Anti‐AnWj antibody induced haemolytic transfusion reaction in a patient with primary acquired pure red cell aplasia

Abstract

A 45-year-old Caucasian woman of Northern European ancestry presents with new symptomatic normocytic anaemia. Admission bloodwork revealed a haemoglobin of 58 g/L (reference range 118-148 g/L) with reticulocytopenia of 8 Â 10 9 /L (reference range 20-110 Â 10 9 /L). Serum erythropoietin exceeded 750 IU/L (reference range 2.6-18.5 IU/L). A weak pan-reactive antibody was identified during antibody screen by indirect antigen testing (IAT), being mildly enhanced by low ionising strength saline (LISS) and in papain-treated cells. It was not eliminated by Knop's inhibition reagent (IGBRL reagents, Filton, UK) or in dithiothreitol-treated cells. Direct antigen testing (DAT) was negative.Our patient's sole co-morbidity was alcohol excess (>200 United Kingdom (UK) units of alcohol/week). Comprehensive preliminary assessments were otherwise unrevealing, bar weak positive antinuclear antibodies with homogenous (AC-1) pattern and positive pANCA (anti-MPO negative). A bone marrow biopsy was undertaken.Pending diagnosis, a supportive red cell transfusion regimen was initiated. As the detected pan-reactive antibody was extremely weak, it