Mizuno Kota, Yamazaki Rie, Uemura Tomoe, Koda Yuya, Kikuchi Taku, Mori Takehiko
Division of Hematology, Department of Medicine, Keio University School of Medicine.
Center for Transfusion Medicine and Cell Therapy, Keio University Hospital.
Rinsho Ketsueki. 2020;61(10):1482-1486. doi: 10.11406/rinketsu.61.1482.
A 74-year-old woman with a history of pregnancies, but without previous transfusions, received a red blood cell transfusion for aplstic anemia. She lost consciousness due to severe anemia two weeks later and was transported by ambulance to our hospital. Delayed hemolytic transfusion reaction (DHTR) was diagnosed based on the detection of anti-E antibody and positive E antigen of the previously transfused product. A transfusion of E antigen-negative red cell products was performed. However, DHTR due to anti-c antibody developed 16 d after the transfusion of a c antigen-positive product. Based on the onset of ≥14 d after the transfusions and the detection of a causative IgM-type antibody, DHTR due to a primary immune response was diagnosed. Because the incidence of DHTR is low, physicians rarely experience it in clinical practice. However, in our case, DHTR due to a primary immune response, which is even rarer in DHTR cases, developed twice within a short period. A history of transfusion and pregnancy as well as preexisting irregular antibodies have been identified as risk factors for DHTR. Thus, more attention should be paid to the risk of DHTR redevelopment by repeated transfusions.
一名74岁有多次妊娠史但既往未输血的女性因再生障碍性贫血接受了红细胞输血。两周后，她因严重贫血失去意识，被救护车送往我院。根据检测到抗-E抗体以及先前输注产品的E抗原阳性，诊断为迟发性溶血性输血反应（DHTR）。输注了E抗原阴性的红细胞产品。然而，在输注c抗原阳性产品16天后，出现了由抗-c抗体引起的DHTR。基于输血后≥14天发病以及检测到致病性IgM型抗体，诊断为由初次免疫反应引起的DHTR。由于DHTR的发生率较低，医生在临床实践中很少遇到。然而，在我们的病例中，由初次免疫反应引起的DHTR在DHTR病例中更为罕见，却在短时间内发生了两次。输血和妊娠史以及既往存在的不规则抗体已被确定为DHTR的危险因素。因此，应更加关注重复输血导致DHTR再次发生的风险。
