A Hemolytic Transfusion Reaction Caused by an Unexpected Leb Antibody

A Black male patient aged 21 years with a history of sickle cell disease and HIV was admitted to the hospital with vaso-occlusive crisis. A transfusion reaction was called after the patient developed a fever (39.5°C), tachycardia, chills, and hematuria after receiving 300 mL of red blood cells. A posttransfusion specimen was submitted to the Immunohematology Reference Laboratory for investigation. Antibody identification revealed an anti-Leb as the probable cause of the immediate acute hemolytic transfusion reaction. Lewis antibodies are considered clinically insignificant. This case shows the importance of considering cold antibodies, including Lewis antibodies, as a possible cause of an acute hemolytic transfusion reaction.