Hemolytic transfusion reaction attributable to anti-Dia

Area of Science:

• Transfusion Medicine
• Immunology
• Hematology

Background:

• Many institutions transitioned from indirect antiglobulin test (IAT) crossmatch to electronic crossmatch systems for patients with negative antibody detection tests.
• This shift aims to streamline transfusion processes but may overlook certain antibody specificities.

Observation:

• A 22-year-old female with beta thalassemia and sickle cell anemia experienced an acute hemolytic transfusion reaction during routine red blood cell exchange transfusion.
• The patient had a negative antibody detection test prior to transfusion.

Findings:

• The reaction was attributed to anti-Dia antibodies, a low-prevalence antigen.
• This case highlights the risk of transfusion reactions in patients with antibodies to rare antigens, even with negative antibody screens.

Implications:

• Electronic crossmatching alone is insufficient for transfusion-dependent patients, especially those with sickle cell disease.
• Recommendations include adding Di(a+) cells to antibody detection tests and performing IAT crossmatching for all sickle cell disease patients to prevent future reactions.