Mitsuyama Takehiko, Takahashi Saki, Kondo Emi, Mutoh Toshitaka, Kawakami Kosuke, Yoshizato Toshiyuki
Department of Obstetrics and Gynecology, National Hospital Organization Kokura Medical Center, Kitakyushu, Japan.
Department of Diagnostic Laboratory, National Hospital Organization Kokura Medical Center, Kitakyushu, Japan.
J Obstet Gynaecol Res. 2025 Jul;51(7):e16362. doi: 10.1111/jog.16362.
Delayed hemolytic transfusion reaction (DHTR) is a rare post-transfusion complication, typically involving extravascular hemolysis. We present an unusual case of postpartum DHTR caused by anti-C antibodies in a 35-year-old Japanese woman, gravida 2, para 1, with no history of transfusion, alloimmunization, or underlying hemoglobinopathy. The patient developed dark-colored urine on postpartum day 25, 12 days after receiving a blood transfusion for hemorrhage due to placenta accreta spectrum. Laboratory findings revealed indirect hyperbilirubinemia, elevated lactate dehydrogenase, low haptoglobin, and hemoglobinuria, indicating concurrent extravascular and intravascular hemolysis. DHTR was confirmed by the detection of anti-C antibodies and the presence of C-antigen-positive transfused red cells. Maternal sensitization likely resulted from subclinical fetomaternal transfusion, with an immune response triggered post-transfusion. This case highlights the diagnostic challenges of DHTR in the postpartum setting, emphasizing the importance of post-transfusion antibody screening and the need for heightened awareness of unexplained fever as a potential early indicator.
迟发性溶血性输血反应（DHTR）是一种罕见的输血后并发症，通常涉及血管外溶血。我们报告一例不寻常的产后DHTR病例，发生在一名35岁的日本女性身上，该女性孕2产1，无输血史、同种免疫史或潜在血红蛋白病。患者在产后第25天出现深色尿液，这是在因胎盘植入谱系出血接受输血12天后。实验室检查发现间接胆红素血症、乳酸脱氢酶升高、触珠蛋白降低和血红蛋白尿，提示同时存在血管外和血管内溶血。通过检测抗-C抗体和存在C抗原阳性的输注红细胞确诊为DHTR。母体致敏可能是由于亚临床胎儿-母体输血，输血后触发免疫反应。该病例突出了产后环境中DHTR的诊断挑战，强调了输血后抗体筛查的重要性以及提高对不明原因发热作为潜在早期指标的认识的必要性。
