Acute hemolytic transfusion reaction due to a warm reactive anti-A1

Floris HelmichFedde van der Graaf


Anti-A1 are regularly observed by reverse testing and are generally considered clinically irrelevant. For compatibility testing and the selection of blood, we use the type-and-screen (T&S) strategy, in which ABO confirmation of patients with a definitive blood group is performed by forward grouping only. Because anti-A1 seem clinically irrelevant, it is our policy to provide group A blood in patients with an anti-A1 . This is a case report of a 96-year-old woman who died shortly after transfusion of blood group A red blood cells (RBCs). She was known to have blood group A2 with an anti-A1 and the absence of other RBC antibodies. Directly after starting transfusion, acute dyspnea was observed, while other clinical signs for a transfusion reaction were absent. In the laboratory, indications for a severe hemolytic transfusion reaction (HTR) triggered serologic investigations and complement deposition experiments. Analyses revealed that the anti-A1 was present as a high-titer IgM class immunoglobulin that induced complement deposition on A1 RBCs. The anti-A1 reacted in a wide temperature amplitude up to 37°C with A1 RBCs, while weak agglutination was observed with A2 RBCs at room temperature. A pretransfusion detectable anti-A1 cau...Continue Reading


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