An acute hemolytic transfusion reaction due to the "anti-c" rhesus antibody: A case report emphasizing the role of transfusion medicine

Sachan, Deepti; Jayakumar, Rajeswari; Varghese, Joy; Rela, Mohamed

doi:10.4103/0973-6247.154256

Cited by 10 publications

(9 citation statements)

References 9 publications

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“…Curiously, certain Rh antibodies (particularly those with anti‐C specificity) have been described to cause delayed reactions associated with hemoglobinemia and hemoglobinuria. The pathophysiology of hemoglobinemia and hemoglobinuria in Rh antibody–mediated HTR has not been established …”

Section: Discussionmentioning

confidence: 99%

A curious case of delayed hemolytic transfusion reaction with evanescent antibodies in a patient with hereditary hemorrhagic telangiectasia

et al. 2019

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BACKGROUND Delayed hemolytic reactions are potential complications of incompatible transfusions and are usually associated with the identification of a new antibody on serologic studies, following a second immunization event. However, in rare cases, the antibody investigation remains negative even if the clinical presentation would lead one to suspect otherwise. CASE REPORT A 44‐year‐old woman with hereditary hemorrhagic telangiectasia presented to the emergency department with hematuria and low back pain after she had received three units of RBCs 2 weeks earlier. Hematology and biochemistry results were consistent with delayed hemolytic transfusion reaction, but surprisingly, serologic antibody investigations were negative. It was only when her plasma was tested with enzyme (ficin)‐treated panel cells that anti‐e was finally detected, with a 3+ reaction with all homozygous e+ cells. No reaction was seen with heterozygous e+ cells. Four months later, an anti‐K was also detected on standard panels, while the anti‐e remained detectable only with ficin‐treated panel cells. Three years later, both antibodies had vanished and remained undetectable. The weakness of anti‐e reaction, combined with the quick evanescence of both antibodies led to the suspicion of a potential underlying immunodeficiency disorder, which was confirmed by low immunoglobulin levels on two occasions. CONCLUSION To our knowledge, this is the first case of immunodeficiency disorder diagnosed after the identification of evanescent antibody reactions. This case also outlines the importance of a good clinical history that should lead to further investigations when a hemolytic transfusion reaction is suspected.

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Section: Discussionmentioning

confidence: 99%

A curious case of delayed hemolytic transfusion reaction with evanescent antibodies in a patient with hereditary hemorrhagic telangiectasia

et al. 2019

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“…Many researchers found that the little c is the most prevalent and clinically significant RHantigen following D and cause delayed transfusion reactions and hemolytic disease of the new born [25][26][27].…”

Section: Plos Onementioning

confidence: 99%

Genotyping versus phenotyping of non-ABO erythrocyte antigens in patients with the Mediterranean hemopathic syndromes: Effect of transfusion therapy

et al. 2021

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The Mediterranean hemopathic syndromes (MHS) are the most prevalent hemoglobinopathies in the Mediterranean basin. Transfusion therapy is the main therapy for these disorders, particularly for severe forms of the disease. Currently, pre-transfusion serological typing of erythrocyte antigens is the standard tool for reducing complications of transfusion in those patients. This study compared genotyping with phenotyping of non-ABO erythrocyte antigens in patients with MHS and assessed the effect of transfusion therapy on their results. One-hundred ninety-eight MHS patients were recruited, screened, and proven negative for allo-antibodies. They were grouped into two groups: (1) 20 newly diagnosed patients with no transfusion history and (2) 178 previously diagnosed patients undergoing transfusion therapy. Patients were interviewed and clinically examined. Full blood count (FBC) and high performance liquid chromatography (HPLC) were done for group 1 only. Genotyping and phenotyping of non-ABO erythrocyte antigens were performed for group 1, and 25 patients out of group 2 were propensity score-matched (PSM) with group 1. Both groups were gender and age matched; 55% and 74% of groups 1 and 2 had major disease, respectively. Insignificant differences were observed between genotyping and phenotyping of non-ABO erythrocyte antigens in group 1, while significant discrepancies and mixed field results were noted in group 2 patients. Discrepancies were obvious with JKa, JKb, and little c antigens. Conclusively, molecular typing is a powerful tool for pre-transfusion testing in chronically transfused MHS patients. This testing reduces incidence of transfusion reactions. JKa, JKb and little c antigens are the most clinically significant non-ABO erythrocyte antigens.

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“…Hemolytic complication of blood transfusion generally may be divided into two categories depending on the time of the appearance of the first symptoms: (1) Acute hemolytic transfusion reactions (AHTRs) and (2) delayed hemolytic transfusion reactions (DHTRs). AHTRs may occur within 24 hours after the transfusion of incompatible blood, while DHTRs occur due to the delayed antibody response from 24 hours up to months or years after transfusion of apparently compatible blood (1). Common reported non-ABO AHTRs are due to Kidd, Diego, and P antigens, etc.…”

Section: Introductionmentioning

confidence: 99%

Acute Hemolytic Transfusion Reaction Due to Anti-c Rhesus Antibody in a Patient With Subdural Hematoma: A Case Report Emphasizing the Shortcoming of Spin Cross-Match

Niazkar

Ghorbani

Maleki

et al. 2020

ACTA

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The Rh blood group system is a complex blood group which includes different antigen specificities such as c antigen. Anti-c antibody is associated with both acute and delayed hemolytic transfusion reactions as well as hemolytic disease of the newborn (HDN). Rh mediated hemolytic transfusion reactions (HTR) are mostly immunoglobulin G (IgG) mediated and results in extravascular hemolysis and delayed HTR (DHTR). However, we are presenting a case of acute intravascular hemolytic transfusion reaction due to anti-c in a patient with acute subdural hematoma. A 77-year-old woman was referred to our hospital with a loss of conscious and left-sided hemiparesis. After an emergency MRI, she was diagnosed with Acute Subdural hematoma, and an emergency craniotomy was performed. Since Acute Subdural hematoma is a neurosurgery emergency, laboratory technician performed an Immediate-spincrossmatchedd for blood bag to preserve time. During the transfusion of the first packed cell, the patient developed severe hypotension and tachycardia. Thus, the transfusion was stopped. Laboratory results raised the suspicion of an Acute Intravascular Hemolysis. Antibody identification revealed that the patient had an irregular blood phenotype (C2+/c-/E-/e3+/K-), and the presence of alloantigen-c Rh antibody confirmed the suspicion of HTR. In patients with multi transfusion history and pregnant women, pre-transfusion screening of irregular antibodies must be performed. The immediate spincrossmatchh must be prevented in patients with a history of multi transfusions, even in emergency situations.

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An acute hemolytic transfusion reaction due to the "anti-c" rhesus antibody: A case report emphasizing the role of transfusion medicine

Cited by 10 publications

References 9 publications

A curious case of delayed hemolytic transfusion reaction with evanescent antibodies in a patient with hereditary hemorrhagic telangiectasia

A curious case of delayed hemolytic transfusion reaction with evanescent antibodies in a patient with hereditary hemorrhagic telangiectasia

Genotyping versus phenotyping of non-ABO erythrocyte antigens in patients with the Mediterranean hemopathic syndromes: Effect of transfusion therapy

Acute Hemolytic Transfusion Reaction Due to Anti-c Rhesus Antibody in a Patient With Subdural Hematoma: A Case Report Emphasizing the Shortcoming of Spin Cross-Match

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