Status:
Ready to upload
Record number:
2299
Adverse Occurrence type:
MPHO Type:
Estimated frequency:
This is a case report and does not present frequency of the adverse occurrence. Acute or delayed hemolytic reactions due to non-ABO red cell antibodies is quite rare. According to a Norwegian report (Espinosa et al. 2024), haemolytic transfusion reactions caused by non-ABO red cell antibodies has incidence of 1 in 47,000 transfused red cell concentrates (for acute hemolytic reactions the incidence was 1 in 123,333).
Time to detection:
It took between 1-2 days to detect the occurrence of the incident. Haptoglobin was 86 mg/dL 5 hours post-transfusion and became undetectable within 48 hours.
Alerting signals, symptoms, evidence of occurrence:
The post-transfusion direct antiglobulin test (DAT) became positive; the eluate contained anti-Fy(a) and anti-K. 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 5 hours post-transfusion and became undetectable within 48 hours. Of 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 post-transfusion DAT became positive. The eluate test confirmed that the patient had anti-Fy(a) and anti-K antibodies. The blood transfused to the patient was not compatible with their blood type. The first unit of blood was K positive and Fy(a) negative and the second unit of blood was K negative and Fy(a) positive.
Imputability grade:
3 Definite/Certain/Proven
Groups audience:
Keywords:
References:
Suggest new keywords:
non-ABO red cell antibodies
anti-K
anti-Fy(a)
Reference attachment:
Suggest references:
1) 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.
2) Espinosa, Aurora, Christine Torsvik Steinsvåg, and Øystein Flesland. "Haemolytic transfusion reactions caused by non‐ABO red cell antibodies reported to the Norwegian Haemovigilance System 2004–2020." Vox Sanguinis (2024).
Note:
This article may be relevant to the Process group and I would like to suggest the second review to be from the Process group.
First revision by the Clinical Complications group - second review by the Process group (EP)
Expert comments for publication:
This case report underlines the risk of hemolytic transfusion reactions due to non-ABO antibodies and the benefits of single-unit transfusions, postponing transfusion until crossmatched RBC are available, and avoiding unnecessary transfusions for patients with upper gastrointestinal bleeds.