DOI QR코드

DOI QR Code

Case of Acute Hemolytic Transfusion Reaction due to Anti-Fya Alloantibody in a Patient with Autoimmune Hemolytic Anemia

자가면역용혈환자에서 항-Fya 동종항체에 의한 급성용혈성수혈반응 1예

  • Choi, Seung Jun (Department of Laboratory Medicine, Yonsei University College of Medicine) ;
  • Nah, Hyunjin (Department of Laboratory Medicine, Serim Hospital) ;
  • Kim, Yundeok (Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Kim, Sinyoung (Department of Laboratory Medicine, Yonsei University College of Medicine) ;
  • Kim, Hyun Ok (Department of Laboratory Medicine, Yonsei University College of Medicine)
  • 최승준 (연세대학교 의과대학 진단검사의학교실) ;
  • 나현진 (세림병원 진단검사의학과) ;
  • 김윤덕 (연세대학교 의과대학 내과학교실) ;
  • 김신영 (연세대학교 의과대학 진단검사의학교실) ;
  • 김현옥 (연세대학교 의과대학 진단검사의학교실)
  • Received : 2018.08.03
  • Accepted : 2018.09.15
  • Published : 2018.12.31

Abstract

A 72-year-old man with general weakness visited the outpatient clinic of the hematology department. The patient had been treated under the diagnosis of autoimmune hemolytic anemia for 2 years. His hemoglobin level at the time of the visit was 6.3 g/dL, and a blood transfusion was requested to treat his anemia. The patient's blood type was A, RhD positive. Antibody screening and identification test showed agglutination in all reagent cells with a positive reaction to autologous red blood cells (RBCs). He had a prior transfusion history with three least incompatible RBCs. The patient returned home after receiving one unit of leukoreduced filtered RBC, which was the least incompatible blood in the crossmatching test. After approximately five hours, however, fever, chills, dyspnea, abdominal pain, and hematuria appeared and the patient returned to the emergency room next day after the transfusion. The $anti-Fy^a$ antibody, which was masked by the autoantibody, was identified after autoadsorption using polyethylene glycol. He was diagnosed with an acute hemolytic transfusion reaction due to $anti-Fy^a$ that had not been detected before the transfusion. In this setting, it is necessary to consider the identification of coexisting alloantibodies in patients with autoantibodies and to become more familiar with the method of autoantibody adsorption.

72세 남자 환자가 전신 무력감을 호소하면서 본원 혈액내과 외래로 내원하였다. 환자는 내원 2년 전 온난자가항체에 의한 자가면역용혈빈혈로 진단받고 치료 중이었다. 내원 당시 환자의 혈색소 수치는 6.3 g/dL로, 빈혈을 교정하기 위해 수혈이 의뢰되었다. 환자의 혈액형은 A형, RhD 양성이었고, 비예기항체 검사에서 범응집 소견 및 자가대조검사에서 양성 소견을 보이고 과거 교차시험에서 최소반응강도를 보이는 적혈구 3단위를 수혈받은 기왕력이 있어, ABO 동형의 적혈구와 교차시험을 하여 최소반응강도를 보이는 적혈구 1단위를 출고하였다. 환자는 수혈을 받은 후 별다른 증상 없이 귀가하였으나, 귀가 후 약 5시간 후부터 발생한 발열, 오한, 호흡곤란, 복통, 혈뇨를 주소로 수혈 다음 날 본원 응급실로 내원하였다. Polyethylene glycol을 이용한 자가흡착검사 후 획득한 상층액을 이용하여 시행한 비예기항체검사에서 항-$Fy^a$가 동정되어, 자가 항체에 의해 가려져 수혈 전에 검출하지 못한 항-$Fy^a$에 의한 급성용혈성수혈반응으로 진단하였다. 본 증례를 통해 자가항체가 동정되는 환자에 대해서 반드시 공존하는 동종항체 확인에 대한 고려가 필요하다는 것을 인지하게 되었고, 이런 자가항체를 제거하여 검사하기 위해 자가흡착검사 방법에 대해 좀 더 익숙해질 필요가 있다는 경험을 하였다.

Keywords

References

  1. Fung MK, Eder AF, Spitalnik SL, Westhoff CM. Technical manual. 19th ed. Bethesda, Maryland: American Association of Blood Banks, 2017:330-2
  2. Kim KH, Han JY, Kim JM, Park KH, Han KS. Fatal acute hemolytic transfusion reaction due to anti-E+Fya. Korean J Lab Med 2003;23:57-9
  3. Park KU, Jeon AR, Heo SR, Song J, Han KS. Alleles for associated with Fy(a), Fy(b), Fy(x) and Fy(x) antigens in a Korean population. Korean J Blood Transfus 2005;16:209-17
  4. Hong YJ, Chung Y, Hwang SM, Park JS, Kwon JR, Choi YS, et al. Genotyping of 22 blood group antigen polymorphisms and establishing a national recipient registry in the Korean population. Ann Hematol 2016;95:985-91 https://doi.org/10.1007/s00277-016-2645-7
  5. Han KS, Park KU, Song EY. Transfusion medicine. 4th ed. Seoul: Korea Medical Book Publisher, 2014:227-8
  6. Leger RM, Garratty G. Evaluation of methods for detecting alloantibodies underlying warm autoantibodies. Transfusion 1999;39:11-6 https://doi.org/10.1046/j.1537-2995.1999.39199116889.x
  7. Branch DR, Petz LD. Detecting alloantibodies in patients with autoantibodies. Transfusion 1999;39:6-10 https://doi.org/10.1046/j.1537-2995.1999.39199116888.x
  8. Fung MK, Eder AF, Spitalnik SL, Westhoff CM. Technical Manual. 19th ed. Bethesda, Maryland: American Association of Blood Banks, 2017:397
  9. Cid J, Ortin X, Pinacho A, Parra R, Contreras E, Elies E. Use of polyethylene glycol for performing autologous adsorptions. Transfusion 2005;45:694-7 https://doi.org/10.1111/j.1537-2995.2005.04369.x
  10. Petz LD. A physician's guide to transfusion in autoimmune haemolytic anaemia. Br J Haematol 2004;124:712-6 https://doi.org/10.1111/j.1365-2141.2004.04841.x
  11. Yurek S, Mayer B, Almahallawi M, Pruss A, Salama A. Precautions surrounding blood transfusion in autoimmune haemolytic anaemias are overestimated. Blood Transfus 2015;13:616-21
  12. Lee W, Seo Y, Cheong JW, Kim S, Kim HO. Effect of the least incompatible blood transfusion in patients with panagglutination (least incompatible blood transfusion). Korean J Blood Transfus 2013;24:48-57
  13. Chung Y, Hong YJ, Hwang SM, Kim TS, Park KU, Song J, et al. The current status of management for specific antigen-negative blood units in Korea. Korean J Blood Transfus 2013;24:248-57
  14. Cho EH, Chun S, Seo JY, Kang ES, Cho D, Kim DW. A system for cryopreservation of rare red blood cell units; right time to start. Korean J Blood Transfus 2015;26:323-5 https://doi.org/10.17945/kjbt.2015.26.3.323
  15. Kim J, Choi KY, Youn KW, Kim Y, Min HK, Kim HO. Requirement of establishment of frozen blood storage system for management of rare blood supply and strategic national stockpile. Korean J Blood Transfus 2018;29:3-17 https://doi.org/10.17945/kjbt.2018.29.1.3