Delayed Hemolytic Transfusion Reaction (DHTR), pancreatitis, anti-E, -c, -M, and -Jk(a)

A 77-year-old man was transfused with 5 units of RBCs (1 autologous and 4 allogeneic) for a bilateral total knee replacement. On postoperative day 7, he experienced abdominal pain and nausea. His urine output decreased and darkened in color. On postoperative day 9, he was weak and jaundiced, and his hematocrit level was 20.8 percent. On postopeative day 10, his hematocrit level was 19.8 percent and the reticulocyte count was 9.2 percent. An antibody screen revealed anti-E, -c, -M and anti-Jka in his plasma and circulating RBCs were negative for the corresponding antigens. Each of the 4 allogeneic units of RBCs was mismatched with at least one of the newly formed antibodies. A DHTR was diagnosed involving all four RBC units. The biological parameters of hemolysis were also compatible: direct and indirect bilirubin (0.7 and 1.6 mg/dL), LDH (1175 U/L), haptoglobin (undetectable) and bilirubinuria. Serum amylase and lipase levels were elevated and decreased during the subsequent 3 weeks. The diagnosis of pancreatitis was also confirmed.