Fatal Acute Hemolytic Transfusion Reaction (AHTR), anti-Vw + Mi(a), Mi.I, GP.Vw

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Record number: 
Adverse Occurrence type: 
MPHO Type: 
Estimated frequency: 
Case report
Time to detection: 
Alerting signals, symptoms, evidence of occurrence: 
Nausea, vomitting, fever, jaundiced patient.
Demonstration of imputability or root cause: 
Increased red cell destruction was documented along with the serologic identification of the antibodies. Post transfusion sample had increased free hemoglobin and increased bilirubin. A retrospective crossmatch was incompatible.
Imputability grade: 
2 Probable
Groups audience: 
Suggest new keywords: 
Miltenberger antibody
hemolytic transfusion reaction
MNS glycophorin hybrid
Suggest references: 
- Molthan, L. (1981). Intravascular hemolytic transfusion reaction due to anti-Vw+Mia with fatal outcome. Vox Sang 40:105-8 - Heathcote, Damien J., Timothy E. Carroll, and Robert L. Flower. "Sixty years of antibodies to MNS system hybrid glycophorins: what have we learned?." Transfusion medicine reviews 25.2 (2011): 111-124.
Expert comments for publication: 
A case of likely antibody to low incidence antigen in the MNS blood group system. When this case was published, few of the Miltenberger antigens were described. In the 1960s a numbering system, the “Miltenberger” series (or Miltenberger subsystem), was introduced by Cleghorn to classify, MNS antigen profiles, what were later identified as hybrid glycophorins. These antigens were subsequently identified by GP in the ISBT system. These antigens have a very low frequency in the Caucasian population but some like GP.Mur occurs more frequently in south east Asian population. Antibodies to these antigens can occur naturally as well as on exposure of allo-antigens (reviewed by Heathcote et al, Transfusion Medicine Reviews, 2011). This case is likely due to antibody to GP.Vw (anti-Vw+Mia) as per ISBT nomenclature. Fatal hemolytic reaction may be due to multiple factors including failure of the staff to recognize a transfusion reaction. Antigens in the "Miltenberger" series are estimated to occur with 0.05% frequency in the Caucasian population but is higher in south east Asian population especially in some tribal groups in Taiwan. Blood banks in that region will look for these antibodies as they have been implicated in hemolytic transfusion reactions as well as in hemolytic disease of newborn.