Postpartum acute hemolytic transfusion reactions associated with anti-Lea in two pregnancies complicated by preeclampsia


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American National Red Cross

Subject: Medical Laboratory Technology


ISSN: 0894-203X
eISSN: 1930-3955





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VOLUME 33 , ISSUE 3 (September 2017) > List of articles

Postpartum acute hemolytic transfusion reactions associated with anti-Lea in two pregnancies complicated by preeclampsia

Marcia Marchese

Keywords : anti-Lea, hemolytic, transfusion reaction, preeclampsia, pregnancy

Citation Information : Immunohematology. Volume 33, Issue 3, Pages 114-118, DOI:

License : (Transfer of Copyright)

Published Online: 09-October-2019



Lewis blood group antibodies, which are mostly naturally occurring and considered clinically insignificant, have rarely been documented as a cause of acute hemolytic transfusion reactions (AHTRs). This report presents two cases of AHTRs caused by anti-Lea occurring in postpartum black females (one group B, one group AB) whose pregnancies were complicated by preeclampsia. Neither anti-Lea was detected by automated solid-phase red cell adherence technology in pre-transfusion testing. Therefore, red blood cell units, compatible by electronic crossmatch, were issued and transfused. The subsequent transfusion reactions were characterized by acute intravascular hemolysis, evidenced by both clinical and laboratory criteria. These two cases demonstrate that, even when least anticipated, hemolytic transfusion reactions may occur. As expected, neither live-born neonate was affected by hemolytic disease of the fetus and newborn. Because both transfusion reactions occurred in non–group O, postpartum black females with pregnancies complicated by preeclampsia, possible links between in vivo hemolytic anti-Lea, non–group O pregnant black females, and preeclampsia may require additional investigation.

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1. Perkins RP. The significance of the anti-Lewis antibodies in pregnancy. Am J Obstet Gynecol 1970;107:28–32.

2. Ernster L. Antibodies to Le(a) and Le(b): a challenge to identify regardless of how you detect them. Immunohematology 2008;24:58–61.

3. Fung MK, Grossman BJ, Hillyer CD, Westhoff CM, Eds. Technical manual. 18th ed. Arlington, VA: American Association of Blood Banks, 2014.

4. Hoglund P, Rosengren-Lindquist R, Wikman AT. A severe haemolytic transfusion reaction caused by anti-Le(a) active at 37 degrees C. Blood Transfus 2013;11:456–9.

5. Irani MS, Figueroa D, Savage G. Acute hemolytic transfusion reaction due to anti-Le(b). Transfusion 2015;55:2486–8.

6. Weir AB, Woods LL, Chesney C, Neitzer G. Delayed hemolytic transfusion reaction caused by anti-LebH antibody. Vox Sang 1987;53:105–7.

7. Duncan V,  Pham HP, Williams III LA. A possible case of a haemolytic transfusion reaction caused by anti-Lea antibody (letter). Blood Transfus 2015;13:535–6.

8. Menendez JB, Edwards B. Early identification of acute hemolytic transfusion reactions: realistic implications for best practice in patient monitoring. Medsurg Nurs 2016;25:90, 109.

9. Gathiram P, Moodley J. Pre-eclampsia: its pathogenesis and pathophysiolgy. Cardiovasc J Afr 2016;27:71–8.

10. Flegel WA. Pathogenesis and mechanisms of antibodymediated hemolysis. Transfusion 2015;55(Suppl 2):47.

11. Klein HG, Anstee DJ. Mollison’s blood transfusion in clinical medicine. 12th ed. Chichester, UK: John Wiley & Sons, Ltd, 2014.

12. Nardozza LM, Lobo GR, Moron AF, Camano L, Araujo Junior E, Guimaraes Filho HA. Anti-Lewis alloimmunization: report of seven cases. Clin Exp Obstet Gynecol 2008;35:311–2.

13. Makroo RN, Arora B, Bhatia A, Chowdhry M, Luka RN. Clinical significance of antibody specificities to M, N and Lewis blood group system. Asian J Transfus Sci 2014;8:96–9.

14. Issitt PD, Anstee DJ. Applied blood group serology. 4th ed. Durham, NC: Montgomery Scientific Publications, 1998.

15. Kato H, Nakayama T, Uruma M, et al. A retrospective observational study to assess adverse transfusion reactions of patients with and without prior transfusion history. Vox Sang 2015;108:243–50.

16. Brand A. Immunological complications of blood transfusions. Presse Med 2016;45:313.

17. Strobel E. Hemolytic transfusion reactions. Transfus Med Hemother 2008;35:346–53.

18. Rolih S, Thomas R, Sinor L. Detection of Lewis, P1, and some MNS blood group system antibodies by a solid phase assay. Immunohematology 1995;11:78–80.