Fatal delayed hemolytic transfusion reaction due to anti-c + E

Area of Science:

• Immunology
• Transfusion Medicine
• Hematology

Background:

• Red blood cell (RBC) transfusions are common, but alloimmunization can lead to transfusion reactions.
• Compatibility testing aims to prevent immune-mediated hemolytic transfusion reactions (TRs).

Observation:

• A 72-year-old man developed a severe, fatal hemolytic transfusion reaction six days after receiving multiple units of apparently compatible RBCs.
• The reaction presented with fever, decreased hematocrit, hemoglobinemia, hemoglobinuria, hyperbilirubinemia, and oliguria, progressing to anuria and death.

Findings:

• Pre-transfusion serologic studies revealed complete compatibility between donor and recipient blood.
• No unexpected antibodies were detected initially, but a rapid anamnestic antibody response to donor antigens occurred after a six-day latent period.

Implications:

• This case underscores the potential for delayed antibody formation and severe reactions even with initially compatible blood products.
• It emphasizes the need for vigilance and further investigation into mechanisms of delayed hemolytic transfusion reactions.
• Consideration of anamnestic responses in transfusion medicine is crucial for patient safety.