Red cell exchange to mitigate a delayed hemolytic transfusion reaction in a patient transfused with incompatible red blood cells.
OBJECTIVE
A red cell exchange was performed to prevent a potentially fatal hemolytic transfusion reaction in a patient with anti-e who was transfused with e-antigen unscreened red blood cells during liver transplant surgery.


METHODS
A 64-year-old woman with cirrhosis due to hepatitis C was scheduled to receive a liver transplant. She had a previously documented anti-e, an antibody to the Rh(e)-antigen that is known to cause delayed hemolytic transfusion reactions. Pre-operatively and intra-operatively, she had massive hemorrhage which required transfusion of 34 e-antigen unscreened red blood cells (RBCs) most of which were incompatible. The hemoglobin dropped from 9.1 g/dL on post-operative day (POD)1 to 6.6 g/dL on POD6, with no evidence of blood loss. The bilirubin also increased from 5.0 mg/dL on POD 1 to 11.0 mg/dL on POD 6. As she was also becoming more hemodynamically unstable, a red cell exchange with 10 units of e-negative RBCs was performed on POD 6. She improved clinically and was extubated the following day. A few residual transfused e-positive red cells were detected after the red cell exchange until POD 13.


CONCLUSIONS
This case illustrates how a red cell exchange can mitigate the potentially harmful effects of a delayed hemolytic transfusion reaction caused by red cell antibodies. With massive intraoperative blood loss it may not be possible to have antigen-negative RBCs immediately available, particularly for the e-antigen, which is present in 98% of the donor population. The ability to perform such a procedure may be life-saving in such patients. J. Clin. Apheresis 32:59-61, 2017. © 2016 Wiley Periodicals, Inc.
Therapeutic Services, Blood Center of Wisconsin, Milwaukee, Wisconsin.|Transfusion Services, Aurora Health Care, Milwaukee, Wisconsin.|Medical College of Wisconsin, Milwaukee, Wisconsin.
Mehraboon S
MS
Irani
Medical College of Wisconsin, Milwaukee, Wisconsin.|Medical Sciences Institute, Blood Center of Wisconsin, Milwaukee, Wisconsin.
Matthew S
MS
Karafin
Transfusion Service, ACL Laboratories and Aurora Health Care, St. Luke's Medical Center, Milwaukee, Wisconsin.
Luke
L
Ernster
D001787:Blood Group Incompatibility / Q000276:immunology*; D017707:Erythrocyte Transfusion; D004912:Erythrocytes / Q000276:immunology; D005260:Female; D006461:Hemolysis / Q000276:immunology*; D006801:Humans; D007518:Isoantibodies / Q000097:blood; D016031:Liver Transplantation / Q000009:adverse effects; D008875:Middle Aged; D065227:Transfusion Reaction / Q000517:prevention & control*
D007518:Isoantibodies
anti-e; delayed hemolytic transfusion reaction; red cell exchange