Bahri Tanaz, de Bruyn Kim, Leys Rineke, Weerkamp Floor
Department of Hematology, Maasstad Hospital, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands.
Laboratory of Clinical Chemistry, Hematology and Transfusion Medicine, Maasstad Hospital, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands.
Transfus Med Hemother. 2018 Nov;45(6):438-441. doi: 10.1159/000488863. Epub 2018 Aug 24.
The Wr blood group antigen is a low-frequency antigen. Antibody screening sets used in pretransfusion laboratory investigations usually do not contain a Wr(a+) cell. If subsequent cross-matching is performed without indirect antiglobulin test (IAT), Wr antibodies reacting with donor red blood cells (RBCs) will be missed. For reasonable economic and time-saving arguments the risk of missing the detection of a potential clinically relevant antibody is worldwide accepted.
A 66-year-old women with a negative antibody screen rapidly deteriorated after she received two units of RBCs for symptomatic anemia after hip surgery. Diagnosis of a transfusion reaction was obscured by pre-existing and nonspecific symptoms. Laboratory investigation indicated acute hemolysis. Cross-matching in IAT was positive for the first unit, and an extended antibody identification panel showed reactivity with Wr(a+) cells. The patient did not respond to supportive therapy and died within 48 h after the start of transfusion.
This dramatic case provides further evidence on the clinical relevance of Wr blood group antibodies. In addition, it underlines the clinical importance of risk awareness in the blood transfusion chain and the possible complexity in relation to patient monitoring in daily transfusion practice.
Wr血型抗原是一种低频抗原。输血前实验室检查中使用的抗体筛查试剂通常不包含Wr(a+)细胞。如果随后的交叉配血不进行间接抗球蛋白试验（IAT），与供者红细胞（RBC）发生反应的Wr抗体将会漏检。出于合理的经济和节省时间的考虑，漏检潜在临床相关抗体的风险在全球范围内是被认可的。
一名66岁女性，抗体筛查阴性，因髋关节手术后出现症状性贫血接受了两单位红细胞输注后病情迅速恶化。既往存在的非特异性症状掩盖了输血反应的诊断。实验室检查提示急性溶血。第一单位红细胞在IAT交叉配血中呈阳性，进一步的抗体鉴定谱显示与Wr(a+)细胞发生反应。患者对支持治疗无反应，输血开始后48小时内死亡。
这一严重病例进一步证明了Wr血型抗体的临床相关性。此外，它强调了输血链中风险意识的临床重要性以及日常输血实践中患者监测可能存在的复杂性。
