Cherian G, Search S, Thomas E, Poole J, Davies S V, Massey E
Musgrove Park Hospital, Taunton.
Transfus Med. 2007 Aug;17(4):312-4. doi: 10.1111/j.1365-3148.2007.00739.x.
The Wright (Wr(a)) antigen is found on the red blood cells of approximately 1 : 1000 Caucasians. Anti-Wr(a) has been reported to be present in 1 : 25 to 1 : 100 healthy blood donors and an even higher proportion of hospital patients. Incompatibility due to anti-Wr(a) might therefore be expected to occur in approximately 1 in 50,000 blood transfusions. Reports of haemolytic transfusion reactions (HTR) and haemolytic disease of the newborn due to anti-Wr(a) are, however, rare. We report an acute HTR due to anti-Wr(a) in a 58-year-old man with myelodysplastic syndrome associated with rigors, shortness of breath and a significant rise in serum bilirubin from 16 micromol L(-1) pretransfusion to 110 micromol L(-1) immediately afterwards. This was accompanied by the appearance of bilirubin and urobilinogen in his urine and a fall in haemoglobin of nearly 2 g dL(-1) following the transfusion. Anti-Wr(a) was the only antibody implicated. When tested against the recipients plasma, Wr(a+) panel cells and the transfused unit responsible for the reaction were 2-3+ by indirect antiglobulin test (IAT) and the donation typed as Wr(a+). The recipient had the common Wr(a-) phenotype. The reaction resulted in the patient being admitted to hospital for 2 days. The increasing use of electronic issue may result in more frequent reports of reactions due to anti-Wr(a) using current screening cells.
赖特（Wr(a)）抗原存在于约千分之一的高加索人的红细胞上。据报道，每25至100名健康献血者中就有1人存在抗-Wr(a)，而在住院患者中的比例更高。因此，预计每50000次输血中可能会发生1次因抗-Wr(a)导致的血型不合。然而，关于抗-Wr(a)导致的溶血性输血反应（HTR）和新生儿溶血病的报道却很少。我们报告了一名58岁患有骨髓增生异常综合征的男性因抗-Wr(a)发生急性HTR，伴有寒战、呼吸急促，血清胆红素从输血前的16微摩尔/升急剧升至输血后即刻的110微摩尔/升。输血后，其尿液中出现胆红素和尿胆原，血红蛋白下降近2克/分升。抗-Wr(a)是唯一涉及的抗体。用受者血浆进行检测时，通过间接抗球蛋白试验（IAT），Wr(a+)细胞面板和导致反应的输血单位呈2 - 3+凝集，献血被鉴定为Wr(a+)。受者具有常见的Wr(a-)表型。该反应导致患者住院2天。随着电子发血的使用增加，使用当前的筛查细胞可能会导致更多抗-Wr(a)反应的报告。
