A Hemolytic Transfusion Reaction Caused by an Unexpected Leb Antibody

Abstract

A Black male patient aged 21 years with a history of sickle cell disease and HIV was admitted to the hospital with vaso-occlusive crisis. A transfusion reaction was called after the patient developed a fever (39.5°C), tachycardia, chills, and hematuria after receiving 300 mL of red blood cells. A posttransfusion specimen was submitted to the Immunohematology Reference Laboratory for investigation. Antibody identification revealed an anti-Leb as the probable cause of the immediate acute hemolytic transfusion reaction. Lewis antibodies are considered clinically insignificant. This case shows the importance of considering cold antibodies, including Lewis antibodies, as a possible cause of an acute hemolytic transfusion reaction.

Serological characteristics of Lewis antibodies and their clinical significance – A case series

“…Recently published literature highlights that the IgM class of Lewis antibodies (both anti-Le a and -Le b ) reacting at 37°C can lead to acute hemolytic reactions in transfused recipients. 4 In the current study, delayed hemolytic transfusion reaction, secondary to a Lewis antibody, was suspected in two patients, which was corroborated by the laboratory features of hemolysis (one had anti-Le a and the other had anti-Le b , IgM class antibodies, C3d positive DAT) and a temporal association with transfusion. 2, Individuals with a pre-existing Lewis antibody, are known to exhibit an anamnestic reaction, subsequent to an antigen-incompatible transfusion.…”

“… 13 Despite occurring frequently amongst antenatal women, Lewis antibodies have rarely been implicated in HDFN as most of them are of the IgM class and Lewis antigens are poorly expressed at birth owing to their gut immaturity. 2 , 3 , 4 In the present study, no case of Lewis antibody-related HDFN was observed, even though IgG antibodies were demonstrated in the sera of pregnant women.…”

“…Lewis antibodies have been thought to play a small role in the clinical transfusion practice, but recent reports suggest that these antibodies have gained more importance in the context of transfusion and transplantation. 4 Data regarding the prevalence of Lewis antibodies and their clinical significance in the Indian context is very limited. Hence, this study was aimed at analyzing the serological characteristics and clinical significance of Lewis antibodies encountered in our patient and donor populations.…”

Situation analysis and blood transfusion strategy of Lewis antibodies in Hunan Province

“…Some were not found during the pre-transfusion antibody detection test but were found during acute hemolytic transfusion reaction after blood transfusion. [7][8][9] Thus, the clinical significance of Lewis antibodies must be valued and deeply explored. In this study, we conducted a retrospective analysis of the Lewis blood group system antibodies of patients detected at the Third Xiangya Hospital of Central South University from 2019 to 2021.…”