Acute Hemolytic Transfusion Reaction (AHTR), anti-Jk(a) missed on microcolumn agglutination antibody screening test method

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Record number: 
Adverse Occurrence type: 
MPHO Type: 
Estimated frequency: 
Case Report
Time to detection: 
2.5 hours
Alerting signals, symptoms, evidence of occurrence: 
Patient's haemoglobin levels dropped to 7.2g/dL prompting a second RBC transfusion, 19 days after the first transfusion. 2.5 hours after the second transfusion, the patient developed a transfusion reaction resulting in chills, lumbar pain and dark red urine.
Demonstration of imputability or root cause: 
Post-transfusion samples were grossly hemolysed , with dark red hue similar to hemolysis of 200 mL RBC in 3000 mL of plasma. Post transfusion increase in free plasma hemoglobin, and fall in hemoglobin to 6.5 g/dL from pre-transfusion level of 7.2 g/dL. Patient phenotype was Jk(a-b+), while the red cell units transfused typed as Jk(a+b+) and Jk(a+b-).Retrospective testing of patient plasma by solid-phase method and Erythrocytes Magentized technology on day 14 after the first transfusion but before the second transfusion demonstrated the presence of anti-Jka antibody. This was not detected by the routine micro column agglutination method.
Imputability grade: 
3 Definite/Certain/Proven
Groups audience: 
Suggest new keywords: 
missed red cell antibody
micro column agglutination
Acute hemolytic transfusion reaction
solid phase red cell antibody detection
Reference attachment: 
Suggest references: 
Villa, M.A., Moulds, M., Coluccio, E.B., Pizzi, M.N., Paccapeio, C., Revelli. N., Morelati, F., Truglio, F., Manera, M.C., Tedeschi, A. and Marconi, M. (2007). An acute haemolytic transfusion reaction due to anti-Jk. Blood Transfus 5(2):102-106.
Expert comments for publication: 
Anti-Jka antibody can fix complement and cause acute intravascular hemolysis. Anti-Jka antibodies can be missed by micro column methods. This case demonstrates development of anti-Jka most likely due to secondary response to blood transfusion, followed by acute intravascular hemolysis when a second red cell unit that was Jk(a+b-) was transfused. Anti-Jka was not identified by the micro column agglutination method on days 14 and 19 after the transfusion of first red cell, however were identified by solid-phase method.