An acute hemolytic transfusion reaction caused by an anti-P1 that reacted at 37 degrees C.

TitleAn acute hemolytic transfusion reaction caused by an anti-P1 that reacted at 37 degrees C.
Publication TypeJournal Article
Year of Publication1998
AuthorsArndt PA, Garratty G, Marfoe RA, Zeger GD
Pagination373 - 7
Date Published1998
ISBN Number0041-1132
Other Numberswdn, 0417360
Keywords*Blood Group Incompatibility/co [Complications], *Blood Transfusion/ae [Adverse Effects], *Hemolysis, *P Blood-Group System, Acute Disease, Aged, Blood Grouping and Crossmatching, Female, Humans, Immunoglobulin G/bl [Blood], Immunoglobulin M/bl [Blood], Mercaptoethanol, Osmolar Concentration, Temperature, Titrimetry

BACKGROUND: Hemolytic transfusion reactions (HTRs) due to anti-P1 have rarely been reported. There is only one report (from 1945) of an acute HTR due to anti-P1., CASE REPORT: A 74-year-old woman with anti-P1 was given blood that had been found to be compatible by the use of prewarmed serum and saline-suspended red cells (RBCs) and of an antiglobulin test with anti-IgG. The test mixtures were not centrifuged or inspected for agglutination after the 37 degrees C incubation phase. After transfusion of 50 mL of P1 + blood, the patient had an acute HTR (hemoglobinemia, hemoglobinuria, and increased blood pressure, temperature, and respiration)., RESULTS: When studied by a reference laboratory, the anti-P1 was shown to be easily detectable (3+ agglutination) by a prewarming technique (saline or low-ionic-strength saline [LISS]), which included centrifugation at 37 degrees C, but only weak reactions were observed when centrifugation after 37 degrees C incubation was omitted. The indirect antiglobulin test was weakly positive (1+) with anti-IgG, but polyspecific anti-human globulin reacted 2+. The anti-P1 agglutinin was IgM, and its titer was 16 at 37 degrees C (prewarmed) and 256 at 23 degrees C; it caused hemolysis of RBCs at 37 degrees C under conditions known to enhance hemolysis. An indirect monocyte monolayer assay gave results of 11.2 and 22 percent in testing of P1 + RBCs incubated with the patient's serum alone and with patient's serum plus fresh normal serum (as a source of complement), respectively (normal

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