Premium
Clinical significance of anti‐Jr a : report of two cases and review of the literature
Author(s) -
Kwon MeeAe Y.,
Su Leon,
Arndt Patricia A.,
Garratty George,
Blackall Douglas P.
Publication year - 2004
Publication title -
transfusion
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.045
H-Index - 132
eISSN - 1537-2995
pISSN - 0041-1132
DOI - 10.1111/j.1537-2995.2004.00643.x
Subject(s) - hemolysis , medicine , titer , clinical significance , serology , antibody , surgery , pediatrics , immunology
BACKGROUND: Jr a is a high‐frequency antigen seen in all populations, but the clinical significance of Jr a antibodies is incompletely understood. Two cases are reported in which patients with anti‐Jr a received incompatible transfusions. CASE REPORTS: A 69‐year‐old Japanese man had anti‐K and anti‐Jr a . Despite multiple transfusions of Jr(a+), K– RBCs, his clinical course remained stable without evidence of hemolysis. A 45‐year‐old Japanese woman with anti‐Jr a was transfused with two units of Jr(a+) RBCs without clinical evidence of hemolysis. However, the same patient received an additional unit of Jr(a+) RBCs 1 week after the initial transfusions and, within 6 hours of transfusion, developed signs and symptoms of an acute hemolytic transfusion reaction. STUDY DESIGN AND METHODS: Routine serologic methods were used to study the patients’ RBCs and plasma. A monocyte monolayer assay (MMA) was used to determine the potential clinical significance of the anti‐Jr a , where reactivity (R) greater than 5 percent indicates potential clinical significance. RESULTS: The anti‐Jr a in the first case had a pretransfusion titer of 32 with a MMA result of 3.3 percent R. No clinical or laboratory evidence of hemolysis was seen after transfusion of 4 units of Jr(a+), K– RBCs. The anti‐Jr a in the second case had a pretransfusion titer of 32 with a MMA result of 24.5 percent R. This patient developed an acute hemolytic reaction after transfusion of Jr(a+) RBCs. CONCLUSION: Anti‐Jr a can be clinically significant as demonstrated by acute hemolysis in the second case. The MMA accurately predicted the clinical outcome of each case and appears to be a useful tool in predicting the biologic behavior of anti‐Jr a .