Anti-AnWj causing acute hemolytic transfusion reactions in a patient with aplastic anemia
Version of Record online: 10 JAN 2012
© 2012 American Association of Blood Banks
Volume 52, Issue 7, pages 1476–1481, July 2012
How to Cite
Xu, Z., Duffett, L., Tokessy, M., Cote, J., Goldman, M. and Saidenberg, E. (2012), Anti-AnWj causing acute hemolytic transfusion reactions in a patient with aplastic anemia. Transfusion, 52: 1476–1481. doi: 10.1111/j.1537-2995.2011.03477.x
- Issue online: 10 JUL 2012
- Version of Record online: 10 JAN 2012
- Received for publication July 19, 2011; revision received October 18, 2011, and accepted November 2, 2011.
BACKGROUND: AnWj is a high-prevalence red blood cell (RBC) antigen in the ISBT 901 series. Only nine reports of anti-AnWj have been published since it was first documented in 1972; two of these cases involved transfusion reactions. We present a case of a patient with aplastic anemia who developed anti-AnWj with clinically significant hemolysis after transfusion of AnWj-positive RBCs.
STUDY DESIGN AND METHODS: A 56-year-old woman with aplastic anemia developed a pan-reactive antibody with clinically significant hemolysis after transfusion of RBCs. Investigations included antibody identification by serologic methods at the national immunohematology reference laboratory and the in vitro monocyte-monolayer assay (MMA) to predict clinical significance.
RESULTS: The antibody was identified as having specificity for the AnWj antigen. The posttransfusion MMA indicated that the antibody had complement-fixing capability highly likely to cause clinically significant acute hemolytic transfusion reactions. The patient required long-term transfusion support with AnWj-negative RBCs and Lu(a−b−) RBCs of the In(Lu) type which have reduced AnWj expression. Cross-Canada and international collaboration was required to obtain rare units for transfusion.
CONCLUSION: A case of acute hemolytic transfusion reaction caused by anti-AnWj is reported in a patient with aplastic anemia requiring allogeneic stem cell transplantation. This is the second documented case of anti-AnWj to cause a hemolytic transfusion reaction. The case demonstrates the complexity of managing patients with rare antibodies and the importance of international collaboration in the management of these difficult cases.