Acute Hemolytic Transfusion Reaction (AHTR), anti-A in platelets

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Record number: 
Adverse Occurrence type: 
MPHO Type: 
Estimated frequency: 
Case Report
Time to detection: 
30 minutes
Alerting signals, symptoms, evidence of occurrence: 
A 2 year old female received 145 ml of group O leukoreduced, irradiated apheresis platelets and developed symptoms and signs of shock as evidenced by skin pallor, vomiting, decreased blood pressure (116/57 - 87/28 mmHg), decreased temperature (36.6 - 35.1°C), increased pulse (121 - 160 beats per minute), and increased respiratory rate (28 - 32 breaths per minute). She had marked intravascular hemolysis of group A red cells following a transfusion containing high-titered anti-A isoagglutinin.
Demonstration of imputability or root cause: 
Clinical and serologic evidence of intravascular hemolysis, hemoglobinuria. The pre-transfusion blood sample showed no hemolysis but the post transfusion sample was moderately hemolyzed and showed autoagglutination of the red blood cells. Minor crossmatch performed with the pre-transfusion sample showed agglutination, graded 4+, and moderate hemolysis at 37°C, indicating that the donor’s plasma contained anti-A isoagglutinin strongly reactive against the patient’s group A red cells.
Imputability grade: 
3 Definite/Certain/Proven
Groups audience: 
Suggest new keywords: 
Increased pulse, decreased temperature,
Suggest references: 
- Sapatnekar, S., Sharma, G., Downes, K.A., Wiersma, S., McGrath, C. and Yomtovian, R. (2005). Acute hemolytic transfusion reaction in a pediatric patient following transfusion of apheresis platelets. J Clin Apher 20(4):225-229; - Berseus, O., Boman, K., Nessen, S. C.and Westerberg, L. A. (2013). Risks of hemolysis due to anti-A and anti-B caused by the transfusion of blood or blood components containing ABO-incompatible plasma. Transfusion 53 Suppl 1: 114S-123S.
Must index also the second reference provided (Evi)
Expert comments for publication: 
Antibodies of the ABO system are clinically the most important in transfusion medicine for 2 main reasons: (1) almost all adults have anti-A or -B or both when the corresponding antigen is absent and (2) ABO antibodies cause acute intravascular hemolytic transfusion reactions.