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Adverse Occurrence type:
Time to detection:
Alerting signals, symptoms, evidence of occurrence:
A 67-year old white woman received transfusions of a total of 87 units of whole blood and red blood cells during and within 48 hours following a pneumonectomy. Although she had previously received blood transfusions, unexpected antibodies were not detectable by routine screening. On the second postoperative day, she developed fever, hemoglobinemia, hemoglobinuria, and oliguria. The hemoglobin level fell from a high of 20.4 g/dl on the second postoperative day to 14 g/dl on the fourth postoperative day, without apparent bleeding. Bilirubin rose to 12 mg/dl over this period.
Demonstration of imputability or root cause:
The patient was antibody negative prior to transfusion but in the eighth postoperative day, an IgM anti-P(1) antibody was detected for the first time. Direct antiglobulin test was positive with an anti-human IgM. Re-testing of pre-transfusion serum showed an anti-P(1) antibody at 15 C for 30 minutes which was missed using standard crossmatching techniques.
Suggest new keywords:
DHTR (delayed hemolytic transfusion reaction)
Chandeysson, PL, Flye, MW, Simpkins, SM and Holland, PV. (1981). Delayed hemolytic transfusion reaction caused by anti-P1 antibody. Transfusion 21:77-82
Per Daniela: adv. occ. taxonomy: Harm to a recipient/Immunological complications/Delayed Hemolytic Reaction
Expert comments for publication:
Anti-P and -PP(1)Pk are naturally occurring antibodies invariably present in individuals with the very rare Pk and p phenotypes.