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Fatal hemolytic transfusion reaction resulting from ABO mistyping of a patient with acquired B antigen detectable only by some monoclonal anti‐ B reagents
Author(s) -
Garratty G.,
Arndt P.,
Co A.,
Rodberg K.,
Furmanski M.
Publication year - 1996
Publication title -
transfusion
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.045
H-Index - 132
eISSN - 1537-2995
pISSN - 0041-1132
DOI - 10.1046/j.1537-2995.1996.36496226152.x
Subject(s) - monoclonal , monoclonal antibody , abo blood group system , clone (java method) , medicine , antigen , group b , polyclonal antibodies , group a , blood transfusion , transfusion medicine , immunology , antibody , chemistry , biochemistry , dna
Background: Some monoclonal anti‐B reagents are prepared exclusively from an anti‐B clone, ES4, that is known to detect acquired B antigens that are not detectable by other anti‐B clones or polyclonal anti‐B reagents. Case Report: A 92‐year‐old group A, Rh‐negative man with diverticulitis was mistyped as group AB with the use of a monoclonal anti‐B. The hospital did not detect anti‐B in the patient's serum. After a negative antibody screen, blood was issued through an abbreviated crossmatch (i.e., immediate‐spin crossmatch). The patient was given 3 units of group AB blood and 1 unit of group A blood, and no problems were reported. After the transfusion of a inverted question markfourth unit of AB blood the patient had a severe hemolytic transfusion reaction which resulted in kidney failure and death 10 days later. After the transfusion reaction, the patient's pretransfusion red cells were found to be group A with an acquired B antigen. The monoclonal anti‐B used the hospital was formulated from the ES4 clone. A sample of the patient's serum taken before the transfusion was later found to contain a weak anti‐B, detectable most obviously by the antiglobulin test, which was not performed at the crossmatch stage. The manufacturers of monoclonal anti‐B reagents prepared from ES4 have since modified their reagents (i.e., lowered the pH) so that they now detect only the strongest examples of acquired B antigen. Conclusion: A fatal hemolytic transfusion reaction resulted because a monoclonal anti‐ B that detected acquired B antigen was used to type red cells from an elderly man whose serum had weak anti‐B that was not detected by abbreviated compatibility testing.