A 53-year old man without history of prior transfusion, underwent operation for regurgitation of mitral valve and stenosis of coronary artery with 18 units of fresh whole blood transfusion.
He was blood group B, Rh D (+), and no irregular red cell alloantibodies were revealed with pre-operative routine screening or crossmatching tests. The post-operative course was generally well, but moderate anemia appeared gradually from about 2 weeks after operation, and then hemoglobinuria and severe reticulocytosis were followed at about 1 week later. Moreover laboratory tests showed increase of LDH and indirect bilirubin levels with decreased haptoglobin level.
Thus delayed hemolytic transfusion reaction was suspected by these clinical or laboratory findings. Potent anti-Hro antibody accompanied with anti-P1 were detected in his serum during rescreening tests, and his own red blood cels did not react completely with the other anti-Hro sera. Such cells showed no exceptional strong D activity comparing with usual D positive red blood cells, therefore it had been really unable to be recognized as -D-/-D- during routine testings.
A very rare case of delayed hemolytic transfusion reaction due to anti-Hro antibody in a patient with -D-/-D- was reported.
