Delayed Hemolytic Transfusion Reaction (DHTR), anti-C, a primary response

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Record number: 
Adverse Occurrence type: 
MPHO Type: 
Time to detection: 
4 weeks
Alerting signals, symptoms, evidence of occurrence: 
Two hours after delivery, the patient developed profuse vaginal bleeding and her blood pressure became unobtainable. The patient was resuscitated with intravenous fluids. She was determined to have disseminated intravascular coagulation (DIC) due to hypovolemic shock and received twelve units of red blood cells, six units of fresh frozen plasma, and eight units of cryoprecipitate. Four weeks after delivery, the patient noted tea-colored urine and felt weak. Investigation revealed anemia (hemoglobin 8.0 g/dl), hemoglobinuria, bilirubin 1.3 mg/dl, and reticulocytosis. The direct antiglobulin test (DAT) was weakly positive. Five days later she was found to have hemolytic anemia and an anti-Le(b) was found in her serum.
Demonstration of imputability or root cause: 
Studies 11 weeks postpartum revealed microscopic agglutination of C-positive red blood cells in the antiglobulin phase. Six months postpartum the anti-Lewis antibodies were no longer detected but anti-C was now reactive at 37°C in albumin and 1+ in the antiglobulin phase (titer 2). The father and child were Rh (C) positive, R(1)R(1).
Imputability grade: 
2 Probable
Groups audience: 
Suggest new keywords: 
hypovolemic shock, reticulocystosis, anti-Lewis, anti-Le(b), anti-C
Reference attachment: 
Suggest references: 
Patten E, Reddi CR, Riglin H, Edwards J. (1982). Delayed hemolytic transfusion reaction caused by a primary immune response. Transfusion 22:248-50
Expert comments for publication: 
Rh antibodies often have the capacity to cause severe immediate or delayed extravascular hemolytic transfusion reactions and all Rh antibodies should be considered to be potentially clinically significant. Rh antibodies include: D, C, C(w), E, c, e, e(8), Ce, f, Go(a), G, V (Rh 10), Rh17, Rh29, RH19