Devenish A, Kay L A
North London Blood Transfusion Centre, Colindale Avenue, Colindale, London, NW9 5BG, England.
Immunohematology. 1994;10(4):120-3.
A patient was transfused with a total of 14 units of red blood cells (RBCs) over 33 days (January 14 to February 15) at two hospitals. Febrile transfusion reactions were noted on three occasions, and hemoglobinuria was seen twice. Alloantibodies were not detected in a sample dated February 14, following a transfusion reaction, and this sample was referred to the North London Blond Transfusion Centre. Further samples were also obtained from before and after all transfusions at both hospitals. The patient's RBCs typed as A, D+, probable Rh phenotype (cDE/cDE). The direct antiglobulin test was negative, and serum samples following the second transfusion were red/brown in color. Serologic investigations were inconclusive on all samples taken until February 13 (after the fourth transfusion). At this time, a weak anti-e reacting by manual polybrene technique and an anti-e+f reacting by two-stage papain technique were detected. The serum also contained potent HLA antibodies. The patient subsequently received leukocyte-depleted group A, cDE/cDE RBCs with out any untoward effect. This case demonstrates the importance of a complete transfusion history and emphasizes that alloantibodies detectable only by nonstandard techniques can be clinically significant.
一名患者在33天内（1月14日至2月15日）于两家医院共输注了14单位红细胞（RBC）。记录到3次发热性输血反应，出现血红蛋白尿2次。在2月14日一次输血反应后的样本中未检测到同种抗体，该样本被送至北伦敦血型输血中心。还从两家医院所有输血前后获取了更多样本。患者的RBC血型为A、D+，可能的Rh表型为（cDE/cDE）。直接抗球蛋白试验为阴性，第二次输血后的血清样本呈红棕色。直到2月13日（第四次输血后），对所有采集样本进行的血清学调查均无定论。此时，通过手工聚凝胺技术检测到一种弱抗 - e，通过两步木瓜蛋白酶技术检测到一种抗 - e + f。血清中还含有强效HLA抗体。该患者随后接受了白细胞去除的A组、cDE/cDE RBCs，未出现任何不良反应。该病例证明了完整输血史的重要性，并强调仅通过非标准技术可检测到的同种抗体可能具有临床意义。
