Abstract
A 63-year-old man with chronic myelomonocytic leukemia and chronic renal failure received red cell concentrates (RCC) perioperatively during inguinal hernia repair. Irregular antibodies measured before the operation were negative, but on the 7th postoperative day, anti-E antibody was positive, and E antigen of the transfused RCC was also positive. There was no evidence of hemolysis, but if a delayed hemolytic transfusion reaction (DHTR) were to occur, the patient was not expected to survive. Therefore, RBC exchange was performed to remove E antigen-positive RBCs using plasmapheresis with the blood purification system for continuous hemodiafiltration (CHDF) and a blood plasma separation membrane. Native plasma was returned to the patient, the red blood cells were removed, and replaced with E-antigen negative RCC, albumin and saline. After RBC exchange, the percentage of E antigen-positive RBCs were decreased, and no transfusion reaction occurred. When patients with chronic renal failure have a risk of DHTR, RBC exchange may prevent DHTR.
