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Acute Hemolytic Transfusion Reaction Due to the “Anti-E” Rhesus Antibody in a Patient with Crohn's Disease by Ari Ahn, Sang-Hyun Hwang

Background: The rhesus (Rh) system is the second most important blood group system after ABO, with highly immunogenic antigens. Although the anti-E Rh antibody has been reported to cause hemolytic disease of the newborn and delayed hemolytic transfusion reactions, acute hemolytic transfusion reactions (AHTR) have been rarely reported.
Methods: Peripheral blood (PB) samples were screened for irregular antibodies using a commercial ID-Diacell I - II antibody screening Panel (Bio-Rad Laboratories, Glattbrugg, Switzerland) and ID-cards “LISS/Coombs” (Bio-Rad, Switzerland). The antibody was confirmed using ID DiaPanel, an antibody identification panel (Bio-Rad, Switzerland). Rh phenotyping was performed for RhC/c and RhE/e antigens using an immediate-spin tube test with monoclonal anti-C, -c, -E, and -e (OrthoClinical Diagnostics, High Wycombe, UK) in saline-filled test-tubes.
Results: The patient was negative for antibody screening test before transfusion. After receiving a total of 6 units of cross-matching negative RBC transfusion, the antibody screening test result increased to 2+ after showing traces and the antibody was confirmed as anti-E Rh antibody. The Rh phenotype of the patient was C (+), c (+), E (-), and e (+). In addition, we verified that all the six units of RBCs transfused were E (+) except for the two units transfused before surgery.
Conclusions: Here is an unusual case of an AHTR due to the anti-E Rh antibody after E-positive RBC transfusion in a patient with Crohn's disease. Because anemia is common in patients with Crohn's disease, it is important to determine the cause of the anemia and necessary to examine the Rh phenotype before transfusions because of the high need for transfusion due to any cause. Awareness of this possibility will ensure safe blood transfusion with special care to screen for antibodies and perform Rh phenotyping, thereby minimizing morbidity and preventing potential mortality.

DOI: 10.7754/Clin.Lab.2019.190232