Delayed Hemolytic Transfusion Reaction (DHTR), anti-c in a patient with sickle cell anemia

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Record number: 
Adverse Occurrence type: 
MPHO Type: 
Time to detection: 
5 days
Alerting signals, symptoms, evidence of occurrence: 
Five days after 4 units of packed RBC, the patient developed generalized joint pain and fever of 39°C. Her Hb level dropped from 12.0 g/dL to 9.3 g/dL and the unconjugated bilirubin level rose to 27 mmol/L. She was jaundiced and had hemoglobinuria.
Demonstration of imputability or root cause: 
An RBC alloantibody with specificity to the Rh system (anti-c, titer 1:16.384) was identified by the indirect antiglobulin test. The Rh phenotype of the RBC used in the last packed RBC transfusion was CcDEe. The patient’s RBC phenotype was CDe.
Imputability grade: 
2 Probable
Groups audience: 
Reference attachment: 
Suggest references: 
Fabron, A, Jr., Moreira, G, Jr. and Bordin, JO. (1999). Delayed hemolytic transfusion reaction presenting as a painful crisis in a patient with sickle cell anemia. Sao Paulo medical journal = Revista paulista de medicina 117:38-9
Expert comments for publication: 
Rh (D) 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.