DOUBLE DELAYED HEMOLYTIC TRANSFUSION REACTIONS CAUSED BY MULTIPLE ANTIBODIES, ANTI-C, ANTI-e, ANTI-Jka, AND ANTI-P1

We report a patient who showed delayed hemolytic transfusion reaction (DHTR) twice in two weeks due to multiple antibodies anti-C, -e and -Jka. The patient was a 67-year-old male with liver cirrhosis and hepatoma. The first DHTR was observed on day 7 after transfusion of 6 units of red cells for bleeding from gastric varices. Levels of both LDH and total bilirubin were remarkably increased and occult hemoglobulin was detected in urine. Anti-C was demonstrated in serum and in the eluate of red cells, however, the direct antigloblin test was negative. On the night of day 9 after the first transfusion, he received 2 additional units of compatible red blood cells (C-negative) crossmatched by the saline and enzyme methods. The second DHTR with hemoglobinuria was observed immediately after transfusion. Anti-e, anti-Jka, and anti-P1 as well as anti-C were later identified in the serum used for cross-matching. Clinical symptoms including blacktea-colored urine and melena transiently occurred but no serious sequelae were seen. In terms of the sensitivity and specificity, the polyethylene glycol antiglobulin test is superior to the albumin antiglobulin test, as the latter detected earlier and easier antibodies to C and JKa observed in this case, whereas the former hardly could do.