Status:
Ready to upload
Record number:
2286
Adverse Occurrence type:
MPHO Type:
Estimated frequency:
The frequency of HTRs due to non-ABO antibodies is difficult to estimate accurately, as it is often under-reported. However, it is thought to be much less common than HTRs due to ABO incompatibility, with an estimated incidence of 1 in 250,000 to 1 in 1,000,000 units of red blood cells (RBCs) transfused.
Time to detection:
Diagnosis a week after the transfusions.
Alerting signals, symptoms, evidence of occurrence:
The pre- and post-transfusion hemoglobins were 11.2 g/dL (result not available prior to transfusion) and 12.9 g/dL, respectively. Hemoglobin decreased despite no additional bleeding; lactate dehydrogenase increased. Total bilirubin increased from 0.3 to 1.3 g/dL (indirect 0.9 g/dL) while creatinine increased from 0.8 to 1.14 mg/dL. Haptoglobin was 86 mg/dL five hours post-transfusion and became undetectable within 48 hours. Note: The patient was afebrile throughout hospitalization and did not exhibit any non-laboratory signs/symptoms of hemolysis.
Demonstration of imputability or root cause:
The patient’s previously identified antibodies included anti-Fy(a) and anti-K. After the HTR, when reviewing the compatibility of the two O-negative RBC units given to the patient, it was found that both units were incompatible: Specifically, the first unit was K+ and Fy(a)−, and the second unit K− and Fy(a)+.
Imputability grade:
3 Definite/Certain/Proven
Groups audience:
Keywords:
Suggest new keywords:
AHTR (acute hemolytic transfusion reaction)
RBC (red blood cell)
non-ABO antibodies
anti-Fy(a)
anti-K
Reference attachment:
Suggest references:
Canver MC, Cushing MM, Vagelatos G, Vasovic LV. Visual evidence of a hemolytic transfusion reaction identified by blood bank testing after emergency blood transfusion. Transfusion. 2019 Nov;59(11):3301-3302. doi: 10.1111/trf.15522. Epub 2019 Oct 1. PMID: 31574169.
Expert comments for publication:
This case underlines the risk of hemolytic transfusion reactions due to non-ABO antibodies and the benefits of single-unit transfusions, postponing transfusion until crossmatched RBCs are available, and avoiding unnecessary transfusions for patients with upper gastrointestinal bleeds.