Fatal acute hemolytic transfusion reaction due to anti-B from a platelet apheresis unit stored in platelet additive solution.

Abstract

BACKGROUND:

Hemolytic transfusion reactions from out-of-group plasma in platelet (PLT) transfusions are uncommon, with most involving passive transfer of anti-A. Only rare reactions have ever been reported due to anti-B.

STUDY DESIGN AND METHODS:

An apheresis PLT product was donated by a blood group O male, processed using PLT additive solution, and pathogen reduced. Postreaction recipient testing included an antibody screen using gel technology, a direct antiglobulin test (DAT) using immunoglobulin G and C3, and an eluate against group O and B cells. Postreaction donor testing included measuring anti-B titers in saline, with and without anti-human globulin.

RESULTS:

A 60-year-old blood group B patient with relapsed acute myeloid leukemia developed confusion, fever, and hypotension within hours after a blood group O PLT transfusion. The posttransfusion reaction evaluation was remarkable for a positive DAT 3+ for C3; the eluate showed anti-B. Rapid extravascular hemolysis occurred, with a 50% decline in hemoglobin, a high lactate dehydrogenase, and a high bilirubin. She was resuscitated with fluids, blood products, pressors, and oxygen and died of asystole 60 hours later. The donor's anti-B titers were 128 by tube testing at immediate spin and 512 at the anti-human globulin phase. Notably, a group B patient at a different hospital received a split of the same apheresis unit, with no reaction.

CONCLUSION:

To our knowledge, this is the first fatality reported from passively transfused anti-B. The fact that one transfusion recipient died whereas another did not have any reported reaction highlights the potential importance of recipient variables in isohemagglutinin-mediated hemolysis.

• Authors: Raisa Balbuena-Merle, F Bernadette West, Christopher A Tormey, Jeanne E Hendrickson
• Journal: Transfusion (Transfusion) Vol. 59 Issue 6 Pg. 1911-1915 (06 2019) ISSN: 1537-2995 [Electronic] United States
• PMID: 30865314 (Publication Type: Case Reports, Journal Article)
• Copyright: © 2019 AABB.

Chemical References

• ABO Blood-Group System
• Isoantibodies
• Organ Preservation Solutions

Topics

• ABO Blood-Group System (immunology)
• Blood Group Incompatibility (blood, etiology, immunology)
• Blood Preservation (methods)
• Fatal Outcome
• Female
• Hemolysis (immunology)
• Humans
• Isoantibodies (adverse effects, blood)
• Leukemia, Myeloid, Acute (blood, immunology, therapy)
• Male
• Middle Aged
• Organ Preservation Solutions
• Platelet Transfusion (adverse effects)
• Plateletpheresis
• Transfusion Reaction (blood, etiology, immunology)