Acute Hemolytic Transfusion Reaction (AHTR), anti-Fy3

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Adverse Occurrence type: 
MPHO Type: 
Estimated frequency: 
Case Report
Alerting signals, symptoms, evidence of occurrence: 
The patient received two units of RBCs pre-operatively, underwent surgey on day 7 and received two more units of RBCs two days later post-op before reaction. Patient's urine was dark during surgery and postoperatively. Her posttransfusion plasma was red. Her Hb dropped from 8.4 to 6.4 g/dL over 24 hours after the transfusion. Her total bilirubin rose to 4.0 mg/dL, with LDH value of 1558 U/L and a haptoglobin of 10.9 mg/dL. Both the antibody detection test and the DAT were positive.
Demonstration of imputability or root cause: 
Patient typed as Fy(a-b-). One unit transfused was Fy(a-b+) and two others were Fy(a+b+). Peri transfusion sample demonstrated positive DAT and antibody identification panel demonstrated no reactivity only with two cells that were Fy(a-b-). Antibodies to all other antigens was ruled out and this antibody was confirmed to anti-Fy3 by a reference laboratory.
Imputability grade: 
3 Definite/Certain/Proven
Groups audience: 
Reference attachment: 
Suggest references: 
Olteanu, H., Gerber, D., Partridge, K. and Sarode, R. (2005). Acute hemolytic transfusion reaction secondary to anti-Fy3.Immunohematology 21(2):48-52.
Expert comments for publication: 
A rare case of anti-Fy3 antibody with no other Fy allo-antibody causing intravascular hemolysis.