A clinically significant erythrocyte antibody detectable only by 51Cr survival studies

Abstract

Hemolytic transfusion reactions are typically explained by red cell serologic incompatibilities. A patient was described in whom a clincially significant red cell alloantibody could not be demonstrated despite the occurrence of several clinically severe hemolytic reactions. Serologic studies using multiple techniques demonstrated ony an anti-Bga; these studies included standard procedures as well as more sensitive experimental techniques. A 51Cr survival study using red cells from a random unit, compatible in vitro with conventional techniques, showed 72% survival at 1 h and 7% survival at 24 h. R2R2 (hr"(e) negative) red cells in 2nd 51Cr survival study showed 90% survival at 1 h and 92% survival at 6 h. The patient was transfused with R2R2 units which were tolerated well and survived normally. Extensive serologic testing still demonstrated only an anti-Bga. A 3rd 51Cr survival study, 10 mo. after the 1st study, with an R1R1 (hr"(e) positive) sample showed 90% survival at 1 h and 42% survival at 6 h. A 4th study using a larger aliquot of hr"(e) negative 51Cr-labeled red cells, examined over 2 wk showed a near normal 21-day survival of 50%. These 51Cr survival studies, along with normal survival of hr"(e) negative units, suggest that this patient destroys hr"(e) positive red cells despite negative serologic testing.