A CASE OF DELAYED HEMOLYTIC TRANSFUSION REACTION PROBABLY CAUSED BY A PRIMARY IMMUNE RESPONSE
A CASE OF DELAYED HEMOLYTIC TRANSFUSION REACTION PROBABLY CAUSED BY A PRIMARY IMMUNE RESPONSE
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可能由原发性免疫反应引起的迟发性溶血性输血反应一例
DOI：
10.3925/jjtc1958.50.768
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发表时间：
2004
期刊：
影响因子：
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通讯作者：
H. Ikeda
中科院分区：
文献类型：
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作者：
K. Ishimaru;C. Tenman;Y. Fujiwara;M. Ohe;T. Kato;H. Ikeda
我们在这里报告一例罕见的迟发性溶血性输血反应（DHTR）病例，可能是由初次免疫反应引起的。患者是一名32岁的日本女性，因宫外孕接受了手术。为了治疗术中失血性休克，她接受了 5 单位的红细胞（Jka、C 和 e 抗原均呈阳性），通过使用聚乙二醇 (PEG-TAT) 的间接抗球蛋白测试，这些红细胞是交叉配型相容的。输血后第22天，她出现血红蛋白尿、网织红细胞增多以及血清LDH（1,106IU/L）和总胆红素（5.6mg/dL）水平升高的症状。在此期间，她没有接受进一步的输血。对输血后24天收集的患者血清进行不定期抗体筛查，通过PEG-TAT检测到抗Jka。她的血型为 B、DccEE、Jk (a-b+)。然后她接受了 1 单位红细胞（Jka 阴性，但 C、e 阳性）。输血后贫血有所改善，未观察到溶血性输血反应。首次输血后第24天检测到的患者中的IgM型抗C+e似乎与DHTR无关，因为第24天输注C+e+红细胞并没有引起DHTR。此外，我们证明了抗 Jka 的免疫球蛋白 (Ig) 类别在临床过程中从 IgM 转变为 IgG。这些结果表明 DHTR 可能是由于初级免疫反应引起的抗 Jka 引起的。
We report here a rare case of delayed hemolytic transfusion reaction (DHTR) probably caused by a primary immune response. The patient was a 32-year-old Japanese female who underwent surgery for ectopic pregnancy. For treatment of intraoperative hemorrhage shock, she received 5 units of RBCs (all positive for Jka, C and e antigen) that were crossmatch-compatible by indirect antiglobulin testing using polyethylene glycol (PEG-TAT). On day 22 after transfusion, she showed symptoms of hemoglobinuria, reticulocytosis, and elevated serum levels of LDH (1,106IU/L) and total-bilirubin (5.6mg/dL). She did not receive further transfusion during this period. On irregular antibody screening of patient serum collected 24 days after transfusion, anti-Jka was detected by PEG-TAT. Her blood was typed as B, DccEE, Jk (a-b+). She then received 1 unit of RBCs (Jka-negative but C, e-positive). Her anemia improved after transfusion and no hemolytic transfusion reaction was observed. IgM type anti-C + e in the patient detected on day 24 after the first transfusion did not seem to be involved in the DHTR because transfusion of C + e + RBCs on the 24th day did not cause DHTR. Further, we demonstrated that the immunoglobulin (Ig) class of the anti-Jka switched from IgM to IgG during the clinical course. These results suggest that the DHTR was probably due to anti-Jka caused by a primary immune response.