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Adverse Occurrence type:
Antibodies to Cartwright antigens (Yta and Ytb) rarely cause shortened RBC survival due to hemolysis. DHTR have been reported to occur much more often in transfused patients with hemoglobinopathies compared to transfused patients with other disorders.
Time to detection:
Alerting signals, symptoms, evidence of occurrence:
A 26-year-old female with B-thalassemia/sickle cell anemia was admitted to the hospital with symptoms of a painful crisis. She was transfused with 4 units of RBCs that were microscopically incompatible. 8 days later the patient was readmitted with back pain, hemoglobinuria and a drop in the hematocrit value. All cross-matches were now strongly incompatible. Anti-E, anti-c, anti- Jka and anti-Yta were identified. DAT was positive, and the eluate contained anti-c and anti-Jka. The patient's hematocrit continued to decrease to 14 per cent. 51Cr red blood cell survival studies showed significantly shortened survival of both autologous and R1R1, Jk(a-), Yt(a+) erythrocytes.
Demonstration of imputability or root cause:
Clinical signs and laboratory values were compatible with a DHTR.
Hillyer, C.D., Hall, J.M., Tiegerman, K.O. and Berkman (1991). Case report and review: alloimmunization, delayed hemolytic transfusion reaciton, and clinically siginficant anti-Yt(a) in a patient with Beta thalassemia/sickle cell anemia. Immunohematology 7(4):102-106.
Expert comments for publication:
The patient presented here had been alloimmunized to multiple antigens by previous transfusions, a fact not evident of her first admission. A brisk anamnestic response led to a serious DHTR. The microscopic incompatibility of the transfused RBCs was thought to be due to the anti-HTLA antibody (anti-Yta).