Delayed Hemolytic Transfusion Reaction (DHTR), anti-At(a)

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Record number: 
Adverse Occurrence type: 
MPHO Type: 
Estimated frequency: 
Rare, case report
Time to detection: 
10 days
Alerting signals, symptoms, evidence of occurrence: 
Low hemoglobinemia (6.8 g per dL), increase of total bilirubin and lactate dehydrogenase (1.4 mg per dL and 783 IU per L, respectively).
Demonstration of imputability or root cause: 
The direct and indirect antiglobulin tests were newly positive with strengths of 3+. Studies of serum and an acid eluate revealed anti-At(a), but no other RBC antibodies.
Imputability grade: 
2 Probable
Groups audience: 
Suggest new keywords: 
antibody to high frequency red cell antigen
confused with auto-immune antibody
Reference attachment: 
Suggest references: 
Cash KL, Brown T, Sausais L, Uehlinger J, Reed LJ. (1999). Severe delayed hemolytic transfusion reaction secondary to anti-At(a). Transfusion 39:834-7
Expert comments for publication: 
August (At(a)) is a high incidence antigen. It is a rare RBC alloantibody found in the black population. This case demonstrates the importance of differentiating an RBC alloantibody against a high-incidence antigen from an autoantibody and identifying its specificity so that transfusion of antigen-positive units can be avoided.