Padmore Ruth, Berardi Philip, Erickson Kathy, Desjardins Diana, Giulivi Antonio, Tokessy Melanie, Neurath Doris, Saidenberg Elianna
Division of Hematopathology and Transfusion Medicine, The Ottawa Hospital and Eastern Ontario Regional Laboratory Association, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada.
Division of Hematopathology and Transfusion Medicine, The Ottawa Hospital and Eastern Ontario Regional Laboratory Association, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada.
Transfus Apher Sci. 2014 Oct;51(2):168-71. doi: 10.1016/j.transci.2014.08.011. Epub 2014 Aug 15.
Kpa antigen is a low incidence red blood cell antigen within the Kell system. Anti-Kpa alloantibody may be associated with acute and delayed hemolytic transfusion reactions.
We report a case of a clinically significant acute extravascular hemolytic transfusion reaction mediated by previously unrecognized (and undetected) anti-Kpa alloantibody. This reaction occurred in a patient who met all criteria for electronic crossmatch, resulting in the transfusion of an incompatible red cell unit.
Post-transfusion investigation showed the transfused red cell unit was crossmatch compatible at the immediate spin phase but was 3 + incompatible at the antiglobulin phase. No evidence of intravascular hemolysis was observed upon visual comparison of the pre- and post-transfusion peripheral blood plasma. Further testing showed the presence of anti-Kpa antibody. The clinical course of the patient included acute febrile and systemic reaction.
Acute extravascular hemolytic transfusion reaction may occur due to undetected anti-Kpa alloantibody. Various strategies for crossmatching are discussed in the context of antibodies to low incidence antigens.
Kpa抗原是凯尔血型系统中一种低频率红细胞抗原。抗Kpa同种抗体可能与急性和迟发性溶血性输血反应有关。
我们报告一例由先前未识别（且未检测到）的抗Kpa同种抗体介导的具有临床意义的急性血管外溶血性输血反应。该反应发生在一名符合电子交叉配血所有标准的患者身上，导致输注了不相容的红细胞单位。
输血后调查显示，输注的红细胞单位在立即离心阶段交叉配血相容，但在抗球蛋白阶段为3+不相容。输血前后外周血浆的目视比较未观察到血管内溶血的证据。进一步检测显示存在抗Kpa抗体。患者的临床过程包括急性发热和全身反应。
未检测到的抗Kpa同种抗体可能导致急性血管外溶血性输血反应。在针对低频率抗原抗体的背景下讨论了各种交叉配血策略。
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