No Transfusion is the Best Transfusion: A Rare Case

Abstract

Presence of antibodies against red cell antigens remains a major problem in thalassemia patients. β-thalassemia major patients do commonly suffer from alloimmunization, which is rarely seen in thalassemia intermedia patients. Association of multiple antibodies and antibody against high frequency blood group antigen further complicates the transfusion therapy. Advance immunohematological tests like adsorption, elution, and phenotyping are necessary along with antibody screening and identification. We present a case about a 25-year male thalassemia intermedia patient, whose blood sample when crossmatched found incompatible with more than 100 units of packed red blood cells. Various tests like direct and indirect antiglobulin (Coombs) tests, 3-cell panel, 4-cell panel, 10-, 11-, 16-cell panels, adsorption, elution, minor phenotyping were done to resolve the case. We found multiple alloantibodies with no autoantibody. The present case emphasizes on importance of minor phenotyping before first transfusion in all multitransfused patients, importance of immunohematological tests in resolving blood incompatibility and our experience of dealing high frequency antigen.