Acute Hemolytic Transfusion Reaction (AHTR) due to autoanti-I with high thermal amplitude

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Adverse Occurrence type: 
MPHO Type: 
Estimated frequency: 
Case Report
Time to detection: 
Alerting signals, symptoms, evidence of occurrence: 
Clinical or laboratory features of hemolysis following transfusion of second unit reported. These included, fever, rigors, loin pain, sweating, tachycardia and kidney tenderness on palpation. Patient also passed dark urine with increase bilirubin are present. IgM autoanti-I detected at 4°C and at 30°C.
Demonstration of imputability or root cause: 
Positive DAT before and after transfusion which demonstrated complement and IgM specificity. Serum pre-transfusion was straw colored and post transfusion was dirty brown indicating hemolysis. Cold antibody had thermal amplitude ranging upto 30°C. As the units transfused were cold in a small baby, it was hypothesized that this cold auto antibody caused hemolysis.
Imputability grade: 
2 Probable
Groups audience: 
Suggest new keywords: 
acute hemolytic transfusion reaction
cold red cell transfusion
Reference attachment: 
Suggest references: 
Win, N., Needs, M., Rahman, S., Gold, P. and Ward, S. (2011). An unusual case of an acute hemolytic transfusion reaction caused by an autoanti-I. Immunohematology 27(3):101-103.
Expert comments for publication: 
Rare case of cold autoantibody with low titre (1:256) at 4°C but with high thermal amplitude causing hemolysis subsequent to transfusion of two red cell units removed from the refrigerator without allowing to warm to room temprature.