title: Case report: massive postpartum transfusion of Jr(a+) red cells in the presence of anti-Jra.
abstract: Jr(a) is a high-prevalence antigen. The rare Jr(a-) individuals can form anti-Jr(a) after exposure to the Jr(a) antigen through transfusion or pregnancy. The clinical significance of anti-Jr(a) is not well established. This study reports a case of a 31-year-old woman with a previously identified anti-Jr(a) who required massive transfusion of RBCs after developing life-threatening postpartum disseminated intravascular coagulopathy. Despite the emergent transfusion of 15 units of Jr(a) untested RBCs, she did not develop laboratory or clinical evidence of acute hemolysis. The patient's anti-Jr(a) had a pretransfusion titer of 4 and a monocyte monolayer assay (MMA) reactivity of 68.5% (reactivity > 5% is considered capable of shortening the survival of incompatible RBCs). The titer increased fourfold to 64 and the MMA reactivity was 72.5% on Day 10 posttransfusion. Review of laboratory data showed evidence of a mild delayed hemolytic transfusion reaction by Day 10 posttransfusion. Despite rare reports of hemolytic transfusion reactions due to anti-Jr(a) in the literature, most cases, including this one, report that this antibody is clinically insignificant or causes only mild delayed hemolysis. Clinicians should be advised to balance the risks of withholding transfusion with the small chance of significant hemolysis after transfusion of Jr(a+) RBCs in the presence of anti-Jr(a).
authors.affiliation: Transfusion Medicine Fellow, Department of Laboratory Medicine, University of Washington, Seattle, 98104, USA.
authors.forename: S
authors.initials: S
authors.lastname: Yuan
authors.forename: R
authors.initials: R
authors.lastname: Armour
authors.forename: A
authors.initials: A
authors.lastname: Reid
authors.forename: K F
authors.initials: KF
authors.lastname: Abdel-Rahman
authors.forename: D M
authors.initials: DM
authors.lastname: Rumsey
authors.forename: M
authors.initials: M
authors.lastname: Phillips
authors.forename: T
authors.initials: T
authors.lastname: Nester
mesh_terms: D000328:Adult; D001789:Blood Group Antigens / Q000276:immunology; D001787:Blood Group Incompatibility; D016063:Blood Loss, Surgical; D004211:Disseminated Intravascular Coagulation; D004899:Erythroblastosis, Fetal / Q000276:immunology / Q000628:therapy*; D017707:Erythrocyte Transfusion / Q000379:methods; D005260:Female; D006461:Hemolysis / Q000276:immunology; D006801:Humans; D007044:Hysterectomy; D007231:Infant, Newborn; D007518:Isoantibodies / Q000276:immunology; D006473:Postpartum Hemorrhage / Q000276:immunology / Q000601:surgery; D011247:Pregnancy
chemical_list: D001789:Blood Group Antigens; D007518:Isoantibodies