Anti-Fya-mediated delayed hemolytic transfusion reaction following emergency-release red blood cell transfusion: possible involvement of HLA-DRB1*04:03 in the Japanese population
Anti-Fya-mediated delayed hemolytic transfusion reaction following emergency-release red blood cell transfusion: possible involvement of HLA-DRB1*04:03 in the Japanese population
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DOI：
10.1007/s12185-021-03242-3
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发表时间：
2021-10-29
影响因子：
2.1
通讯作者：
Miura, Yasuo
中科院分区：
文献类型：
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作者：
Matsuno, Takahiro;Matsuura, Hideaki;Miura, Yasuo
一例43岁日本男性患者接受了开放性肝脏手术以进行肿瘤切除术，在紧急放行输注16个单位Fy（a +）红细胞后第13天出现血红蛋白水平降低。由于贫血伴有乳酸脱氢酶、间接胆红素和网织红细胞增加以及结合珠蛋白减少，因此归因于溶血。在溶血反应的诊断检查中，IgG的直接抗球蛋白试验结果为阳性，从患者外周红细胞中分离的抗体被鉴定为抗Fy（a）（滴度，4）。溶血反应为一过性（约10天），严重程度为中度，未导致任何明显的器官损伤。然而，在致病性输血后第17天需要输注2个单位的单次相容红细胞。值得注意的是，HLA分型显示患者携带HLA-DRB 1 *04：03等位基因，该等位基因与高加索人群中的免疫原性和抗Fy（a）应答的诱导有关。总之，这是日本人群中首例记录的与HLA-DRB 1 *04：03相关的确定性抗Fy（a）介导的迟发型溶血性输血反应病例。
A 43-year-old Japanese male, who had undergone open liver surgery for tumor resection, presented with decreased hemoglobin levels on Day 13 post-emergency-release transfusion of 16 units of Fy(a +) red blood cells. As the anemia was accompanied by increased lactate dehydrogenase, indirect bilirubin, and reticulocytes, as well as decreased haptoglobin, it was attributed to hemolysis. In the diagnostic workup for hemolytic reaction, the direct antiglobulin test result for IgG was positive and the antibody dissociated from the patient's peripheral red blood cells was identified as anti-Fy(a) (titer, 4). The hemolytic reaction was transient (approximately 10 days), of moderate severity, and did not result in any obvious organ damage. However, a single compatible red blood cell transfusion of 2 units was required on Day 17 after the causative transfusion. Notably, HLA typing revealed that the patient carried the HLA-DRB1*04:03 allele, which has been implicated in immunogenicity and induction of anti-Fy(a) response in Caucasian populations. In summary, this is the first documented case of definitive anti-Fy(a)-mediated delayed hemolytic transfusion reaction associated with HLA-DRB1*04:03 in the Japanese population.