddenly had a IHTR. In order to analyze a mechanism of IHTR, the anti-Jk(b) and anti-Di(b) antibodies, anti-HLA antibodies and the concentrations of inflammatory cytokines were measured in serum samples. The anti-Jk(b) and anti-Di(b) antibodies increased prior to IHTR experienced on day 9. The concentrations of IL-6 and IL-1beta increased from day 2, while the concentration of IL-8 increased from day 7. The anti-HLA class I antibody could be detected 2 days before IHTR. Thus, the anti-Jk(b) and anti-Di(b) antibodies induced the production of inflammatory cytokines and symptoms of DHTR and IHTR. The anti-HLA class I antibody could be produced in spite of using the filer for removing leukocytes, and may take part in the induction of IHTR. Further, blood products should be transfused soon after completing a crossmatch test in patients with anti-RBC alloantibodies.
authors.affiliation: Department of Internal Medicine, Takarazuka Municipal Hospital, Takarazuka, Hyogo, Japan. takahiro603@ybb.ne.jp
authors.forename: Takahiro
authors.initials: T
authors.lastname: Okamoto
authors.forename: Makiko
authors.initials: M
authors.lastname: Hashimoto
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Samejima
authors.forename: Ako
authors.initials: A
authors.lastname: Mori
authors.forename: Mari
authors.initials: M
authors.lastname: Wakabayashi
authors.forename: Akira
authors.initials: A
authors.lastname: Takeda
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Nakamura
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Naruse
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Bouike
authors.forename: Nobuo
authors.initials: N
authors.lastname: Araki
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001323:Autoantibodies / Q000097:blood / Q000276:immunology; D001789:Blood Group Antigens / Q000276:immunology*; D001788:Blood Grouping and Crossmatching; D016207:Cytokines / Q000097:blood / Q000276:immunology; D017707:Erythrocyte Transfusion / Q000009:adverse effects*; D006680:HLA Antigens / Q000276:immunology*; D006801:Humans; D006968:Hypersensitivity, Delayed / Q000097:blood* / Q000276:immunology; D006969:Hypersensitivity, Immediate / Q000097:blood* / Q000276:immunology; D007518:Isoantibodies / Q000097:blood / Q000276:immunology*; D007667:Kidd Blood-Group System / Q000276:immunology; D008297:Male; D012204:Rh-Hr Blood-Group System / Q000276:immunology; D013997:Time Factors
chemical_list: D001323:Autoantibodies; D001789:Blood Group Antigens; D016207:Cytokines; D006680:HLA Antigens; D007518:Isoantibodies; D007667:Kidd Blood-Group System; D012204:Rh-Hr Blood-Group System