Platelet transfusion reaction associated with interdonor HLA incompatibility

Area of Science:

• Immunology
• Transfusion Medicine
• Hematology

Background:

• A patient with chronic lymphocytic leukemia (CLL) experienced a severe transfusion reaction.
• The reaction occurred post-transfusion of HLA-compatible platelets despite previous uneventful blood product administration.

Observation:

• The patient developed chills, fever, and respiratory distress following platelet transfusion.
• The platelet donor possessed lymphocytotoxic antibodies against HLA-A2 cross-reacting group (CREG) antigens.
• These antibodies reacted with lymphocytes from a recent red blood cell (RBC) donor, not the patient.

Findings:

• The patient had no pre-existing antibodies against RBC, HLA, platelets, or granulocytes.
• Subsequent transfusions from the same donor, after plasma exchange, were tolerated without adverse events.
• The reaction was attributed to an interdonor reaction involving RBC donor cells and donor antibodies.

Implications:

• This case highlights the potential for interdonor reactions in transfusion medicine.
• It suggests that donor antibodies, even if not directed at the recipient, can cause adverse events.
• Consideration of donor antibody profiles may be necessary in complex transfusion scenarios.