Delayed Hemolytic Transfusion Reaction, anti-LebH

An 83-year-old female was admitted with rectal bleeding. After demonstrating a bleeding site in the ascending colon, a colectomy was performed. She was group B, Rh-positive, and no unexpected antibodies were detected in her serum. During surgery and in the immediate postoperative period, she received 14 units of red blood cells (RBC). Twelve days after transfusion, she developed fever, followed by gross hemoglobinuria. The significance of the clinical picture was not initially recognized. She again required blood, at which time she had a weakly positive direct antiglobulin test specific for complement. Antibodies to LebH and anti-E were demonstrated in her serum with a possible anti-K also present. The patient was given E- and K-negative units with almost immediate severe hemolysis manifested by gross hemoglobinuria, anemia, spherocytosis, depressed serum haptoglobin, and elevated plasma free hemoglobin. The patient was subsequently transfused with red cells negative for E, K and Leb antigens. The patient was closely observed and no signs of hemolysis were noted.