Raos M, Thornton N, Lukic M, Golubic Cepulic B
Clinical Department of Transfusion Medicine and Transplantation Biology, University Clinical Hospital Zagreb , Kispaticeva 12, Zagreb 10 000 , Croatia.
International Blood Group Reference Laboratory, NHS Blood and Transplant , Filton , UK.
Immunohematology. 2021 Mar;37(1):13-17. doi: 10.21307/immunohematology-2021-003.
Many patients with anti-Yt receive multiple transfusions of Yt(a+) red blood cells (RBCs) with no ill effects. However, anti-Yt has been implicated in hemolytic transfusion reactions. Antibody identification typically determines specificity of antibodies and their clinical significance to justify blood requirements for antigen-negative blood when clinically significant antibodies are involved. Occasionally, specificity of antibody is of variable significance. Variability in clinical significance is a characteristic of anti-Yt that may affect the clinical management of such patients. This case reports the outcome of an incompatible transfusion in an 83-year-old female patient with anti-Yt, -D, -C, -Le, and -HI who was admitted to the hospital for a severe urinary tract hemorrhage and fever. The patient was transfused with 1 crossmatch-incompatible group A, Yt(a+), D-, C-, E-, S- RBC unit in an emergency medical event. During that time, the patient exhibited chills, shivering, and tachycardia. Decreases in hemoglobin and hematocrit were noted. Laboratory parameters for hemolysis, such as total bilirubin, direct bilirubin, and lactate dehydrogenase, were increased. Based on clinical and laboratory evaluation, it was concluded that the patient had an acute hemolytic transfusion reaction caused by anti-Yt. The patient was successfully treated with antipyretics, antihistamines, and corticosteroids. Urinary tract hemorrhaging was stopped. Anemia was additionally improved with parenteral iron supplementation, and further transfusion was not required. Many patients with anti-Yt receive multiple transfusions of Yt(a+) red blood cells (RBCs) with no ill effects. However, anti-Yt has been implicated in hemolytic transfusion reactions. Antibody identification typically determines specificity of antibodies and their clinical significance to justify blood requirements for antigen-negative blood when clinically significant antibodies are involved. Occasionally, specificity of antibody is of variable significance. Variability in clinical significance is a characteristic of anti-Yt that may affect the clinical management of such patients. This case reports the outcome of an incompatible transfusion in an 83-year-old female patient with anti-Yt, -D, -C, -Le, and -HI who was admitted to the hospital for a severe urinary tract hemorrhage and fever. The patient was transfused with 1 crossmatch-incompatible group A, Yt(a+), D–, C–, E–, S– RBC unit in an emergency medical event. During that time, the patient exhibited chills, shivering, and tachycardia. Decreases in hemoglobin and hematocrit were noted. Laboratory parameters for hemolysis, such as total bilirubin, direct bilirubin, and lactate dehydrogenase, were increased. Based on clinical and laboratory evaluation, it was concluded that the patient had an acute hemolytic transfusion reaction caused by anti-Yt. The patient was successfully treated with antipyretics, antihistamines, and corticosteroids. Urinary tract hemorrhaging was stopped. Anemia was additionally improved with parenteral iron supplementation, and further transfusion was not required.
许多抗-Yt抗体的患者多次输注Yt(a+)红细胞（RBCs）均未出现不良影响。然而，抗-Yt抗体曾被认为与溶血性输血反应有关。抗体鉴定通常用于确定抗体的特异性及其临床意义，以便在涉及具有临床意义的抗体时，为输注抗原阴性血液的用血需求提供依据。偶尔，抗体的特异性具有可变的意义。临床意义的变异性是抗-Yt抗体的一个特征，可能会影响此类患者的临床管理。本病例报告了一名83岁患有抗-Yt、-D、-C、-Le和-HI抗体的女性患者因严重尿路出血和发热入院后发生的一次不相容输血的结果。在一次紧急医疗事件中，该患者输注了1个交叉配血不相容的A型、Yt(a+)、D-、C-、E-、S-红细胞单位。在此期间，患者出现寒战、颤抖和心动过速。血红蛋白和血细胞比容下降。溶血的实验室参数，如总胆红素、直接胆红素和乳酸脱氢酶升高。根据临床和实验室评估，得出该患者发生了由抗-Yt抗体引起的急性溶血性输血反应的结论。患者通过使用退烧药、抗组胺药和皮质类固醇成功治愈。尿路出血停止。通过肠外补充铁剂，贫血状况进一步改善，无需进一步输血。许多抗-Yt抗体的患者多次输注Yt(a+)红细胞（RBCs）均未出现不良影响。然而，抗-Yt抗体曾被认为与溶血性输血反应有关。抗体鉴定通常用于确定抗体的特异性及其临床意义，以便在涉及具有临床意义的抗体时，为输注抗原阴性血液的用血需求提供依据。偶尔，抗体的特异性具有可变的意义。临床意义的变异性是抗-Yt抗体的一个特征，可能会影响此类患者的临床管理。本病例报告了一名83岁患有抗-Yt、-D、-C、-Le和-HI抗体的女性患者因严重尿路出血和发热入院后发生的一次不相容输血的结果。在一次紧急医疗事件中，该患者输注了1个交叉配血不相容的A型、Yt(a+)、D-、C-、E-、S-红细胞单位。在此期间，患者出现寒战、颤抖和心动过速。血红蛋白和血细胞比容下降。溶血的实验室参数，如总胆红素、直接胆红素和乳酸脱氢酶升高。根据临床和实验室评估，得出该患者发生了由抗-Yt抗体引起的急性溶血性输血反应的结论。患者通过使用退烧药、抗组胺药和皮质类固醇成功治愈。尿路出血停止。通过肠外补充铁剂，贫血状况进一步改善，无需进一步输血。
