Delayed Hemolytic Transfusion Reaction

Abstract

Twenty-three cases of delayed hemolytic transfusion reaction (DHTR) occurring at the Mayo Clinic from 1964 through 1973 are reviewed. Nineteen patients had clinical manifestations of hemolysis, of which fever has the most frequent presenting symptom. The degree of hemolysis served as an index of morbidity. In 4 cases there was oliguria, 2 of these patients experiencing renal shutdown. In 1 case, hemolysis led to a disseminated intravascular coagulation syndrome. Death occurred subsequent to DHTR in 3 patients. The direct antiglobulin test was positive in all but 1 case; this finding coincided with elevated unconjugated bilirubin in 14 cases and decreased haptoglobin levels in 15 cases. Anti-Jka antibody accounted for somewhat more than 1/3 of reactions and, along with anti-E, c, D, Fya and K antibodies accounted for 91% of cases.