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Adverse Occurrence type:
Few reports published and relatively unknown clinical significance
Time to detection:
Two weeks after the first red blood cell transfusion
Alerting signals, symptoms, evidence of occurrence:
A 32-year-old African-American woman with a history of sickle cell disease was presented for surgical evaluation. She has a history of anti-Fy(a). In the course of the compatibility testing the identification study was inconclusive. One unit of weakly crossmatch-incompatible fy(a-), C-, E-, K- and HbS-negative RBCs was transfused without incident. Anti-Jo(a) and anti-Jk(b) were reported by the reference lab several days later. Fortunately, the transfused RBC unit was Jk(b-) and the crossmatch was attributed to anti-Jo(a). Two weeks after the transfusion of a Jo(a) incompatible red blood cell unit the patient developed fever (38.4ºC) and lactic acid dehydrogenase (LDH), potassium and creatinine increase.
Demonstration of imputability or root cause:
There was no other reliable cause that could explain the clinical and biological findings.
Jajosky RP, Lumm WC, Wise SC, Bollag RJ, Shikle JF. (2017). A suspected delayed hemolytic transfusion reaction mediated by anti-Joa. Immunohematology 2017 Jun;33(2):73-75.
Expert comments for publication:
There was no patient follow-up despite the transfusion of a second incompatible Jo(a) red blood cell unit. This is curious because a worsening of clinical signs and symptoms should be expected.