Status:
Ready to upload
Record number:
1738
Adverse Occurrence type:
MPHO Type:
Estimated frequency:
N/A. Anti-Jsb, an infrequent antibody of the Kell blood group system, has been implicated in hemolytic disease of the newborn, but no case of delayed hemolytic transfusion reaction (DHTR) due to anti-Jsb has been reported before.
Time to detection:
15 days
Alerting signals, symptoms, evidence of occurrence:
A 39-year-old black woman was admitted with a diagnosis of adenocarcinoma of colon. At this time her direct antiglobulin test (DAT) was negative and anti-D and anti-C were present in her serum. She received two units of blood during transverse colectomy. Eight months later, due to pericardial effusion, pancytopenia and hypertension, red blood cells (RBC) were requested. Pretransfusion testing showed a negative DAT and strongly anti-D and anti-C in the serum. Additional weak positive reactions were seen with rr panel cells that were attributed to "anti-Bg's". She was transfused with 4 units of crossmatch compatible RBC. A rapid decrease in hemoglobin was noticed, and she was admitted to the hospital 15 days posttransfusion. Her admission hemoglobin was 5.7 g/dl, hematocrit 18.2 percent, urinalysis normal, and urine culture negative. The patient had a 2+ mixed field DAT and anti-D, anti-C, and anti-Jsb were present in her serum. Another eluate of the patient's RBC demostrated anti-Jsb. On posttransfusion day 21 she received two units of Js(b-) RBC without any complication.
Demonstration of imputability or root cause:
Clinical and serological findings supported the hypothesis that the anti-Jsb antibody was able to induce a DHTR. The decrease in hemoglobin and hematocrit could not be attributed solely to a DHTR. The patient's bone marrow was hypocellular and she had experienced a gradual drop in hemoglobin and hematocrit even before the transfusions. However, after receiving four units of crossmatch compatible blood her hemoglobin steadily decreased. After receiving two units of Js(b-) blood her hemoglobin was stable for 14 days and the DAT was negative. Due to the fact the patient had a Js(b+) phenotype the possibility of an auto-anti-Jsb was excluded. A transient depression of the Jsb antigen was also excluded and the Jsb could be readily demonstrated on the red cells when anti-Jsb sera from five sources were used. The hypothesis of a Jsb variant is presented as the most probably explanation to understand the production of allo anti-Jsb reacting with all Js(b+) RBC except her own.
Imputability grade:
2 Probable
Groups audience:
Keywords:
Suggest references:
Waheed A, Kennedy MS. (1982). Delayed hemolytic transfusion reaction caused by anti-Js(b) in a Js(a+b+) patient. Transfusion 22: 161-162.
Expert comments for publication:
This is the first description of a DHTR induced by an anti-Jsb antibody. The case is further complicated by the fact that the patient's pretransfusion RBC typed as Js(b+). Serologic studies that were complete demonstrated that this was a case of allo-anti-Jsb in a Js(b+)m patient which provides evidence of heterogeniety of the Js locus.