Lab Med Online.  2021 Apr;11(2):139-144. 10.47429/lmo.2021.11.2.139.

Acute Hemolysis Due to Rh Antibodies Against C and e Antigens after Rh-incompatible Transfusion in a Patient, Not Detected During Pre-transfusion Testing

• Kim KJ
• Lee HJ
• Oh SH
• Kim IS

• KMID: 2525805
• DOI: http://doi.org/10.47429/lmo.2021.11.2.139

Abstract

Pre-transfusion laboratory tests include ABO and RhD typing, antibody screening test, antibody identification test, and cross-matching. The objective of pre-transfusion testing is to ensure that serologically compatible blood products are administered to patients, thus preventing transfusion complications. Rhesus (Rh) system is considered the second most important after the ABO system, as Rh antigens are highly immunogenic and anti-Rh antibodies can cause hemolytic transfusion reactions (HTR) and hemolytic disease of the fetus and newborn. HTR caused by anti-Rh antibody usually results in delayed onset HTR. There is little information on whether antibodies against C and e antigen can elicit acute hemolytic transfusion reaction. We present here, a rare case of acute hemolytic transfusion reaction caused due to antibodies against C and e antigens, which were not detected during our pre-transfusion protocol.

Keyword

Anti-C; Anti-e; Acute hemolytic transfusion reaction; Pre-transfusion testing; Rh-incompatible transfusion

Figure

• 

  Fig. 1 The pre-transfusion protocol followed in our hospital according to the results of antibody screening. Abbreviations: Ab, antibody; AHG, anti-human globulin; LISS, low-ionic-strength saline.

• 

  Fig. 2 Simplified laboratory values and history of multiple transfusions including antibody screening and cross-matching of the patient. *The donor blood used in every Rh-incompatible transfusion revealed the presence of C and e antigen. **Compatible pre-transfusion testing indicates negative antibody screening and compatible saline cross-matching. Abbreviations: LDH, lactate dehydrogenase; Hb, hemoglobin; Rh-I, Rh-incompatible transfusion; Rh-C, Rh-compatible transfusion.

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