Status:
Ready to upload
Record number:
1247
Adverse Occurrence type:
MPHO Type:
Estimated frequency:
Extremely rare
Time to detection:
Immediately after the transfusion of the first unit
Alerting signals, symptoms, evidence of occurrence:
The patient (male, 75 years of age with CLL and anaemia) presented chills, fever (40ºC), nausea, vomiting and clinical signs of haemoglobinuria and haemoglobinemia immediately after transfusion. The haemoglobin level decreased from 7.1 to 6.4 g/dl, the haematocrit decreased from 23.1 to 19.8%, and indirect bilirrubin increased from 1.57 to 4.85 mg/ml. The phenotype of the patient's cells was A DCcee K negative and that of the transfused unit was A DccEe K negative. The DAT technique was negative in samples obtained before and after transfusion. An anti-E antibody was detected (at a level of 2+) by the standard two-stage enzyme test, but not by any of the applied IAT (Diamed IAT, tube tests: LISS IAT, PEG IAT). Anti-E was, however detected by DiaMed IAT (weak +) 24h later.
Demonstration of imputability or root cause:
The clinical and biological signs are compatible with an acute hemolytic transfusion reaction (AHTR).
Imputability grade:
2 Probable
Groups audience:
Keywords:
Reference attachment:
Suggest references:
Michalewska, B., Ejduk, A. and Pniewska, K. (2005). Acute haemolytic transfusion reaction apparently caused by the 'enzyme-only' anti-E. Vox Sang 89(1): 61.
Note:
The case in my opinion has some intriguing and/or problematic aspects... Anti-E usually induces DHTR and not AHTR... The anti-E was only detected in the enzymatic phase... The DAT was always negative even in the postransfusion sample... So, it can be a true exceptional case but we can decide if it is suitable or not to be included in the library. Anyway, the imputability should be Possible or Probable.
Expert comments for publication:
Hemolytic transfusion reactions caused by "enzyme-only" antibodies occur very rarely and when occurred they are usually delayed hemolytic transfusion reactions (DHTR).