Anti-Kpa-induced severe delayed hemolytic transfusion reaction.

TitleAnti-Kpa-induced severe delayed hemolytic transfusion reaction.
Publication TypeJournal Article
Year of Publication2009
AuthorsKoshy R, Patel B, Harrison JS
JournalImmunohematology / American Red Cross//IMMUNOHEMATOLOGY
Pagination44 - 7
Date Published2009
ISBN Number0894-203X
Other Numbers8806387
Keywords*Anemia, Hemolytic/bl [Blood], *Anemia, Hemolytic/di [Diagnosis], *Kell Blood-Group System/im [Immunology], Anemia, Hemolytic/et [Etiology], Anemia, Hemolytic/im [Immunology], Anemia, Hemolytic/pp [Physiopathology], Blood Group Incompatibility, Blood Grouping and Crossmatching, Erythrocyte Transfusion, European Continental Ancestry Group, Female, Hemolysis, Hemorrhage/th [Therapy], Humans, Isoantibodies/bl [Blood], Liver Failure/et [Etiology], Middle Aged, Renal Insufficiency/et [Etiology]

Kpa is a low-frequency antigen occurring in less than 2 percent of the Caucasian population. Mild to moderate delayed hemolytic transfusion reactions (DHTR) and hemolytic disease of the fetus and newborn attributable to anti-Kpa have been reported. Severe overt DHTR has not been reported with anti-Kpa. A case of a severe DHTR attributed to anti-Kpa after multiple RBC transfusions is being reported. A 52-year-old Caucasian woman received multiple units of RBCs for a lower gastrointestinal bleed. She was referred to our institution for hepatic and renal failure, which was supported by laboratory findings of peak LDH, bilirubin, BUN, and creatinine elevations. Hemoglobin had dropped on Day 10 after transfusion. The DAT and antibody screen (ABS) were negative. Initial workup and subsequent ABS were negative. Anti-Kpa was identified when an additional RBC panel was tested. One of the RBC units transfused was incompatible by antihuman globulin (AHG) crossmatch with the patient's plasma and typed positive for Kpa. DHTR was confirmed after extensive workup. The patient responded to supportive therapy and experienced an uneventful recovery. DHTR may not be considered when DAT and ABS are negative. However, correlation of recent transfusion with signs and symptoms should alert the clinician to entertain and investigate a DHTR that should include the AHG crossmatch of all implicated RBC units. The severity of the reaction also raises concerns as to when and what antigen specificity should be considered for inclusion in the antibody screening cells.

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