Anti-AnWj causing acute hemolytic transfusion reactions in a patient with aplastic anemia

Transfusion. 2012 Jul;52(7):1476-81. doi: 10.1111/j.1537-2995.2011.03477.x. Epub 2012 Jan 10.

Abstract

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.

Publication types

  • Case Reports

MeSH terms

  • Anemia, Aplastic / blood
  • Anemia, Aplastic / immunology
  • Anemia, Aplastic / therapy*
  • Blood Group Antigens / immunology*
  • Blood Group Incompatibility / blood
  • Blood Group Incompatibility / etiology
  • Blood Group Incompatibility / immunology
  • Blood Group Incompatibility / therapy*
  • Erythrocyte Transfusion*
  • Erythrocytes / immunology*
  • Female
  • Hemolysis / immunology*
  • Humans
  • Isoantibodies / blood
  • Isoantibodies / immunology*
  • Middle Aged

Substances

  • Blood Group Antigens
  • Isoantibodies