Abstract
Antibodies against Rh antigens have been associated with clinically significant hemolytic transfusion reactions. We describe here the uneventful transfusion of C+e+ red cells to a previously transfused patient with anti-C and anti-e.
A 69-year-old male with a wound infection had a history of transfusion one year prior, at which time no alloantibodies were detected. Seven units of concentrated red cells were ordered for debridement surgery. Anti-HI was identified in the patient's plasma, but he required transfusion before antibody screening was complete. Compatibility testing with anti-HI-depleted plasma allowed the release and transfusion of 4 units (2 bags) of red cells. Anti-C and -e were identified after transfusion. Subsequently, 6 units (4 bags) of C- e- red cells were transfused for postoperative hemorrhage. Although the first 4 units of red cells were C+e+, no evidence of hemolysis was observed in 4 months following transfusion.
Titers of anti-C+e increased from 1 : 2 on Day 0 to 1 : 4 on Day 30 : however, no hemolysis was observed with this increase. IgG subclasses of anti-C+e could not be identified because of the low titer. While the direct antiglobulin test was negative on Days 5 and 7, panagglutinating antibodies including anti-C+e were eluted from patient's red cells on both 2 days.
Anti-C+e titer was low and incompatible blood was partially lost due to perioperative bleeding, so it is plausible that hemolysis was not observed in this situation. Nevertheless, to reduce the likelihood of incompatible transfusion events, it is important to educate physicians about the value of early antibody screening.
