Value of Testing at 30°C for the Identification of Cold Alloantibodies in the Presence of Cold Autoantibodies [Abstract]

April 25, 2012

[N A J Med Sci. 2012;5(2):131-134.] PDF File

Ding Wen Wu, MD, PhD;* Peihong Hsu, MD; Jane Freeman, MT(ASCP), SBB

Acute hemolytic transfusion reaction due to hemolytic  anti-Lea is a rare phenomenon. We present here a case report of an acute hemolytic transfusion  reaction, and demonstrated that an additional procedure of incubation at 30oC facilitated  the identification of a hemolytic anti- Lea in this diagnostic challenged case. A 46 year  old man with a history of AIDS and dementia presented with symptomatic anemia. During transfusion  of the 2nd unit of packed RBCs, the patient experienced high fever, back pain and dark brown  urine. The blood bank and laboratory workup revealed evidence of a quickly resolved acute  intravascular hemolysis. Other causes of intravascular hemolysis were ruled out with various  laboratory tests. Initial blood bank antibody workup revealed a cold auto-anti-I,  and a cold allo-antibody of undetermined specificity. Tests at 30oC were described by Lawrance  Petz and George Garratty for workup of cold auto-antibodies at 30oC. We extrapolated their  method to clearly identify a hemolytic anti-Lea with broad thermal amplitude. Phenotyping  and crossmatching at 30oC revealed that the 1st unit was implicated in the  acute hemolytic transfusion reaction. This is the first report to successfully identify a  hemolytic anti-Lea using the method at 30oC for cold allo-antibody workup. 

Key Words: acute hemolytic  transfusion reaction, intravascular hemolysis, acute hemolytic transfusion reaction,  intravascular hemolysis, anti-Lea antibody, cold auto-antibody, cold allo-antibody 

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Ding Wen Wu, MD, PhD;1* Peihong Hsu, MD;2 Jane Freeman, MT(ASCP), SBB3

1 Department of Pathology, Mount Sinai Medical Center, New York, NY
2 Department of Pathology, Long Island Jewish Medical Center, New Hyde Park, NY
3 Department of Pathology and Laboratories, Grady Memorial Hospital, Atlanta, GA 

*Corresponding Author: Department  of Pathology, Mount Sinai Medical Center, New York, NY. (Email: dingwen888@yahoo.com) 

CONFLICT OF INTEREST 

The authors have no conflict of interest to disclose. 

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