Delayed Hemolytic Transfusion Reaction (DHTR), anti-Duffy Fy(5)

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Record number: 
Adverse Occurrence type: 
MPHO Type: 
Time to detection: 
4 days
Alerting signals, symptoms, evidence of occurrence: 
A patient with sickle cell disease received one unit of blood and on the fourth day, had a sudden increase in temperature to 40°C. She appeared pale and complained of low back pain. She had hemoglobinuria with DIC and her plasma was pink. A blood smear showed fragmented red cells. The following day, she had thrombocytopenia and a massive upper gastrointestinal bleed.
Demonstration of imputability or root cause: 
The patient's post transfusion serum showed a weakly reactive anti-E and anti-C by antiglobulin and positive for Fy(5). The direct antiglobulin test (DAT) was positive. An ether eluate from the red cells showed anti-Fy(5) only, suggesting the cause of the reaction although the other two antibodies role could not be determined.
Imputability grade: 
2 Probable
Groups audience: 
Suggest new keywords: 
Duffy, anti-Fy5, anti-C, anti-E, GI (gastrointestinal) bleed
Reference attachment: 
Suggest references: 
Chan-Shu SA. (1980). The second example of anti-Duffy5. Transfusion 20:358-60
Expert comments for publication: 
In the Dufffy system, Anti-Fya, -Fyb, and -Fy3 have caused severe immediate and delayed hemolytic transfusion reactions, and anti-Fy5 has been incriminated in delayed reactions. The most commonly encountered immune antibodies are D > K> E> Fya> Jka.