A suspected delayed hemolytic transfusion reaction mediated by anti-Joa

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Immunohematology

American National Red Cross

Subject: Medical Laboratory Technology

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ISSN: 0894-203X
eISSN: 1930-3955

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VOLUME 33 , ISSUE 2 (June 2017) > List of articles

A suspected delayed hemolytic transfusion reaction mediated by anti-Joa

Ryan P. Jajosky * / Wendy C. Lumm / Scott C. Wise / Roni J. Bollag / James F. Shikle

Keywords :  Joa, delayed hemolytic transfusion reaction (DHTR), Dombrock blood group system, high-prevalence antigen

Citation Information : Immunohematology. Volume 33, Issue 2, Pages 73-75, DOI: https://doi.org/10.21307/immunohematology-2019-011

License : (Transfer of Copyright)

Published Online: 09-October-2019

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ABSTRACT

A 32-year-old African-American woman with a history of sickle cell disease presented for surgical evaluation of left total hip arthroplasty due to avascular necrosis of the femoral head. In anticipation of a complex orthopedic procedure, pre-surgical blood work was ordered. The patient’s Fenwal blood sample typed as group O, D+. Although the patient had a history of anti-Fya, the antibody identification was inconclusive, so the workup was sent to a reference laboratory. The patient was last transfused with red blood cells (RBCs) 2 years earlier, but had no history of transfusion reactions. Due to surgery, the patient’s hemoglobin (Hb) decreased from 10.2 g/dL (preoperative) to 8.6 g/dL (postoperative). One unit of weakly crossmatchincompatible Fy(a–), C–, E–, K–, and sickle cell hemoglobin S (HbS)-negative RBCs was transfused without incident, and the patient was discharged. Several days later, the reference lab reported two new specificities, anti-Joa and anti-Jkb. Fortunately, the transfused RBC unit was Jk(b–). Therefore, the crossmatch incompatibility was attributed to anti-Joa, which targets a highprevalence antigen found in 100 percent of most populations. Two weeks after discharge, the patient returned in sickle vasoocclusive pain crisis. The patient was clinically stable, but her Hb was 6.7 g/dL.  One unit of Fy(a–), Jk(b–), C–, E–, K–, HbS– RBCs, which was weakly crossmatch-incompatible, was transfused. The following day, her Hb was unchanged, lactic acid dehydrogenase increased from 951 to 2464 U/L, potassium increased from 3.7 to 4.6 mEq/L, creatinine increased from 0.60 to 0.98 mg/dL, and the patient developed a 38.4°C fever. These findings are consistent with a delayed hemolytic transfusion reaction (DHTR), mediated by anti-Joa, occurring 2 weeks after the first RBC transfusion. Further care could not be provided because the patient left the hospital against medical advice. The purpose of this case study is to report findings consistent with a DHTR attributed to antiJoa, an antibody with relatively unknown clinical significance.

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REFERENCES

1. Reid ME, Lomas-Francis C, Olsson ML. The blood group antigen factsbook. 3rd ed. San Diego, CA: Academic Press, 2012.

2. Lomas-Francis C, Reid ME. The Dombrock blood group system: a review. Immunohematology 2010;26:71–8.

3. Reid ME. Complexities of the Dombrock blood group system revealed. Transfusion 2005;45:92S–9S.

4. Baumgarten R, van Gelder W, van Wintershoven J, et al. Recurrent acute hemolytic transfusion reactions by antibodies against Doa antigens, not detected by crossmatching. Transfusion 2006;46:244–9.

5. Noumsi GT, Billingsley KL, Moulds JM. Successful transfusion of antigen positive blood to alloimmunised patients using a monocyte monolayer assay. Transfus Med 2015;25:92–100.  

6. Silvy M, Beley S, Granie, T, et al. Heterogeneity of alleles encoding high- and low-prevalence red blood cell antigens across Africa: useful data to facilitate transfusion in African patients. Br J Haematol 2013;163:528–36.

7. Scofield TL, Miller JP, Storry JR, et al. Evidence that Hy– RBCs express weak Joa antigen. Transfusion 2004;44:170–2.

8. Westhoff CM, Silberstein LE, Wylie DE, et al. 16Cys encoded by the RHce gene is associated with altered expression of the e antigen and is frequent in the R0 haplotype. Br J Haematol 2001;113:666–71.

9. Josephson CD, Su LL, Hillyer KL, et al. Transfusion in the patient with sickle cell disease: a critical review of the literature and transfusion guidelines. Transfus Med Rev 2007;21: 118–33.

10. Arndt PA, Garratty G. A retrospective analysis of the value of the monocyte monolayer assay results for predicting the clinical significance of blood group alloantibodies. Transfusion 2004;44:1273–81.

11. Misra H, Lickliter J, Kazo F, et al. PEGylated carboxyhemoglobin bovine (SANGUINATE): results of a phase I clinical trial. Artif Organs 2014;38:702–7.

 

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