We experienced a patient with a life-threatening suspected delayed hemolytic transfusion reaction (DHTR). The patient was a 73-year-old female with liver cirrhosis. Her blood type was A+, D+C-c+E+e-. She had has 2 pregrancies and a history of 2 transfusions. She received 1 unit of whole blood and 2 units of concentrated red cells for the treatment of anemia (Hb 7.1g/d
l) on December 2 and 3, 1992.
No irregular antibodies were found before transfusion and crossmatch test showed no significant agglutination by the indirect antiglobulin test. Her hemoglobin level dropped to 1.4g/d
l between the day 7 to the day 9 after transfusion without any bleeding signs. At the same time GOT, LDH and T. Bil. levels, increased remarkably. However, no hematuria was seen hematuria. Serological studies showed the presence of strong antibodies against high frequency red cell antigen. The antibody was identified as anti-En
a, which is associated with the MNS blood system. Anti-En
a titer increased 16 to 256 times by the saline method, and 256 to 64, 000 times by the indirect antiglobulin test from the day 9 to day 12 after transfusion. These findings strongly suggested DHTR secondary response. The elution test using cells from her elder sister (also En (a-)) showed the existence of anti-C and anti-e. It is therefore difficult to identify the antibody responsible for the DHTR. Reports of anti-En
a are rare, this being only the second case reported in the Japanese literature.
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