title: Severe hemolytic transfusion reaction due to anti-D in a D+ patient with sickle cell disease.
abstract: A 5-year-old male with sickle cell disease presented with pain, dark urine, and fatigue 10 days after a red blood cell (RBC) transfusion. Laboratory evaluation demonstrated severe anemia, blood type O+, and anti-D in the serum. Anti-D in a D+ patient led to RH genotyping, which revealed homozygosity for RHD*DAU4 that encodes partial D antigen. Anti-D in this patient whose RBCs exclusively express partial D caused a delayed hemolytic transfusion reaction after exposure to D+ RBCs. The finding of anti-D in a D+patient should be investigated by molecular methods to help distinguish an alloantibody from an autoantibody.
authors.affiliation: *Department of Pathology, Houston Methodist Hospital, Houston, TX Departments of †Pediatrics §Pathology and Laboratory Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA ‡Immunohematology and Genomics Laboratory, New York Blood Center, New York City, NY.
authors.forename: Tina S
authors.initials: TS
authors.lastname: Ipe
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Wilkes
authors.forename: Helge D
authors.initials: HD
authors.lastname: Hartung
authors.forename: Connie M
authors.initials: CM
authors.lastname: Westhoff
authors.forename: Stella T
authors.initials: ST
authors.lastname: Chou
authors.forename: David F
authors.initials: DF
authors.lastname: Friedman
mesh_terms: D000755:Anemia, Sickle Cell / Q000150:complications* / Q000628:therapy; D001787:Blood Group Incompatibility / Q000175:diagnosis / Q000209:etiology*; D002675:Child, Preschool; D017707:Erythrocyte Transfusion / Q000009:adverse effects*; D006801:Humans; D007518:Isoantibodies / Q000032:analysis* / Q000276:immunology; D008297:Male; D010146:Pain / Q000175:diagnosis / Q000209:etiology; D011379:Prognosis; D012204:Rh-Hr Blood-Group System / Q000097:blood* / Q000276:immunology; D018029:Rho(D) Immune Globulin; D065227:Transfusion Reaction / Q000175:diagnosis
chemical_list: D007518:Isoantibodies; C061961:RHO(D) antibody; D012204:Rh-Hr Blood-Group System; D018029:Rho(D) Immune Globulin; C026410:Rho(D) antigen