Acute Hemolytic Transfusion Reaction (AHTR), anti-JMH

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Record number: 
Adverse Occurrence type: 
MPHO Type: 
Time to detection: 
Alerting signals, symptoms, evidence of occurrence: 
The patient developed macrohemoglobinuria, and his hemoglobin decreased from 11.1 g/dL to 7.7 g/dl without any sign of significant blood loss. Free plasma hemoglobin increased to 430 mg/l. LDH to 1199 U/l, and total serum bilirrubin rose to 122 uM. The administration of a test dose of 30 ml of RBCs resulted in a new episode of AHTR (lumbar and sternal pain, dyspnea and hemoglobinuria).
Demonstration of imputability or root cause: 
The clinical symptoms and the biological signs were compatible with an AHTR. DAT positive in the postransfusion sample. Serologcal re-examination revealed weakly reactive antibodies with anti-JMH specificity.
Imputability grade: 
2 Probable
Groups audience: 
Reference attachment: 
Suggest references: 
Hoppe B, Pastucha L, Seltsam A, Greinacher A, Salama A. (2002). Acute haemolytic transfusion reactions due to weak antibodies that in vitro did not seem to be clinically significant. Vox Sang 82:207-10
Expert comments for publication: 
It remains unclear whether the AHTR described was solely related to the antibody detected (anti-JMH) or whether they could, at least in part, be caused by other, yet unidentified, factors. Although other similar cases of mild hemolytic transfusion reaction induced by anti-JMH have been described, this specificity is usually clinically insignificant.