P‐TS‐58 | Multiple Rapid Allo‐immunizations and Severe DHTR After Massive Transfusion of RhD‐positive RBC in a RhD‐negative Recipient: Case Report and Literature Review

Delayed hemolytic transfusion reaction (DHTR) is defined by the National Health Safety Network (NHSN) as a reaction that occurs between 24 h and 28 days after cessation of transfusion, with and newly identified red blood cell antibody and signs of hemolysis, increased LDH and bilirubin, and a positive direct antiglobulin test (DAT). Several studies have reported the incidence of DHTR at approximately 1 in 800 patients. Red cell antibodies in the Rh, Kell, Duffy, and Kidd blood group systems have been reported to be most common antibodies causing DHTR. We report an unusual case of rapid alloimmunization with multiple, sequential antibodies leading to severehemolysis in a RhD-negative male patient shortly after massive transfusion of RhD-positive red cells with no prior transfusion history. A 21-year-old male patient, in a motor vehicle related accident with major pelvic fractures and internal soft tissue injury. He received 30, O-RhD-positive RBCs, 23 fresh frozen plasma, 7 apheresis platelets, and 4 bags of pooled cryoprecipitate over 24 h. On Day 5, his antibody screen was negative, but required two O-RhD-negative units upon a sudden drop in hemoglobin and >2 g/dL rise in bilirubin. Type and screen, DAT, antibody identification, and elution studies were performed using standard blood bank and reference lab techniques. On day 11, a strong anti-D was detected in the plasma and the DAT was positive for IgG(3+) and C3 (1+). On day 17, anti-Jka was identified in the plasma, and the anti-D was identified in the eluate. Patient received two additional O, RhD-negative, Jk (a−), RBC due to worsening anemia and ongoing evidence of hemolysis. On Day 19, anti-E was identified in the plasma. To provide phenotype matched blood, red cell genotyping was performed which offered the C-, E-, K-, Fya-, Jka-, S-phenotype. On day 26, a warm autoantibody was detected and the anti-Jka in the eluate. Finally, anti-C and anti-K were identified on Day 29. His hemolysis gradually improved, and the DAT converted to negative. A clinical timeline of patient's progress has been shown in Figure 1. FIGURE 1.

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