Sequential generation of anti-M and anti-Jka leads to two delayed hemolytic transfusion reactions and corresponding strategies
Objective To make transfusion management strategies for patients with history of blood transfusion and/or pregnancy by following up a patient with delayed hemolytic transfusion reactions(DHTR)caused by unexpected antibody produced after blood transfusion.Methods ABO,Rh,MN and Kidd blood group test,direct antiglobulin test,unexpected antibody screening,antibody identification,antibody titer detection,and cross-matching test were performed on a patient with DHTR.Meanwhile,suitable red blood cells were screened for subsequent treatment.Results The patient′s blood group was B,RhD(+)and CCDee,the antibody screening test and cross-matching test were negative before the first trans-fusion.After eight days,hemoglobin of the patient decreased to 57 g/L and the laboratory results indicated delayed hemoly-sis,the antibody screening was positive,and the antibody identification result was anti-M,as RBCs of the patient received typed as M+N+.After the patient received M antigen negative RBCs,the laboratory test results still indicated delayed sero-logic transfusion reaction.A new antibody arose and was identified as anti-Jka while RBCs transfused were M-N+and Jk(a+b-).Afterwards,it was effective for the patient to receive B,RhD(+),M-N+and Jk(a-b+)RBCs.Conclusion Most of the homologous antibodies produced by patients after blood transfusion will disappear within a few years.When patients undergo another transfusion,DHTR may occur because of anamnestic reaction.Establishing a transfusion management docu-ment and creating a card for patients who have already produced RBC alloantibodies can greatly reduce the occurrence of DHTR by informing doctors and staff when the next transfusion is needed.
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