A 19-year-old man was transferred to our hospital after sustaining multiple injuries in a motor vehicle crash. He had no history of previous blood transfusion. On arrival, he became hemodynamically unstable and required a splenectomy. Because of his hemodynamic status, he received several units of blood in the operating room and during his postoperative course. All together, a total of 75 units of blood was required. On the 28th postoperative day, he was noted to have acute hemoglobinemia and hemoglobinuria. A diagnosis of delayed hemolytic transfusion reaction (DHTR) was made because of the presence of anti-E antibody in the patient's plasma. DHTR is usually the result of extravascular hemolysis, and occurs within three weeks of blood transfusion. Since a splenectomy had been performed, we believe that hemolysis occurred in the blood vessels. Although the exact mechanisms of DHTR are not clear, potential sequelae such as hemoglobinuria and subsequent renal failure can be clinically devastating. For this reason, we should always be aware of the potential for developing DHTR when transfusing splenectomized patients.
