Acute Hemolytic Transfusion Reaction (AHTR), anti-Le(b)

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Record number: 
Adverse Occurrence type: 
MPHO Type: 
Estimated frequency: 
Case report
Time to detection: 
During transfusion
Alerting signals, symptoms, evidence of occurrence: 
A 30-year-old African-American woman with metastatic renal cell carcinoma was receiving chemotherapy. She was anemic with hemoglobin (Hb) of 7.2 g/dL and had a negative antibody detection test by the solid-phase red blood cell adherence method. She was transfused with 2 RBC units without incident. Nine days later her Hb was 7.9 g/dL again with a negative antibody detection test. Transfusion of an additional RBC unit was begun. During the transfusion she developed chills, nausea, hypertension, and red-brown urine. The posttransfusion sample plasma was grossly hemolyzed with a strongly positive direct antiglobulin test (DAT) by gel.
Demonstration of imputability or root cause: 
The pretransfusion plasma was normal appearing and the DAT was weaker. The eluate was negative on both occasions. Anti-Le(b) was detected in the posttransfusion sample by MTS gel (Ortho Diagnostics). Both RBC units she had received before the RBC unit that caused the reaction were Le(b1) as was the implicated RBC unit. The antibody was hemolytic in vitro and her phenotype was Le(a-b-). It is possible she was sensitized at the time of the first transfusions.
Imputability grade: 
3 Definite/Certain/Proven
Groups audience: 
Suggest new keywords: 
anti-Le(b), DAT, chills, nausea, hypertension, red-brown urine, hemolysis, red blood cell adherence
acute hemolytic transfusion reaction (AHTR)
Reference attachment: 
Suggest references: 
Irani, M, S., Figueroa, D. and Savage, G. (2015). Acute hemolytic transfusion reaction due to anti-Le(b). Transfusion 55(10):2486-2488.
Expert comments for publication: 
This case illustrates that anti-Le(b) which is usually clinically insignificant can occasionally cause severe hemolytic transfusion reactions. A hemolytic transfusion reaction caused by anti-Le(b) is extremely rare. Only three other reported cases of anti-Le(b) causing hemolytic transfusion reactions could be found in the literature, two of which were abstracts.