? Anti-Diego(a) HTR

[Kellimq]

Hello All

I've just had a patient undergoing an exchange transfusion for sickle cell anemia display symptoms of a transfusion reaction immediately post transfusion of a Diego a positive bag. The reference lab has confirmed the patients serum contains anti-Diego a antibodies. Clinically patients symptoms were of a hemolytic TR with tachycardia, back pain, dark urine, nausea and anxiety. LDH doubled post transfusion, haptoglobin was low but is low usually for this patient. DAT was negative in the post-transfusion sample. My questions are two please.

1. Has anyone ever seen an immediate HTR due to a anti-Diego a antibody?

2. Do sickle cell patients experience 'stronger' symptoms of transfusion reactions?

 

Thanks

From the Lab Down Under.

 

[Malcolm Needs ☆]

1)  I have never seen a transfusion reaction due to anti-Di^a, but the literature states that anti-Di^a usually does not cause an immediate reaction, but normally causes no reaction to a mild, delayed haemolytic transfusion reaction.  That having been said, the literature is a little confusing.  The latest FactsBook now states that anti-Di^a has caused a severe transfusion reaction, but Geoff Daniels, in the latest edition of his book, says that this example also had an anti-c in the plasma, which may have caused the reaction.  So, it seems you pays your money and you takes your choice!!!!!!

 

2)  Not as far as I know, BUT, these patients are much more prone to hyperhaemolysis than other patients, and this complicates the issue.

[jayinsat]

I have seen at least 1 delayed mildly hemolytic transfusion reaction due to Dia.  That's is how it was discovered.  Antibody screens were repeatedly negative pre and post.  DAT postitive (IgG) post transfusion reaction.  1 cell positive on panel that was Dia positive.  A few more Dia positive cells run from expired panels to confirm.  Now we transfuse AHG compatible PRBC'S as antisera for Dia is not available in the USA right now to antigen screen.  Not that we would antigen screen anyway because giving AHG compatible PRBC's is our protocol for these low frequency antigens.

[Kellimq]

Thanks Malcom and Jayinsat. I had found the same statement in Daniels. Our reference lab eluted a very small quantity of anti-Di a from the post Tx red cells, so it does appear this was an immediate TR due to the anti-Di a possibly exacerbated by the hemolysis from the sickling. All other Di a pos cells had been removed from peripheral circulation within an hour. Interesting case. We will now AHG crossmatch her each time as we do not screen or type for low-incidence Ab/Ag either.

 

thanks!

[Malcolm Needs ☆]

I think this should be written up as a case study.  It is extremely important that a case of an acute/immediate haemolytic transfusion reaction due to anti-Di^a is desseminated and placed in the literature.

[goodchild]

I completely agree Malcolm.

 

And then let us know when it's published!

Edited December 19, 2014 by goodchild

[tbostock]

Have you considered a hyperhemolytic reaction not caused by the Di^a?

[Yanxia]

Have you considered a hyperhemolytic reaction not caused by the Di^a?

You are very right about this.

Theoretically hyperhemolysis will cause the after transfusion Hb level lower than before transfusion, and if transfuse Dia neg units will not cause the hemolysis again, then I prefer call it Dia caused HTR.

[Eagle Eye]

Yes this case should get published...

[Auntie-D]

I've seen sickle crisis triggered by transfusing cold units, straight out of the fridge...

[Kellimq]

Hello,

Thank you all for your feedback!

I will do some more investigating with the consultants on this case as I agree, if it is an immediate HTR due to the anti-Dia it should be accessible in a literature review should it ever happen again anywhere else in the world. My patient had 2 more units successfully transfused on the night without futher incident  (in al llikelyhood they were cold) and more units transfused the next day without incident. She was transferred out of ICU to the ward then home the next day. She did not go into a sickle crisis and had no concomitant illness at time of transfusion to exacerbate the hemolysis. Interesting case indeed!

 

Kelli

Lab Down Under