[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
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: firstname.lastname@example.org)
CONFLICT OF INTEREST
The authors have no conflict of interest to disclose.