Recurrent acute hemolytic transfusion reactions by antibodies against Doa antigens, not detected by cross-matching.
An 81-year-old male patient suffered from recurrent acute hemolytic transfusion reactions after transfusion with phenotyped cross-match-negative red blood cells (RBCs). Extensive posttransfusion workup eventually revealed Dombrock (a) (Do(a)) antibodies. Because commercially available cell panels do not allow for identification of anti-Do(a) and owing to the lack of Do(a) typing serum samples, selection of matched units of RBCs is dependent on negative cross-match results. In this case, selection of Do(a-) units by cross-matching failed, indicating that serologic methods were not reliable. A polymerase chain reaction with sequence-specific priming assay was used to detect DOA and DOB alleles, which encode Do(a) and Do(b) antigens, respectively. The patient was confirmed to be DOB/DOB by DNA sequencing. Furthermore, the involved mismatched units in each of the three hemolytic episodes were shown to be Do(a+). In the presenting case, DNA typing appeared to be superior to serologic methods in selecting matched RBC units in the presence of anti-Do(a).
Baumgarten
Ruben
R
Department of Clinical Chemistry & Hematology, Atrium Medical Center, Heerlen, the Netherlands.
van Gelder
Warry
W
van Wintershoven
Joyce
J
Maaskant-Van Wijk
Petra A
PA
Beckers
Erik A M
EA
D036002:ADP Ribose Transferases / Q000235:genetics / Q000276:immunology*; D000208:Acute Disease; D000369:Aged, 80 and over; D000906:Antibodies / Q000097:blood; D001788:Blood Grouping and Crossmatching; D004932:Esophageal and Gastric Varices / Q000628:therapy; D005820:Genetic Testing; D005838:Genotype; D006461:Hemolysis / Q000276:immunology*; D006801:Humans; D008297:Male; D008565:Membrane Proteins / Q000235:genetics / Q000276:immunology*; D012150:Polymorphism, Restriction Fragment Length; D012008:Recurrence; D065227:Transfusion Reaction
D000906:Antibodies; D008565:Membrane Proteins; D036002:ADP Ribose Transferases; C105234:ART4 protein, human