Acute Hemolytic Transfusion Reaction Due to Anti-c Rhesus Antibody in a Patient With Subdural Hematoma: A Case Report Emphasizing the Shortcoming of Spin Cross-Match
The Rh blood group system is a complex blood group which includes different antigen specificities such as c antigen. Anti-c antibody is associated with both acute and delayed hemolytic transfusion reactions as well as hemolytic disease of the newborn (HDN). Rh mediated hemolytic transfusion reactions (HTR) are mostly immunoglobulin G (IgG) mediated and results in extravascular hemolysis and delayed HTR (DHTR). However, we are presenting a case of acute intravascular hemolytic transfusion reaction due to anti-c in a patient with acute subdural hematoma. A 77-year-old woman was referred to our hospital with a loss of conscious and left-sided hemiparesis. After an emergency MRI, she was diagnosed with Acute Subdural hematoma, and an emergency craniotomy was performed. Since Acute Subdural hematoma is a neurosurgery emergency, laboratory technician performed an Immediate-spincrossmatchedd for blood bag to preserve time. During the transfusion of the first packed cell, the patient developed severe hypotension and tachycardia. Thus, the transfusion was stopped. Laboratory results raised the suspicion of an Acute Intravascular Hemolysis. Antibody identification revealed that the patient had an irregular blood phenotype (C2+/c-/E-/e3+/K-), and the presence of alloantigen-c Rh antibody confirmed the suspicion of HTR. In patients with multi transfusion history and pregnant women, pre-transfusion screening of irregular antibodies must be performed. The immediate spincrossmatchh must be prevented in patients with a history of multi transfusions, even in emergency situations.
2. Vamvakas EC, Pineda AA, Reisner R, Santrach PJ, Moore SB. The differentiation of delayed hemolytic and delayed serologic transfusion reactions: incidence and predictors of hemolysis. Transfusion. 1995;35(1):26-32.
3. Eder AF, Chambers LA. Noninfectious complications of blood transfusion. Archives of pathology & laboratory medicine. 2007;131(5):708-18.
4. Mitra R, Mishra N, Rath GP. Blood groups systems. Indian journal of anaesthesia. 2014;58(5):524.
5. Westhoff CM, Siegel DL. Rh and LW blood group antigens. Simon TL, Snyder EL, Solheim BG et al Rossi’s Principles of Transfusion Medicine 4thed A John Wiley & ons, Ltd Publication. 2009:109-20.
6. George AA, Simon CD. Anti-c (Little c) IgM: An Uncommonly Observed but Expected Phenomenon. Lab Med. 2014;45(4):e142-5.
7. Babinszki A, Berkowitz RL. Haemolytic disease of the newborn caused by anti‐c, anti‐E and anti‐Fya antibodies: report of five cases. Prenatal diagnosis. 1999;19(6):533-6.
8. Avent ND, Reid ME. The Rh blood group system: a review. Blood. 2000;95(2):375-87.
9. Williams LA, Raciti PM, DePalma H, Pham HP. Pretransfusion Testing. Transfusion Medicine, Apheresis, and Hemostasis: Elsevier; 2017. p. 143-67.
10. Shulman IA, Meyer EA, Lam H-T, Nelson JM. Additional limitations of the immediate spin crossmatch to detect ABO incompatibility. American journal of clinical pathology. 1987;87(5):677-.
11. Padmore R, Berardi P, Erickson K, Desjardins D, Giulivi A, Tokessy M, et al. Acute extravascular hemolytic transfusion reaction due to anti-Kpa antibody missed by electronic crossmatch. Transfusion and Apheresis Science. 2014;51(2):168-71.
|Issue||Vol 58, No 1 (2020)|
|Antibody Hemolytic Rhesus Transfusion Transfusion reaction|
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