Abstract
We report here a rare case of delayed hemolytic transfusion reaction (DHTR) probably caused by a primary immune response. The patient was a 69-year-old Japanese female who underwent neurosurgery for subarachnoid hemorrhage. For treatment of post-operative hemorrhage, she received 2 units of packed red cells (Ir-RC-MAP) per day for 6 days, for a total of 12 units. On day 33 after the first transfusion, she showed symptoms of hemoglobinuria, anemia, thrombocytopenia, elevated levels of serum LDH and total bilirubin, and a decreased level of serum haptoglobin. Her blood was typed as A, ccDEE. Partial coagulation was observed on Rh blood-type examination for C and e but disappeared on day 37 after the first transfusion. On irregular antibody screening of patient serum collected 37 days after the first transfusion, IgM type anti-C+e was detected by MTS-Pap. We found that the immunoglobulin class of anti-C+e switched from IgM to IgG during the clinical course. These findings suggest that the DHTR was probably due to anti-C+e caused by a primary immune response.
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