A Fatal Hemolytic Transfusion Reaction with Acute Autohemolysis, anti-Kidd (Jka)

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Record number: 
Adverse Occurrence type: 
MPHO Type: 
Estimated frequency: 
Time to detection: 
During transfusion
Alerting signals, symptoms, evidence of occurrence: 
A fatal hemolytic transfusion reaction due to anti-Kidd (Jka) is described in a woman with aplastic anemia associated with acute leukemia. Radioactive chromium studies, which were in progress at the time, made it possible to demonstrate that a severe autohemolytic crisis was a part of the reaction. The relationship between a hemolytic transfusion reaction and the initiation or intensification of autohemolysis is discussed. The difficulties of serologic diagnosis and selection of blood for transfusion in patients with nonspecific antibodies are reviewed. This case illustrates that nonspecific agglutinins can mask the presence of specific anti-red cell antibodies.
Demonstration of imputability or root cause: 
Despite the complete absence of symptoms, shortly after the incompatible transfusion of Jk(a+) cells was completed there was hemoglobinemia and hemoglobinuria. At the same time, plasma and urine radioactivity were increased. Since there had been no radioactivity in her pre-reaction plasma, the hemolytic reaction must have involved not only the cells of the Jk(a+) donor but the patient's Cr51 labeled erythrocytes as well. The red cell survival study demonstrated that during the autohemolytic crisis, 28 per cent of the patient's own red cells were destroyed.
Imputability grade: 
3 Definite/Certain/Proven
Groups audience: 
Suggest references: 
Polesky H, bove JR. (1964). A fatal Hemolytic Transfusion Reaction with Acute Autohemolysis. Transfusion. Jul-Aug 4: 285-292.
Can it be acceptable only for its historical value?. The description and the justification of the hypothesis is now a little dense. However, it is one of the pioneering descriptions of a phenomenon that today is fully demonstrated. It could be recommendable to count on the opinion of a second expert. I am recommending for upload since there are no others like this in the library. When we have another more current reference that describes the auto-hemolytic response to an allo-antibody, we can combine them.
Expert comments for publication: 
This article mainly has historical value. It clearly establishes the triggering of an autohemolytic crisis by a hemolytic transfusion reaction. At that time (1964) this was a hypothesis not fully demonstrated. At present (2016) this is a very well recognized phenomenon.