After 2nd unit of blood, pt had temp increase ~2C and chills. RN stops the transfusion and we do a complete workup. All pretransfusion testing is correct. Pt had a warm auto with our reference lab prior to transfusion. Ref lab unable to rule out Anti-E. Both units E neg ("least incompatible", sorry for those of you who hate that term).

Post reaction specimen looks slightly icteric. Pre-transfusion normal light yellow. Both pre-and post reaction specimens had +/1 DAT's. Post reaction urine amber with 4+ bld (chemical) and 0-2 rbc's microscopic. Bilirubin jumps from normal to 5 something then the next day to 2 then 1.0.  Never saw a bilirubin from a true jaundiced pt. decrease so fast. LDH was >500 on pretransfusion so that was no help. 

Pt is a Pacific Islander with about a total of 16 rbc units transfused within 2 years (i think). Just typing off the top of my head right now. It's not Jk3 according to our reference lab. Sure looks like a febrile, hemolytic transfusion reaction but from what??? Any advice is appreciated. 

Have you done an eluate?

Time to genotype?

4 hours ago, galvania said:

Have you done an eluate?

I'm not certain that would help with an auto-antibody present Anna.  The eluate would probably be panreactive.

2 hours ago, R1R2 said:

Time to genotype?

Possibly, but if it is an antibody directed against a low prevalence antigen, you would not know which genes to probe.

Yes eluate was done at our reference lab prior to transfusion and thus the warm auto with all other usually significant antibodies ruled out except the Anti E. 

Found in clinic notes: Diagnosis- Lymphoma and mentioning now a probable autoimmune hemolytic anemia.

Was the patient septic prior to transfusion? Any pre blood cultures done? What about WBC prior to transfusion? We had a similar case not to long ago, two units were the temp spiked on the patient 2 degrees and both workups were negative. Unlike yours, we  had no blood in urine or other abnormal labs other than elevated WBC count. We did culture the units for 5 days with no growth as final. 

Concerning the eluate - I was thinking more of a pre-and post- to see if there was a difference between them.  Just as an example, if all the cells were reacting at ++ pre-transfusion and now suddenly all the Jka+ cells are reacting at ++++, that might give a clue....