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Acute intravascular hemolysis secondaryto out-of-group platelet transfusion
L G Larsson1, V J Welsh, D J Ladd
1Department of Pathology, Scott & White Clinic and Memorial Hospital and Scott, Sherwood and Brindley Foundation, Texas A&M University Health Science Center, College of Medicine, Temple, Texas 76508, USA.
Background:
Acute intravascular hemolysis is rarely associated with platelet transfusion. Out-of-group single-donor platelets may cause hemolysis if the donor has high-titer ABO hemagglutinins.
Case Report:
A 44-year-old woman, blood group A, was recently diagnosed with acute myeloid leukemia and was receiving chemotherapy. After the transfusion of apheresis platelets from a group O donor, back pain, hemoglobinuria, and hemoglobinemia developed, and her Hb dropped by 2.3 g per dL, despite the transfusion of 2 units of RBCs.
Results:
Investigation revealed acute intravascular hemolysis with a positive DAT due to anti-A(1) on her RBCs. The donor's titer of anti-A(1) was greater than 16,000.
Conclusion:
Review of published cases raises the possibility that hemolytic reactions to out-of-group platelets may be more frequent since the use of apheresis platelets has increased.