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Lemay AS, Tong TN, Branch DR, Huang M, Sumner C, Oldfield L, Hawes J, Cserti-Gazdewich CM, Lau W. The first case of severe acute hemolytic transfusion reaction caused by anti-Sc2. Transfusion 2018; 58:2506-2512. [PMID: 30299537 DOI: 10.1111/trf.14867] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 04/28/2018] [Accepted: 05/09/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND Alloantibodies to the low-frequency antigen Scianna-2 (Sc2) have been implicated in cases of hemolytic disease of the fetus and newborn but never in hemolytic transfusion reactions (HTRs); thus, the clinical significance of anti-Sc2 has yet to be fully addressed. STUDY DESIGN AND METHODS A 26-year-old woman with thalassemia presented rigors, fever, nausea, abdominal pain, and hemolytic biochemistry after exposure to 75 mL of plasma-reduced red blood cells (RBCs). The RBC unit was issued by electronic crossmatch but was 3+ incompatible on recrossmatch by gel indirect antiglobulin test (IAT). The patient had anti-Sc2 previously identified, but considered to be clinically insignificant. The transfusion history was reviewed and a monocyte monolayer assay (MMA) was performed. RESULTS The patient was investigated for a RBC reaction 9 years prior, when she developed symptoms of HTR. The RBC unit was crossmatched by immediate spin due to consistent screen negativity. Full crossmatch found the RBC 1+ incompatible by gel IAT with both pre/post samples, while direct antiglobulin test was negative (pre) and 1+ immunoglobulin G positive (post). The antibody remained unidentified and she was committed to gel IAT crossmatch. Two-years later, the specificity to Sc2 was deduced when one RBC unit was found 3+ incompatible. Finally, the transfusion reaction reported herein occurred when she received by happenstance RBCs from the same donor who was associated with the remote reaction 9 years earlier. MMA yielded highly positive phagocytic indices only for Sc2+ RBCs, including the donor's RBCs that triggered the severe HTR. CONCLUSION This is the first case of HTR caused by anti-Sc2 confirmed by clinical findings and MMA.
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Affiliation(s)
- Anne-Sophie Lemay
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Tik Nga Tong
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.,the Centre for Innovation, Toronto, Ontario, Canada
| | - Donald R Branch
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.,the Centre for Innovation, Toronto, Ontario, Canada.,University Health Network, Toronto, Ontario, Canada
| | - Mary Huang
- Diagnostic Services, Canadian Blood Services, Toronto, Ontario, Canada
| | | | - Lynne Oldfield
- Diagnostic Services, Canadian Blood Services, Toronto, Ontario, Canada
| | - Janice Hawes
- University Health Network, Toronto, Ontario, Canada
| | | | - Wendy Lau
- Diagnostic Services, Canadian Blood Services, Toronto, Ontario, Canada.,The Hospital for Sick Children, Toronto, Ontario, Canada
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