Dzik W, Blank J, Lutz P, Hirose T G, Lomas C, Moulds M
Deaconess Hospital, 185 Pilgrim Road, Boston, MA 02215.
Immunohematology. 1994;10(4):117-9.
An 80-year-old group O, D- (rr) female with anti-C, -D, -E, and -Fya received four units of crossmatch-compatible red blood cells (RBCs). The direct antiglobulin test (DAT) was negative. Two weeks later, jaundice, dark urine, a 16% drop in hematocrit (Hct), a 20% reticulocyte count, and absent haptoglobin occurred. During the next month, her DAT was positive with anti-IgG and -C3d. Acid eluates, which repeatedly showed anti-D specificity, were nonreactive with enzyme-treated D- RBCs. Adsorption with D- RBCs reduced reactivity. An eluate from the adsorbing D- RBCs was nonreactive with D+ KBCs. These findings suggest an autoantibody mimicking alloanti-D. The patient was treated with prednisone and was transfused with group O, D- (rr), K-, Fy(a-) RBCs. Four months later, the Hct was stable. One year later, the DAT remained positive and the eluate demonstrated a panagglutinin.
一名80岁的O型、D-（rr）女性，体内有抗-C、-D、-E和-Fya抗体，输注了4单位交叉配血相合的红细胞（RBC）。直接抗球蛋白试验（DAT）为阴性。两周后，出现黄疸、深色尿、血细胞比容（Hct）下降16%、网织红细胞计数升高20%以及血清结合珠蛋白缺乏。在接下来的一个月里，她的DAT对抗IgG和-C3d呈阳性。酸洗脱液反复显示抗-D特异性，但与酶处理的D-红细胞无反应。用D-红细胞吸附可降低反应性。吸附D-红细胞后的洗脱液与D+红细胞无反应。这些发现提示存在一种模拟同种抗-D的自身抗体。该患者接受了泼尼松治疗，并输注了O型、D-（rr）、K-、Fy（a-）红细胞。四个月后，Hct稳定。一年后，DAT仍为阳性，洗脱液显示为泛凝集素。
