Blood transfusions leading to apparent hemoglobin C, S, and O-Arab hemoglobinopathies.
BACKGROUND
Apparent hemoglobinopathies caused by blood transfusions rarely have been reported in the scientific literature.


OBJECTIVE
To interpret the abnormal hemoglobins appearing as small peaks on hemoglobin chromatograms or electrophoresis membranes.


METHODS
In the clinical laboratories of a university hospital and a metropolitan hospital affiliated with a medical school, we interpreted hemoglobin chromatograms and electrophoresis membranes; correlated them with patients' medical, laboratory, and transfusion records; and when possible, identified the abnormal hemoglobin in the donors' transfusion segments.


RESULTS
We detected 52 incidences of apparent hemoglobinopathies in 32 recipients caused by blood transfusion, of which 46 were hemoglobin C, 4 were hemoglobin S, and 2 were hemoglobin O-Arab. When first detected, the abnormal hemoglobins in recipients ranged from 0.8% to 14% (median, 5.6%). Multiple transfusions with abnormal hemoglobins occurred in 11 patients with 2 patients receiving hemoglobin C blood 5 separate times. One patient received hemoglobin C and later S, and another patient received C and later O-Arab.


CONCLUSIONS
Apparent hemoglobinopathies caused by blood transfusions are far more common than previously reported and represent diagnostic challenges. Misdiagnosis could lead to unnecessary testing, treatment, and counseling. If a hemoglobinopathy from a unit of transfused blood is identified in a recipient, we recommend notifying the donor of that abnormality.
Kozarski
Tzvetan B
TB
Department of Pathology, Box 25, State University of New York, Downstate Medical Center, 450 Clarkson Ave, Brooklyn, NY 11203, USA. tzvetan.kozarski@downstate.edu
Howanitz
Peter J
PJ
Howanitz
Joan H
JH
Lilic
Nenad
N
Chauhan
Yeshpal S
YS
D000755:Anemia, Sickle Cell / Q000209:etiology* / Q000473:pathology; D002851:Chromatography, High Pressure Liquid; D004588:Electrophoresis, Cellulose Acetate; D006444:Hemoglobin C / Q000032:analysis; D006445:Hemoglobin C Disease / Q000209:etiology* / Q000473:pathology; D006451:Hemoglobin, Sickle / Q000032:analysis; D006455:Hemoglobins, Abnormal; D006785:Hospitals, University; D006786:Hospitals, Urban; D006801:Humans; D065227:Transfusion Reaction
D006451:Hemoglobin, Sickle; D006455:Hemoglobins, Abnormal; D006444:Hemoglobin C; C032031:hemoglobin Arab